Long-Term Botox for Hemifacial Spasms

Question

I have had hemi-facial spasms for 10 years. For the last 3-4 years Botox has proved very successful. I am contemplating surgery which is drilling into the skull because I am concerned about Botox losing it's effect after 30 years (when I am 85) and/or causing weakened facial muscles and a dropping face, eyelid, etc. Are there any studies of Botox used for Hemi-Facial Spasms for 30 years out? I cannot find any information on Botox used for 30 years. Please advise.

Ron Shelton, MD · Answer

Although I am not aware of any long-term studies done on the safety of botox used for different conditions when used for thirty years, there do not appear to be problems when patients have had botox injected for cosmetic treatment for many years.  If your treatment is working well, there may not be a good reason to undergo surgery now.  Check with your neurologist if you have not yet done so.

Mark J. Lucarelli, MD · Answer

Hi.  For most patients with hemifacial spasm Botox does work well long-term.

	I have personally treated a significant number of patients with hemifacial spasm for 14 years straight.  It has been extremely rare for these patients to have lost effectiveness of the Botox over time.  Some patients in my practice have been treated with Botox for over 25 years by various doctors. They seem to do well over the long haul.

	Microvascular decompression (a neurosurgical technique) can do wonders, provided that the surgeon has significant experience with the technique.

	The vast majority of my patients choose to keep on with the Botox for hemifacial spasm so long as the results are satisfactory.  A few never felt the Botox gave adequate relief and opted for the neurosurgery early on.

	Hope this helps.

	Mark Lucarelli, MD FACS

	Madison, WI

Kenneth D. Steinsapir, MD · Answer

Dear Balloon

	There are no 30 year studies of BOTOX for hemi-facial spasm because BOTOX has only been available for the past 23 years.  There are studies that have looked at the effects of treatments over 15 years and there is another study that includes patients first treated in 1990.  These studies suggest that treatment continues to be beneficial over these very long time frame.  I more significant question is if you have been properly worked up for blepharospam?  Surgery is generally reserved for situations when there is evidence of compression of the facial nerve by the posterior inferior and anterior inferior cerebellar artery or venous compression.  A teflon felt is inserted between the structures or a stitch may be places to support the blood vessel off the nerve.  This does of course involve neurosurgery.  I would recommend discussing these options with your treating neurologist. Certainly, there should be a high likelihood of successful surgery before abandoning the Botox treatments which sound like they have been helpful for a treatment that may or may not be helpful for you.

Michael McCracken, MD · Answer

Balloon Cottage, 

	There is no reason to think that Botox will stop working for your condition.

	Botox has been FDA approved for treating spasms since 1989, so I see no reason to subject yourself to brain surgery for a condition that Botox is controlling.

Houtan Chaboki, MD · Answer

Hi Balloon Cottage,

	Plastic surgeons and dermatologist do not know the long-term effect of continued Botox Cosmetic use, since it's only been available for approximately 20 years. However, research has shown Botox to still be useful for a long-time, for example over 10 years. Speak with your specialist to help determine appropriate options for you. Best of luck.

	Dr. Chaboki

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Long-Term Botox for Hemifacial Spasms

Answers (9)

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