Hemifacial spasm is an involuntary, intermittent twitching of the muscles on one side of the face, most often beginning around the eye and sometimes spreading to the cheek and mouth. It is usually caused by a small blood vessel pressing on the facial nerve. The standard, highly effective treatment is botulinum toxin type A (Botox) injections, given every three to four months. Private treatment starts from around £400 per session, including a consultant oculoplastic assessment.
What is hemifacial spasm?
Hemifacial spasm (HFS) is a chronic condition in which the muscles supplied by the facial nerve on one side of the face contract involuntarily. It typically starts as occasional twitching of the lower eyelid, then becomes more frequent and may involve the muscles around the eye, cheek and corner of the mouth. In long-standing cases the eye may be pulled partly closed during a spasm.
The usual cause is neurovascular compression — a blood vessel pressing on the facial nerve where it leaves the brainstem. It is distinct from a simple eyelid twitch (myokymia), which is common, harmless and short-lived, and from blepharospasm, which affects both eyes. A consultant assessment confirms the diagnosis and, where appropriate, arranges an MRI scan.
Symptoms of hemifacial spasm
- Twitching on one side of the face, often starting at the lower eyelid
- Spasms that spread to the cheek, brow or corner of the mouth
- Involuntary eye closure during stronger spasms
- Worse with stress, fatigue or talking
- Spasms continuing during sleep in some people — a feature that helps distinguish HFS from a simple twitch
Persistent one-sided facial twitching? A consultant oculoplastic assessment can confirm hemifacial spasm and start effective Botox treatment.
Book an assessmentTreatment options for hemifacial spasm
Botulinum toxin injections are the mainstay of treatment and suit the large majority of patients. Your consultant will explain the options and what fits your situation.
Botulinum toxin type A is the established treatment for hemifacial spasm in the UK. For patients who want to address the underlying nerve compression, microvascular decompression is a neurosurgical option, and we can arrange the appropriate referral and imaging. Explore related oculoplastic treatments.
What happens during Botox treatment
Treatment is a short outpatient procedure performed by a consultant. No anaesthetic or sedation is needed.
- Your consultant examines your spasm pattern and marks the small muscles around the eye and face to be treated.
- Tiny amounts of botulinum toxin type A are injected with a very fine needle into the targeted muscles.
- The injections take about 10–15 minutes in total and cause only brief, minor discomfort.
- You can go straight back to normal activities — there is no downtime.
- The effect builds over a few days and the dose is fine-tuned at review to give the best control with the fewest side effects.
What to expect after treatment
Botox does not cure hemifacial spasm but controls it very effectively, and treatment is simply repeated as the effect wears off.
Days 1–3
The injections start to take effect and the twitching settles. Mild bruising at injection sites can occur and fades quickly.
Week 1–2
Full effect is reached. Most people experience a marked reduction in spasm. A review checks the response and adjusts dosing if needed.
Months 1–3
Good control of the spasm continues. As the effect gradually fades towards the end of this period, twitching begins to return.
Every 3–4 months
Treatment is repeated to maintain control. Over time your consultant refines the dose and injection sites to your individual pattern.
Hemifacial spasm Botox cost
Private treatment is priced per session, with the toxin and consultant time included:
- Botox treatment session: from around £400, including consultant assessment and injections.
- Initial consultation: from approximately £200 if booked separately, often redeemable against treatment.
- Ongoing care: repeat sessions every 3–4 months as the effect wears off.
- Insurance: recognised by major insurers — we can help with authorisation.
See full oculoplastics prices or browse all treatments.