Excessive underarm sweating, or primary axillary hyperhidrosis, is a challenging medical and aesthetic condition that significantly affects quality of life. For patients seeking clinical intervention, the two most common and effective non-surgical treatments are miraDry (microwave thermolysis) and Botox (onabotulinumtoxinA injections). While both procedures dramatically reduce sweat production, they operate on completely different biological mechanisms, require different financial commitments, and carry distinct safety profiles.

This guide provides an evidence-based comparison of these two modalities. We analyze their mechanisms of action, longevity, long-term costs, regulatory histories, and clinical safety profiles—backed by primary clinical literature and raw FDA database registries—to help you determine which treatment is right for your anatomy, lifestyle, and budget.

The Core Comparison Above the Fold

For quick decision-making, the fundamental differences between miraDry and Botox can be summarized across three categories: duration, cost, and treatment location.

miraDry is a permanent, non-surgical device that uses microwave energy to destroy underarm sweat and odor glands. It is FDA-cleared only for the underarms (axillae). While the upfront cost is higher—typically $2,000 to $3,000 per session, with most patients requiring 1 to 2 sessions—it represents a one-time investment with permanent results.
Botox is a temporary, injectable drug that blocks the chemical signals that stimulate sweat glands. It is FDA-approved for underarm sweating, but can also be used off-label (or under specific regulatory approvals) to treat sweating on the hands (palms), feet (soles), and forehead. It requires repeated treatments every 4 to 6 months. Each round costs roughly $1,000 to $1,500, leading to high recurring costs over time.

If you are looking for a permanent underarm solution and are comfortable with a higher upfront cost and a brief period of localized swelling, miraDry is the clear choice. If you require treatment for hands or feet, prefer a reversible option, or want to minimize upfront costs, Botox is the appropriate path.

Histological Framework: Microwaves vs. Chemical Denervation

To understand why one treatment is permanent and the other is temporary, we must examine the microscopic structure of the skin and sweat glands and how each technology interacts with them.

Skin Histology and Sweat Gland Anatomy

Human skin contains two primary types of sweat glands:

Eccrine Glands: These glands are distributed across nearly the entire body but are highly concentrated on the palms, soles, and axillae. They reside at the junction between the lower dermis and the subcutaneous fat. Eccrine glands secrete a clear, odorless fluid consisting primarily of water and sodium chloride, which serves the primary function of thermoregulation.
Apocrine Glands: These glands are larger and are found in areas with abundant hair follicles, such as the axillae and perineum. They empty into the hair follicle canal rather than directly onto the skin surface. Apocrine glands secrete a thicker, viscous fluid containing lipids, proteins, and steroids. When this fluid is broken down by skin-surface bacteria (such as Corynebacterium species), it produces characteristic body odor (bromhidrosis).

The miraDry Mechanism: Selective Microwave Thermolysis

The miraDry system relies on proprietary microwave technology to deliver thermal energy to the dermal-fat interface.

The physics of the device is based on dielectric heating. The device emits microwave energy at a frequency of 5.8 GHz. This frequency specifically excites polar molecules, primarily water. Because sweat glands have a high water content compared to the surrounding lipid-rich subcutaneous fat and collagen-rich dermis, they absorb the microwave energy preferentially.

When the handpiece is applied:

Vacuum Suction: The skin is pulled into the handpiece chamber. This elevates the skin away from deeper structures (such as major nerves and blood vessels) and stabilizes the tissue.
Energy Emission: The microwave energy creates a localized electromagnetic field, raising the temperature at the dermal-fat junction to 60°C–70°C. This temperature is sufficient to cause immediate coagulative necrosis of the eccrine glands, apocrine glands, and hair follicles.
Surface Protection: A hydroconductive cooling system circulates chilled water through the handpiece interface, maintaining the epidermis and upper dermis at approximately 15°C. This creates a steep thermal gradient, protecting the superficial skin from burns while maintaining destructive heat at the target depth (typically 2 to 5 mm).

Histological studies post-miraDry show complete destruction of the secretory coils of sweat glands, which are replaced by fibrotic tissue. Because adult humans do not regenerate eccrine or apocrine glands, this destruction is permanent.

The Botox Mechanism: Synaptic Cleavage of SNARE Proteins

Botox (onabotulinumtoxinA) is a 150 kDa neurotoxin consisting of a 100 kDa heavy chain and a 50 kDa light chain, linked by a disulfide bond. It targets the neuroeffector junction of the sympathetic nerves that innervate eccrine sweat glands. Unlike most sympathetic pathways which use norepinephrine, the sympathetic fibers innervating sweat glands are cholinergic, utilizing acetylcholine (ACh) as their neurotransmitter.

The cellular mechanism consists of four distinct phases:

Binding: The heavy chain of the toxin binds with high affinity to acceptor sites (specifically SV2) on the presynaptic membrane of cholinergic nerve terminals.
Internalization: The toxin-receptor complex is internalized into the nerve terminal via receptor-mediated endocytosis.
Translocation: The light chain is translocated across the endosome membrane into the cytosol, a process mediated by pH changes within the endosome.
Cleavage: Once in the cytosol, the light chain (a zinc-dependent endopeptidase) cleaves SNAP-25 (Synaptosomal-Associated Protein of 25 kDa). SNAP-25 is a member of the SNARE protein complex required for synaptic vesicle fusion with the presynaptic membrane.

Without functional SNAP-25, acetylcholine vesicles cannot dock or fuse with the cell membrane. Consequently, the nerve terminal cannot release acetylcholine into the synaptic cleft. The sweat gland, lacking chemical stimulation, remains inactive.

Over a period of 4 to 9 months, the neuron recovers by sprouting temporary collateral axon terminals. Eventually, the original terminal recovers its vesicle-fusion capability, the sprouts regress, and normal cholinergic transmission is restored. This necessitates repeat injections.

Step-by-Step Clinical Protocols: What to Expect

The patient experience during these two procedures differs significantly in terms of prep work, pain management, procedure duration, and immediate recovery.

The miraDry Clinical Protocol

A miraDry session is a multi-step clinical procedure that typically takes 60 to 90 minutes.

Measurement and Grid Mapping: The provider measures the axillary vault containing hair-bearing skin. This measurement corresponds to a specific sizing grid (ranging from 120 to 180 mm). The provider applies a temporary ink transfer grid to the patient's underarm, which guides the placement of the handpiece.
Tumescent Anesthesia: Local anesthesia is critical because microwave energy causes intense internal heating. The provider injects a large volume of dilute lidocaine with epinephrine (tumescent anesthesia) across the grid. This typically involves 15 to 30 injection points per underarm, using a total of 50 to 100 mL of anesthetic solution. The fluid serves a dual purpose: it completely numbs the treatment zone and acts as a fluid buffer, expanding the distance between the skin surface (containing the sweat glands) and the deep nerves (ulnar, median, and radial nerves) running through the axilla.
Device Application: The handpiece is placed sequentially on each grid coordinate. The device applies vacuum suction, delivers microwave energy, and then applies cooling. Each coordinate cycle takes about 30 to 40 seconds.
Post-Procedure Care: Immediately after the grid is completed, the underarms are cleaned, and ice packs are applied. Patients are instructed to ice the area for 20 minutes on and 20 minutes off for the first 24 to 48 hours to minimize swelling and inflammation.

The Botox Hyperhidrosis Clinical Protocol

A Botox session is a quick, minimally invasive procedure taking approximately 15 to 20 minutes.

Starch-Iodine Test (Optional but Recommended): To locate the areas of highest sweat density, the provider may perform a Minor's starch-iodine test. The underarm is painted with a topical iodine solution and allowed to dry. Fine cornstarch is then dusted over the area. As the patient sweats, the starch and iodine react, turning a deep blue-black in the high-sweat zones.
Grid Mapping: The provider uses a surgical marker to draw a grid of 1.5 cm x 1.5 cm squares over the active sweat-bearing area. This typically results in 10 to 15 grid intersections per underarm.
Preparation and Reconstitution: A vial of Botox (typically 100 units) is reconstituted with 2.0 to 4.0 mL of preservative-free 0.9% sterile saline. Using a high-dilution volume helps the toxin diffuse evenly through the intradermal plane.
Injections: Using a 30-gauge or 31-gauge needle, the provider injects 2 to 4 units of Botox intradermally (producing a small wheal or papule) at each grid intersection. A total of 50 units is injected per underarm.
Post-Procedure Care: There is no recovery window. Patients can return to daily activities immediately, though they are advised to avoid strenuous exercise or hot tubs for 24 hours to prevent premature diffusion of the toxin away from the target intradermal receptors.

Which lasts longer: miraDry or Botox?

The durability of sweat reduction is one of the most critical factors influencing patient choice.

Clinical Parameter	miraDry	Botox (onabotulinumtoxinA)
Duration of Efficacy	Permanent (Lifetime)	Temporary (4 to 6 months average; up to 9 months)
Onset of Action	Immediate	2 to 7 days (Full effect at 2 weeks)
Typical Session Count	1 to 2 sessions	Recurring every 4 to 6 months
Sweat Reduction Rate	~82% average reduction	~80% to 90% temporary reduction
Odor (Apocrine) Effect	Yes, permanently reduces odor	No effect on apocrine-driven odor
Underarm Hair Reduction	Yes, permanently reduces hair (~60% loss)	None

Efficacy Longevity

miraDry: The permanent nature of miraDry is supported by long-term clinical trials showing stable sweat reduction up to two years post-treatment, with histologic validation confirming the absence of viable sweat glands in treated zones. Once the localized swelling from the procedure resolves (usually within 2 to 4 weeks), the resulting sweat level represents the patient's new permanent baseline.
Botox: The duration of Botox depends heavily on individual metabolic rates, the dose injected, and the injection technique. In pivotal clinical trials, a dose of 50 units per axilla demonstrated a duration of effect ranging from 4 to 9 months, with a median duration of approximately 6 months. Retreatment is recommended when hyperhidrosis symptoms return to their baseline severity (typically measured using the Hyperhidrosis Disease Severity Scale, or HDSS).

How much does miraDry cost vs Botox over time?

A common mistake patients make is looking only at the immediate cost of a single procedure rather than modeling the cost over a multi-year horizon. Understanding how Botox is priced per unit vs by area is essential when evaluating these long-term financials.

Upfront Session Costs

miraDry: A single session typically costs between $2,000 and $3,000. While some patients achieve satisfactory results with one session, clinical studies show that approximately 20% to 30% of patients require a second session (typically spaced 3 months after the first) to achieve the desired ~80%+ reduction. Therefore, a complete two-session package generally ranges from $4,000 to $6,000.
Botox: For axillary hyperhidrosis, the standard FDA-approved dosing is 100 units total (50 units per underarm). Based on average US pricing of $10 to $15 per unit, or fixed-area pricing, a single treatment session costs between $1,000 and $1,500.

5-Year Total Cost of Ownership (TCO) Model

To illustrate the long-term financial differences, we can compare a permanent 2-session miraDry package against a twice-yearly Botox regimen over five years.

miraDry (2 Sessions Upfront):
- Year 1: $5,000 (2 sessions)
- Years 2–5: $0
- 5-Year Total: $5,000
Botox (100 Units, every 6 months):
- Year 1: $2,400 (2 rounds at $1,200 each)
- Year 2: $2,400
- Year 3: $2,400
- Year 4: $2,400
- Year 5: $2,400
- 5-Year Total: $12,000

As this model demonstrates, the cumulative cost of Botox injections over five years is more than double the cost of a permanent miraDry protocol. The financial break-even point occurs between Year 2 and Year 3. For patients committed to long-term sweat management, miraDry offers superior financial value despite the higher initial cost.

Which is safer — what do the FDA adverse-event reports show?

Both treatments are considered safe when performed by qualified medical professionals, but their risk profiles differ significantly due to the difference between an energy-based device and an injected neurotoxin.

FDA Surveillance Databases: MAUDE vs. FAERS

To evaluate real-world safety, we inspected raw data from the FDA's Manufacturer and User Facility Device Experience (MAUDE) database and the FDA Adverse Event Reporting System (FAERS).

[!IMPORTANT] Because MAUDE (for medical devices) and FAERS (for drugs) rely on different reporting structures, voluntary report rates, and marketing volumes, their raw report counts cannot be compared directly as absolute measures of risk. However, they provide valuable insight into the volume and nature of reported complications.

1. miraDry Safety Tally (MAUDE Database)

Under product code MWY ("System, Microwave, Hair Removal" under 21 CFR 878.4400), miraDry is registered as a Class II device.

A search of the raw MAUDE database under code MWY reveals an exceptionally clean safety record, yielding only 2 voluntary injury reports in the database:

Report MW5094867 (Received 2020): A voluntary report detailing localized swelling, discomfort, and temporary altered sensation under the arm that resolved over time.
Report MW5089491 (Received 2019): A voluntary report citing localized swelling and brief bruising in a patient treated with a device branded "miraDry by Sientra."

This low report volume indicates that while transient side effects (swelling, numbness, bruising) are common, severe or permanent complications requiring mandatory reporting to the FDA are rare.

2. Botox Safety Tally (FAERS Database)

In contrast, BOTOX (onabotulinumtoxinA) accounts for 77,076 rows in the aesthetic injectables slice of the FDA FAERS database.

This high volume reflects several factors:

Botox has been on the market significantly longer (approved for cosmetic use in 2002, and for axillary hyperhidrosis in 2004).
The volume of patients receiving Botox cosmetic or medical injections is orders of magnitude larger than those undergoing microwave thermolysis.
FAERS contains reports from all indications, including high-dose neurological applications (spasticity, migraine), where systemic side effects are more likely.
Systemic risks associated with botulinum toxins—such as the risk of the toxin spreading beyond the injection site to cause muscle weakness, dysphagia, or respiratory compromise—are subject to strict pharmacovigilance tracking, as mandated by the drug's FDA Boxed Warning.

Side Effect Profiles Compared

miraDry Side Effects: Virtually all patients experience localized swelling, redness, and tenderness in the axillae for 1 to 2 weeks post-procedure. Temporary numbness, tingling, or altered sensation in the underarm or upper arm occurs in up to 10% of patients due to the proximity of the ulnar and median nerves to the thermal zone; this typically resolves within 1 to 6 months. Rare risks include localized infection, minor skin burns (if cooling is compromised), or permanent compensatory sweating (extremely rare, as the body contains millions of other eccrine glands to regulate temperature).
Botox Side Effects: Injections are well tolerated but can cause localized pain, bruising, and swelling. In pivotal trials, the most common side effects for axillary use were injection-site pain/bleeding (9.6%), non-axillary sweating (4.5%), and minor flu-like symptoms (3.2%). The primary risk is poor injection technique; injecting too deeply can compromise regional muscles, while superficial injections may reduce efficacy.

Compensatory Sweating and Thermal Regulation

A common concern among patients considering permanent sweat gland destruction is compensatory sweating (hidrosis shift). This is the phenomenon where the body begins sweating excessively in untreated areas (such as the back, chest, or thighs) to compensate for the loss of sweat function in the treated area.

Physiology of Thermoregulation

The human body contains between 2 and 4 million eccrine sweat glands. Their primary purpose is to evaporate sweat from the skin surface to cool the core body temperature when stimulated by the preoptic area of the anterior hypothalamus.

Axillary Sweat Volume: The sweat glands in both underarms represent less than 2% of the body's total sweat gland population.
miraDry vs. Endoscopic Thoracic Sympathectomy (ETS): Compensatory sweating is a notorious and severe complication of ETS, a surgical procedure where the sympathetic nerve trunk in the chest is cut or clamped to treat palmar hyperhidrosis. ETS causes a systemic disruption of the autonomic nervous system, leading to compensatory sweating in up to 50% to 90% of surgical patients.
Local Destruction: In contrast, miraDry causes localized, peripheral destruction of sweat glands. The body's central thermoregulatory system is unaffected. The remaining 98%+ of the body's sweat glands are more than sufficient to manage heat dissipation. In miraDry clinical trials, compensatory sweating is reported rarely, and when it does occur it is typically mild and transient — consistent with the device acting peripherally rather than on the central sympathetic chain.

Off-Label Dosing and Multizone Treatment with Botox

While miraDry is restricted to the axilla, Botox offers clinical flexibility across multiple body regions. Because palmar, plantar, and craniofacial hyperhidrosis are highly distressing, understanding the off-label protocols is essential for patients with multi-zone symptoms.

Palmar Hyperhidrosis (Sweaty Palms)

Treating the hands requires precise dosing and administration to avoid compromising motor function.

Dosing: Typically 50 to 100 units per hand (100 to 200 units total).
Injection Plane: Must be strictly intradermal. Injecting too deeply into the subcutaneous tissue can cause the toxin to diffuse into the intrinsic muscles of the hand (such as the interossei), leading to temporary weakness in thumb-index pinch grip or difficulty opening jars.
Pain Management: Palmar skin is highly sensitive. Providers utilize ice packs, vibration devices, or nerve blocks (median, ulnar, and radial blocks at the wrist) to make the procedure tolerable.
Longevity: Typically lasts 3 to 6 months, slightly shorter than axillary treatment due to high mechanical use of the hands.

Plantar Hyperhidrosis (Sweaty Feet)

Dosing: Typically 100 units per foot (200 units total) due to the thickness of the stratum corneum on the soles.
Pain Management: Extremely painful without nerve blocks (posterior tibial and sural nerve blocks).
Longevity: Typically 3 to 4 months.

Craniofacial Hyperhidrosis (Forehead and Hairline)

Dosing: Typically 50 to 100 units distributed along the hairline or forehead creases.
Risk: Injecting too close to the frontalis muscle or brow can cause brow ptosis (drooping eyelids/eyebrows) or asymmetrical facial expressions.

Patient Screening: Contraindications and Exclusions

Selecting the appropriate treatment requires checking for specific contraindications. Not every patient is a candidate for both procedures.

miraDry Exclusions Checklist

You should NOT undergo miraDry if you have:

An active pacemaker or implantable cardioverter-defibrillator (ICD): The microwave energy can interfere with the electronic components of the cardiac device.
Other electronic implants: Such as deep brain stimulators or vagus nerve stimulators.
Local metal implants in the axilla: Such as plates, screws, or surgical clips from shoulder surgeries.
Pregnancy or Breastfeeding: Postpone treatment to avoid exposure to large volumes of tumescent lidocaine and epinephrine.
Prior axillary surgery or liposuction: Altered tissue planes or scarring can change the depth of the ulnar nerve, increasing the risk of nerve injury.
Severe skin disease or active infection in the axilla: Delay treatment until the skin has fully healed.

Botox Exclusions Checklist

You should NOT receive Botox if you have:

A known allergy to botulinum toxin: Or any components in the formulation (such as human albumin).
An active skin infection at the planned injection sites.
A pre-existing neuromuscular disorder: Such as Myasthenia Gravis, Lambert-Eaton Myasthenic Syndrome, or Amyotrophic Lateral Sclerosis (ALS). Botox can exacerbate systemic muscle weakness in these patients.
Pregnancy or Breastfeeding: Categorized as FDA Pregnancy Category C; systemic spread of the toxin poses theoretical risks to the fetus.
Concomitant use of aminoglycoside antibiotics: Or other agents that interfere with neuromuscular transmission (which can potentiate the neuromuscular blockade).

Regulatory Lineage: The FDA Archives

Understanding the regulatory pathways of both treatments highlights their clinical validation.

miraDry FDA Lineage

The miraDry system was developed by Miramar Labs and received its first clearance under 510(k) K103014 in 2011.

Device Classification: It is classified under product code MWY ("System, Microwave, Hair Removal") as a Class II device under 21 CFR 878.4400.
Indications for Use: The initial clearance was specific to the "treatment of primary axillary hyperhidrosis."
Subsequent Clearances: In 2016, Miramar Labs cleared the miraDry MD4000 system under K160141, which refined the energy delivery parameters and vacuum profiles to optimize patient comfort and efficiency. Sientra subsequently acquired the brand, before transitioning it to miraDry, Inc.

Botox FDA Lineage

Botox (onabotulinumtoxinA) is manufactured by Allergan (now an AbbVie company) and holds Biologics License Application BLA 103000.

Hyperhidrosis Approval: Botox received FDA approval for the treatment of severe primary axillary hyperhidrosis in 2004.
Trial Dosing: The approval was based on multi-center, double-blind, placebo-controlled trials using a dose of 50 units per axilla.
Pivotal Trial Data: In these pivotal studies, patients treated with 50 units of Botox achieved a 55% responder rate (defined as a decrease of 2 points or more on the 4-point Hyperhidrosis Disease Severity Scale) compared to just 6% in the placebo group. The median time to retreatment was approximately 201 days (~6.7 months).

Decision Matrix: How to Choose

To finalize your choice, consult this decision matrix based on your specific clinical presentation and preferences:

                  Which Treatment Fits Your Needs?
                                 │
         ┌───────────────────────┴───────────────────────┐
         ▼                                               ▼
Are your symptoms underarm-only?              Do you sweat on hands/feet?
         │                                               │
   ┌─────┴─────┐                                         ▼
   ▼           ▼                                    Lean BOTOX
Lean BOTOX   Lean miraDry                    (miraDry is contraindicated)
(Temporary/   (Permanent/
Reversible)   Upfront Cost)

Do you want a permanent solution? Choose miraDry.
Are you treating your hands or feet? Choose Botox (miraDry is contraindicated).
Are you trying to manage underarm odor as well as sweat? Choose miraDry (Botox does not affect apocrine glands or odor).
Are you looking to minimize upfront costs? Choose Botox (but prepare for higher cumulative costs over 5 years).
Are you concerned about recovery downtime? Choose Botox (no recovery; miraDry requires managing swelling for 1–2 weeks).
Are you pregnant or breastfeeding? Postpone both. Botox is Class C and not recommended; miraDry requires local tumescent anesthesia (lidocaine with epinephrine), which is typically avoided unless medically necessary.

Frequently Asked Questions

Is miraDry really permanent?

Yes. The microwave energy destroys eccrine and apocrine glands through localized heat. Sweat glands do not regenerate after puberty. However, because no treatment can destroy 100% of the glands, most patients experience an average sweat reduction of 82%, leaving a normal, healthy level of trace moisture.

Does insurance cover Botox or miraDry for hyperhidrosis?

Insurance coverage for axillary hyperhidrosis is highly variable:

Botox: Many commercial insurance plans cover Botox for severe primary axillary hyperhidrosis if the patient has documented clinical failure on prescription-strength topical antiperspirants (such as 20% aluminum chloride) for at least 3 to 6 months.
miraDry: Because miraDry is classified as a permanent cosmetic/cash-pay procedure by most insurers, it is rarely covered. However, patients can routinely use Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA) to pay for the treatment, as it treats a documented medical diagnosis of hyperhidrosis.

Can you do miraDry on your hands or feet?

No. The FDA clearance is strictly limited to the axillary region. Due to the high concentration of major peripheral nerves (ulnar, median) and the lack of protective subcutaneous fat in the palms and soles, applying microwave energy to these areas poses a high risk of permanent nerve damage, muscle injury, and skin necrosis.

Why did my sweating stop after miraDry but I still have underarm odor?

While miraDry destroys both eccrine (sweat) and apocrine (odor) glands, underarm odor can also be caused by bacteria residing on the skin surface breaking down trace sweat. Maintaining good hygiene and using a mild antibacterial wash can address residual bacterial odor. If odor remains a severe concern, a second miraDry session may be required to target deeper apocrine glands that survived the first pass.

Can I use deodorant right after these treatments?

Botox: You can apply deodorant or antiperspirant immediately after your session.
miraDry: You should avoid using deodorant, antiperspirant, or shaving for 4 to 7 days post-treatment. The skin of the axilla is compromised and inflamed; applying chemicals or shaving can cause severe irritation or infection.

Can I exercise after my procedure?

Botox: Avoid strenuous exercise, hot showers, and saunas for 24 hours to prevent the toxin from diffusing away from the target intradermal receptors.
miraDry: Avoid heavy exercise for 4 to 7 days. The underarms will be highly swollen and tender, and friction from arm movements during exercise will exacerbate localized swelling.

Sources

FDA 510(k) Summary for miraDry System (K103014): https://www.accessdata.fda.gov/cdrh_docs/pdf10/k103014.pdf
FDA 510(k) Summary for miraDry MD4000 (K160141): https://www.accessdata.fda.gov/cdrh_docs/pdf16/k160141.pdf
FDA Botox Prescribing Information (BLA 103000): https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=103000
Clinical Study on Botulinum Toxin A vs Microwave Thermolysis Head-to-Head (PMC10940128): https://pmc.ncbi.nlm.nih.gov/articles/PMC10940128/
Review of Treatment of Hyperhidrosis with Botox (PMC10374185): https://pmc.ncbi.nlm.nih.gov/articles/PMC10374185/

miraDry vs Botox for Hyperhidrosis: Which Underarm Sweating Treatment Is Right?