What are facial spasms?

Man with droopy eye from Botox facial spasmsFacial spasms are involuntary twitching or spasms in the face and eyelid area caused by neuromuscular disorders. These spasms usually aren’t painful but can be uncomfortable and distracting. You may experience spasms daily or every other day, while others may have difficulty driving, reading or performing other daily tasks. Without treatment, these spasms may progress enough to pull your eyelid or eyelids closed. Our physicians treat hemifacial spasms (spasms of one side of your face) and blepharospasms (spasms around your eyes).

What causes facial spasms?

Facial spasms are caused by nerve damage. This damage can be the result of:

  • A neuromuscular disorder or other medical condition, such as an autoimmune disease
  • Injury
  • Poor eyelid hygiene
  • Continual blinking or twitching because of an underlying condition

Dry eye, or blepharitis, caused by poor hygiene may need to be treated before or at the same time as facial spasms, depending on the severity.

Botox® injections to treat facial spasms

The most common treatment for facial spasms is Botox® injections, a solution of purified botulinum toxin used medically and cosmetically. Other treatment options include microvascular decompression surgery or ptosis surgery (eyelid muscle surgery). There has been new research on the effectiveness of low-dose methylphenidate medications, and on the use of cannabinoid oils may be an alternative option for some people. Depending on the severity and frequency of your facial spasms, different treatments may be recommended by your doctor.

How do Botox® injections work for facial spasms?

Botox® is injected into the affected muscles to help them relax. This can reduce and eliminate spasms. The treatment typically takes about 15 minutes to perform. Injections should not feel painful. A topical numbing cream is applied to the injection area along with ice. It commonly feels like plucking an eyebrow hair.

Where is Botox® injected?

Every patient has a unique spasm pattern. Common locations are the eyebrow, eyelid area, lash line area and the forehead. Having a specialized, trained physician examine and determine where to inject Botox® is important for effectively reducing spasms.

Often, physicians are uncomfortable or hesitant to inject Botox® around a person’s eyes, even if it’s a better treatment option for the person. But our oculofacial experts are practiced and confident in retaining the safety of your eye while providing the most effective placement of Botox® for spasms.

How much Botox® is injected?

The number of injections and quantity of Botox® depends on spasm severity. In one treatment session, the average patient receives between 25 units and 50 units. Our physicians start with the least amount possible and add additional units only as needed.

How often will I need Botox®?

Most people with facial spasms need to be treated with Botox® once every three to six months. Botox® metabolizes (breaks down) over time. How fast it breaks down will be different for every person, though, and this means Botox® must be regularly injected to continue being an effective treatment of spasms.

Over time, you may develop antibodies that will reduce the effectiveness of Botox®. In the uncommon case where this occurs, your physician may switch to an alternate botulinum toxin solution.

Risks of Botox®

The risks associated with Botox® treatment include:

  • A tiny bump at the injection spot, which should go away within 30 minutes.
  • Migration of Botox® solution into unwanted areas — to ensure this doesn’t occur, don’t rub the injected area, lie down or exercise during the first four to six hours after treatment.
  • A small amount of redness or irritation at the site of the injection may occur but this isn’t serious.
  • Allergies to Botox® are extremely rare. But if you have difficulty breathing, wheezing, or tightness in the throat or airways, please go to the emergency department.

Injections aren’t known to cause dry or watering eyes.

Benefits and results of Botox®

Treatment should result in more control over facial muscles and reduce or eliminate spasms and twitching. Most people cannot visibly determine if you’ve had Botox®. Unlike fillers, which alter volume underneath the skin, Botox® only limits muscle movement. The amount of Botox® used should not affect the ability to make facial expressions, raise eyebrows, blink, etc.

Is Botox® covered by insurance?

As treatment for the medical condition of facial spasms, this procedure is typically covered by most accepted insurance plans. Please check with your physician or insurance provider for details.

Why choose the Ohio State oculofacial team

Our oculofacial physicians are the only specialized experts in the care of, diagnosis of, treatment of, and surgery for facial eye plastics at The Ohio State University Wexner Medical Center. Every member of our oculofacial team is board certified and has completed a two-year fellowship in eye plastics from the American Society of Ophthalmic Plastic and Reconstructive Surgery. There are only 750 physicians in the world with this comprehensive training (as of January 2023).

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