Hemifacial Spasm: Causes, Treatment and Surgery

What Is Hemifacial Spasm?

Hemifacial spasm makes the muscles on one side of the face twitch on their own. The twitching usually starts around the eye and then spreads to the cheek and mouth. In most people, an artery presses on the facial nerve at the brainstem.

The spasm rarely hurts, and the condition itself is not dangerous. However, it seldom goes away by itself and often becomes more frequent over the years.

Botulinum toxin injections calm the muscles for a few months at a time. In contrast, microvascular decompression (MVD) frees the nerve and aims for lasting relief.

At a Glance

• What it isTwitching you cannot control on one side of the face
• First signA lower eyelid twitch that comes and goes
• Usual causeAn artery or vein pressing on the facial nerve
• DiagnosisAn examination and an MRI of the brain
• TreatmentRepeat injections, or MVD surgery to free the nerve
• Flying homeUK guidance advises about 7 days after brain surgery

What Brought You Here?

First, choose the line closest to your situation. Each one then opens the matching part of this guide.

1. 01An eyelid twitch that keeps coming backHow the spasm usually begins→
2. 02Not sure it is hemifacial spasmBlepharospasm, tics and other twitches→
3. 03Injections help less or wear off too soonWhen to consider surgery→
4. 04Your MRI shows a vessel on the nerveHow microvascular decompression works→
5. 05Worried about hearing or facial weaknessRisks and how the team lowers them→
6. 06Planning surgery from abroadLength of stay, flights and follow-up→

Hemifacial Spasm Symptoms

The main symptom is twitching on one side of the face that you cannot stop. It usually begins in the lower eyelid and then spreads over months or years.

Questions at this stage

When to See a Doctor About Face Twitching

Most eyelid twitches are harmless and stop within days or weeks. However, the NHS advises seeing a GP if a twitch lasts more than 2 weeks.

Twitching alone is not a sign of stroke, but sudden weakness can be. So get help where you are; do not wait for a visit abroad.

What Causes Hemifacial Spasm?

In most people, a blood vessel presses on the facial nerve at the brainstem. Doctors call this primary hemifacial spasm. It usually starts in the 40s or 50s and affects women more often.

The vessel is usually a small artery and sometimes a vein. Then, with every heartbeat, it rubs the nerve's insulating layer. Over time, the nerve fires extra signals, and the face twitches.

Less Common Causes

Sometimes another problem irritates the nerve, which doctors call secondary hemifacial spasm:

• A benign growth, such as an acoustic neuroma or a meningioma
• A cyst or a tangle of abnormal vessels
• Multiple sclerosis or another brainstem lesion
• An earlier nerve injury or facial paralysis, such as Bell's palsy

For this reason, doctors usually order an MRI before treatment. A growth then needs its own plan, such as skull base tumor surgery.

How Doctors Diagnose Hemifacial Spasm

The diagnosis starts with an examination, because the pattern of the spasm tells a lot. An MRI then shows the vessel on the nerve and rules out other causes.

• Examination: the spasm pattern, facial strength, feeling and hearing
• MRI with contrast: rules out a growth or another cause
• Thin-slice MRI and MR angiography: show which vessel touches the nerve
• Nerve test (EMG): sometimes, when the spasm looks unusual

Prof. Albayrak therefore asks for an MRI with contrast before he plans treatment. However, vessels also touch the nerve in some people without twitching. So the examination confirms the diagnosis.

Hemifacial Spasm vs Blepharospasm, Tics and Other Twitches

Other conditions also make the face twitch. However, where the twitch starts usually tells them apart.

For facial pain, in contrast, see our guide to facial nerve pain.

Hemifacial Spasm Treatment Options

Treatment either calms the twitching muscles or frees the nerve from pressure. Injections do the first and need repeating. MVD surgery does the second and aims for a lasting result.

Hemifacial Spasm Treatments Compared

What Botulinum Toxin Injections Involve

First, a doctor injects small amounts into the twitching muscles with a fine needle. The effect starts within days and usually lasts 3-4 months.

Side effects, such as a droopy eyelid, usually fade within weeks. Over the years, however, some people find that each injection works less well.

Microvascular Decompression for Hemifacial Spasm

Microvascular decompression (MVD) frees the facial nerve from the vessel that presses on it. The surgeon moves the vessel away and places a small soft pad in between.

This same operation, microvascular decompression, also treats trigeminal neuralgia.

The Operation Step by Step

Prof. Albayrak performs MVD under general anesthesia, using an operating microscope. In his practice, it usually takes about 2-3 hours.

1. You lie on your side, with your head held still.
2. A short cut behind the ear leads to a small window in the skull.
3. Under the microscope, the surgeon finds the facial nerve and moves the vessel away.
4. A small soft pad then keeps the two apart.
5. Finally, the surgeon puts the bone back and closes the skin.

Why Nerve Monitoring Matters

Throughout surgery, Prof. Albayrak monitors a facial nerve signal, the lateral spread response (LSR). This abnormal signal then usually disappears once the nerve is free. So it tells the surgeon, before closing, that the pressure has gone.

What Are the Risks of Hemifacial Spasm Surgery?

MVD is brain surgery, so it carries real risks, although serious problems are uncommon. Specifically, the main risks affect hearing and facial movement on the side of surgery.

• Hearing loss: the hearing nerve lies right beside the facial nerve
• Facial weakness: may appear days later and usually recovers over months
• Spinal fluid leak: clear fluid from the wound or the nose
• Infection or bleeding: mostly at the wound, rarely inside the head
• Dizziness, headache or nausea: common at first, then they settle
• Spasm that continues or returns: may need time, injections or another operation
• Stroke or death: very rare

To lower these risks, Prof. Albayrak watches the facial nerve's signals throughout surgery. Many teams also track the hearing nerve during MVD.

Recovery After Hemifacial Spasm Surgery

Most people spend 1-2 days in hospital and resume normal life within weeks. The spasm itself, however, can take longer, because an irritated nerve calms down slowly.

A Typical Timeline

When Will the Spasm Stop?

In some people, the twitching stops as soon as they wake up. In others, it fades over weeks or months, which does not mean the operation failed. If it persists for months, Prof. Albayrak repeats the MRI and plans the next step.

Coming to Istanbul from the US, Canada, the UK or Europe

MVD is brain surgery, so plan the trip around recovery and a safe flight home. Also keep your return date flexible.

How Long to Stay in Istanbul

First, add up the consultation, any new tests, the operation and 1-2 days in hospital. Then rest at a nearby hotel until your check-up about a week later. Overall, that usually means 10-14 days in Istanbul.

When You Can Fly Home

First, UK aviation guidance advises about 7 days between brain surgery and a flight. The US CDC also warns that flying after surgery raises the risk of blood clots. So your neurosurgeon confirms the date after a check-up.

Follow-Up at Home

Before you leave, ask for your discharge summary and copies of your scans. Then plan the 1-month and 3-month check-ups, for example with your local doctor.

In the UK, you must not drive after MVD until a doctor confirms your recovery. You must also tell the DVLA, according to its guidance. Elsewhere, rules differ, so ask your doctor before you drive.

For insurance and Medicare, see brain surgery in Turkey: planning from the US. For NHS rules and travel insurance, see planning from the UK. From Canada, check with your provincial health plan and private insurer before you book.

Your Hemifacial Spasm Surgeon in Istanbul

Prof. Dr. Serdar Baki Albayrak

Neurosurgeon · Full Professor of Neurosurgery

Prof. Albayrak uses the same microvascular decompression technique for hemifacial spasm and trigeminal neuralgia. In hemifacial spasm, he also follows the lateral spread response until the nerve is free.

He completed his neurosurgery training at Istanbul University in 2004. Clinical fellowships then followed at the University of Helsinki and at Harvard Medical School. Consultations take place in English or Turkish.

27+Years

5,000+Operations

64Countries

33Publications

Figures from Prof. Albayrak's professional profile, September 2026. See his full publication list.

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