Miradry vs Botox
MiraDry destroys the sweat glands under your arms, so the result is meant to be permanent. It uses microwave energy, and most people need one or two treatments. Botox blocks the nerve signal that switches those glands on, so the result wears off. It is a set of small injections that lasts several months before you repeat it. The real choice is between something permanent that you cannot adjust and something temporary that you can.
What it does
A handpiece pulls the skin up by suction and heats the layer where the glands sit. The glands are damaged for good and do not grow back.
The toxin blocks the nerve messenger that tells sweat glands to work. The glands stay there, unused, until the effect fades.
What it treats
Sweat, and usually odour and underarm hair too, since those structures sit at the same depth.
It can be used almost anywhere sweating is a problem, which MiraDry cannot.
How soon it works
Sweating drops immediately, and the final level settles over about three months.
Full effect by about two weeks.
How long it lasts
Sweat glands do not regenerate. Some people still need a second treatment to get the reduction they want.
Some people get longer. You book again when sweating returns.
How many visits
A second session, about three months later, is common rather than a sign something went wrong.
For as long as you want the result.
What it feels like
Several anaesthetic injections into each armpit first, which is the sore part. Then about an hour of suction, warmth and cooling.
Around fifteen to twenty tiny injections per armpit, just under the skin. It takes minutes. Numbing cream or ice helps.
Downtime
Expect swelling, tenderness and a sunburnt feeling once the numbing wears off. Most of it settles within a week. Lumpiness under the arm can linger for a few weeks.
Some bruising or tenderness at the injection points. People go straight back to work.
Main risk to know
Altered sensation in the underarm or upper arm is common and usually settles within weeks. Lasting nerve irritation is rare but has been reported. Permanent hair loss in the area is expected, not a complication.
Bruising and short-lived soreness. When used on the palms, temporary weakness in the hand grip can happen. It does not happen with underarms.
Cost
A large upfront cost, then in principle nothing more.
Cheaper per visit, repeated two or three times a year. Over several years the running total can pass what MiraDry costs. Ask about insurance, since injections for diagnosed excessive sweating are sometimes covered when antiperspirants have failed.
The at-home or drugstore version
No home device delivers microwave energy to that depth. Nothing sold for home use destroys a sweat gland.
An aluminium chloride antiperspirant applied at night plugs the sweat ducts at the surface. It is the honest first step for both, it is cheap, and for many people it is enough. It irritates some skin.
Who each suits
Permanent versus adjustable
MiraDry's strength is also its catch: The glands are gone. If the result is uneven, or you wanted less reduction than you got, there is no way back.
Botox's weakness is also its safety net: If you dislike anything about the result, you wait a few months and it is gone. That makes it the lower-risk way to find out how life feels without underarm sweating.
Many dermatologists suggest trying Botox first for that reason: One round tells you whether the problem is worth a permanent fix.
Does stopping underarm sweat cause problems elsewhere
Treating the underarms does not stop your body cooling itself: Underarm sweat glands are a small share of the total, and the rest carry on.
Some people do notice more sweating somewhere else: It is usually mild. It happens with both treatments, and it is worth raising at the consultation rather than being surprised by it.
What the evidence looks like
Both treatments have good evidence for cutting underarm sweat: Studies of each show large drops in sweat production and in how much sweating bothers people day to day.
The two have rarely been compared head to head: So the honest way to choose is on how you want to manage the problem, not on which one wins a trial.
Before you book
Try a clinical-strength antiperspirant properly first. Applied at night, on dry skin, for two weeks.
Ask whether your sweating has been diagnosed as hyperhidrosis. That word can unlock insurance cover for injections.
Ask how many MiraDry treatments the clinic expects for you, and whether the second one is included in the price.
If you want the underarm hair kept, say so. MiraDry usually removes it.
Ask what the plan is if the result is uneven.
