Hemifacial Spasm

Hemifacial Spasm Although it is not a common condition by any means, we sometimes see patients suffering from hemifacial spasm. Hemifacial spasm is a rare neuromuscular disease characterized by irregular, involuntary muscle contractions (spasms) on one side of the face. These spasms are triggered by the facial nerve, which originates in the brainstem and exits the skull just below the ear.

Hemifacial spasm often begins with occasional twitching in an eyelid that can progress to complete closure of the affected eye. The spasms usually start in the eyelid and spread downward, eventually impacting the mouth.

What is hemifacial spasm?

Hemifacial spasm occurs in two forms: typical and atypical. Only around 3 percent of patients experience the condition in atypical form. Typically, the twitching starts in the lower eyelid. As it progresses, the twitching spreads to the entire eyelid, then to the orbicularis oris muscle around the lips, and the buccinators muscle in the cheekbone area. It may produce contortions such as a sideways pulling of the mouth.

Hemifacial spasm affects just under one person in 100,000. It occurs in both men and women, although is somewhat more common in middle-aged or elderly women.


There can be different causes of hemifacial spasm. It can occur due a facial nerve injury or a tumor, and there may be a genetic predisposition. At Texas Neurosurgery, the cause we usually see is excessive pressure on a facial nerve when it is exiting the brainstem.

Treating hemifacial spasm

Generally, we use two methods for treating hemifacial spasm at Texas Neurosurgery: Botox injections and microvascular decompression surgery.

Botox — Botulinum toxin, when injected into a muscle, stops the muscle from receiving signals from the nerve to contract. Used cosmetically to treat wrinkles formed by muscle contractions, Botox is very effective treating hemifacial spasm. The Botox is injected directly into the muscle causing the eyelid twitching. There it blocks the nerve message and prevents the muscle from contracting, eliminating the spasm. Botox lasts around four months at which point another injection session must be scheduled to continue blocking the twitching.

Microvascular decompression — This surgery relieves pressure on the facial nerve. However, some serious complications can accompany this surgery. Plus, the condition has about a 10 percent recurrence rate.

If you notice some twitching in your lower eyelid, call us at Texas Neurosurgery. You may have hemifacial spasm and we need to treat it before the condition spreads to the lower portions of your face. Call us at 214-823-2052 for an appointment.

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6080 North Central Expressway Ste. 150
Dallas, TX 75206
(We sit behind the Beeman Hotel)

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