Melbourne Hand Surgery 


Face masks remain mandatory when you attend our practice in person. Videoconsultations are conducted via telehealth at our dedicated virtual clinic to maximise patient and staff safety. We are experiencing extremely high demand for appointments so require that all patients provide a referral prior to booking an appointment so that we can identify and manage urgent and emergency conditions in a timely manner, and so that our surgeons can assess your suitability for a telehealth appointment and identify any further information or tests that might be required before your consultation. If our surgeons assess that your condition (especially recent injuries) is best managed with hand therapy rather than surgery we may recommend that you see a qualified hand therapist (physiotherapist or occupational therapist) rather than schedule an appointment with our surgeons.    If you are eligible to get vaccinated and/or boosted, please do so. Our next available non-urgent appointments are around eight months away; our offices will close on Friday 16 December 2022 and will reopen on Monday 9 January 2023. 

Palmar hyperhidrosis

Fingerprint detail on male fingerPalmar hyperhidrosis is the medical term for excessive sweating of the hands. Excessive sweating can have major effects on your professional or personal life. In most instances there is no medical reason for the excessive sweating, but there are effective treatments available. This treatment is also effective for axillary hyperhidrosis, which is the medical term for excessive sweating of the armpits.

Can you stop my palms from sweating?

Yes. Botulinum toxin is a very effective method of stopping excessive sweating.

needlesyringedrugvialHow does it work?

The botulinum toxin is administed to the affected skin with multiple injections that are spaced out over 1cm areas. The treatment reduces sweating by 90% by blocking signals between the nerves and sweat glands.

Will it work on me?

manokaysignAlmost certainly. Multiple medical studies have demonstrated the safety and efficacy of this treatment. Occasionally patients report that they have had ineffective treatments done elsewhere previously. It is much more likely that in these instances the treatment was not administed correctly, or that an inadequate amount of botulinum toxin was administered. It is extremely unlikely that you are “resistant” or “immune” to botulinum toxin.

Can you treat the fingers as well as the palms?

Absolutely! We can assess your sweating pattern and treat wherever your sweating affects – palms, fingers and arm pits.

How often does treatment need to be repeated?

Most patients experience results lasting 5-12 months. Longer lasting results are seen with higher doses of botulinum toxin.

Is it painful?

No. It is not pain-free, but two wrist injections are all that you will feel for a full single hand treatment. As a plastic, reconstructive and hand surgeon I am experienced in administering local anaesthetic nerve blocks. I find that using local anaesthetic provides significantly greater comfort for my hand patients than using ice or other anaesthetic or distraction methods. The hands are very sensitive and I don’t wish to put my patients through the distress of feeling 30-50 separate injections.

Is it expensive?

The cost of treatment relates to the large volumes of botulinum toxin that need to be administered for an effective treatment. Patients who experience significant problems with sweaty palms find this treatment a lifesaver!

What are the possible side effects?

The possible side effects of botulinum toxin injections to the skin of the hand, in conjunction with local anaesthetic nerve blocks include

  • temporary weakness of the small muscles of the hands, which if it occurs starts within 1-3 days is expected to resolve within 2-3 weeks
  • bruising and/or discomfort at the site of the local anaesthetic injections, with or without vein or arterial puncture
  • discomfort at the site of the botulinum toxin injections during or after the injections
  • skin infection
  • failure to improve the hyperhidrosis to the degree desired
  • temporary or permanent alteration in sensation of the hands or fingers from nerve injury associated with injection into (rather than next to) the nerve

Treatment is not performed on individuals who are pregnant or breastfeeding, or who have neuromuscular disorders or are allergic to albumin. 

Alternative therapies

Before trying botulinum toxin it is advisable to try simple treatments first. Anti-perspirants that have a high aluminium content work by forming a gel plug in the duct of the sweat gland, blocking the sweat gland. Brand names of products that have a high concentration (15% or greater) include Maxim®, Drysol®, CertainDri®, Odaban®, Anhydrol Forte®, Dricolor® and B+Drier®.

Oral medications have a high rate of intolerable side effects, including drowsiness, nausea, blurred vision, dry mouth, rapid heart beat, constipation and urinary retention.

Talcum powder can provide limited relief.

Iontophoresis is a non-invasive electronic device that temporarily blocks the sweat ducts. The device can be used every few days for a period of 20-30 minutes to alleviate the problem.

Thoracoscopic sympathectomy is a surgical procedure that can be performed to permanently address excess sweating. Information from practitioners who practice this procedure advises that it is 80% effective. It requires a general anaesthetic and can have significant side effects such as nerve damage, scarring and compensatory hyperhidrosis.

Further information: 

Lowe N, Campanati A, Bodokh I, Cliff S, Jaen P, Kreyden O, Naumann M, Offidani A, Vadoud J, Hamm H. The Place of Botulinum Toxin Type A in the Treatment of Focal Hyperhidrosis The British Journal of Dermatology. 2004;151(6)

Grunfeld A, Murray CA, Solish N. Botulinum toxin for hyperhidrosis: A review. Am J Clin Dermatol 2009; 10 (2): 87-102


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