Hemifacial Spasm

This information is designed only to help patients talk with their physicians about Hemifacial Spasm (HFS) and is not intended to provide treatment guidelines.


HFS is a neurologic condition with uncontrolled, repeated contractions of the muscles on one side of the face. It usually begins around the eye and may spread down the face to involve the mouth and neck. The eye can be forced closed and the corner of the mouth can be pulled over to the same side. It is not usually painful but can interfere with vision and social activities. It is usually caused by a blood vessel pinching the facial nerve just as it leaves the brainstem. Rarely it can be caused by a tumor. Most patients are diagnosed by a neurologist and begin non-surgical treatments with them.

Pre-operative Video of left HFS

Post-operative video of left HFS


Medical Treatment

Some medical treatments include biofeedback training or a trial of a medication. HFS can be very difficult to treat with medications but a variety of drugs can be tried. The choice of these medications and their potential side-effects are best reviewed with your Neurologist.

Botulinum Toxin (Botox) Injections

Botulinum toxin is produced from the same bacteria responsible for a type of food poisoning called Botulism. When very small amounts are injected into a muscle it can weaken or paralyze the muscle and reduce or stop the spasms. The procedure can be done in the office and does not take long. There are several possible immediate side effects including a drooping eyelid, dryness of the eye or the loss of muscle function at the corner of the mouth causing a lopsided smile. Unfortunately, the effect is only temporary and the procedure may need to be repeated every three to six months. The effectiveness of Botox may be reduced over the years because the patient can develop antibodies against it. The body’s ability to recover from the weakness produced by the Botox may be reduced over time. This can result in permanent facial weakness (eyelid or mouth droop). Many therapists will not use Botulinum toxin except in the eyelid muscles. The benefit of Botox therapy is that it can be repeated as necessary and does not have any of the complications associated with surgery.


Available Surgeries



The picture below is a close-up of Saint Anne smiling in Leonardo da Vinci’s painting “The Virgin and Child with Saint Anne” from approximately 1499. She does not have hemi-facial spasm but I have not yet found a good historical representation of this condition.

ld face 2