Long-Term Botox for Hemifacial Spasms

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.

Doctor Answers 10

Botox safety when used for many years

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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.

Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Botox Effective for Spasm

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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.

Michael McCracken, MD
Lone Tree Oculoplastic Surgeon

Long-term Effect of Botox for Facial Spasms

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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

Houtan Chaboki, MD
Washington DC Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

Long-Term Botox for Hemi-Facial Spasms

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Botox has not been available for 30 years, but significant complications after long term use have not been reported. I suggest you contine your present treatment and resort to surgery only if you have problems in the future. Better alternatives may become available.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Botox is efficient remedy for hemifacial spasm, some forms of TMJ, and many forms of migraine headaches

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Botox is efficient remedy for hemifacial spasm, some forms of TMJ, and many forms of migraine headaches . It has a long safety record of safety and minimal incidence of allergies.

Edward Lack, MD
Chicago Dermatologist

Botox almost certainly your safest option

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The risk you are accepting using Botox is minimal.  People have bean having regular Botox treatments for more than 20 years and there have not been any cumulative side effects observed.  It is true that some people develop immunity to Botox, this is quite rare and only means that Botox no longer works.  It is possible that Myobloc, Dysport, or one of the soon to be introduced botulinum toxins may still work, even if you developed antibodies to Botox.

When compared to Botox, any surgery will look risky.  There may be advantages, however, that make you choose surgery.  For example, Botox, requires regular maintenance and the results will ebb and flow as it wears off and then a new treatment takes effect.  And one treatment may work better than the next, or you may have some weakness that you didn't want with one treatment and not the next.  Surgery may produce a lifelong, maintenance free "cure" to your problem.  But you should consider the risk of surgery against those benefits, and against what I would consider to be close to zero risk of a permanent complication from Botox.  Furthermore, surgery may simply not work, you know what Botox does for you.

Louis W. Apostolakis, MD
Austin Facial Plastic Surgeon
4.8 out of 5 stars 36 reviews

BOTOX® has a 20 year track record of safety

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BOTOX® has been used around the world for over 20 years and over 20 million treatment sessions. Some individuals have been having regular treatment with BOTOX® for cosmetic purposes or for therapeutic purposes [for example, blepharospasm and hemifacial spasm] for close to 20 years, with good results and no problems. So, I have no concerns about using BOTOX® for long-term control of your hemifacial spasms.

Best wishes,

Kevin Smith MD FRCPC Niagara Falls Ontario

Kevin C. Smith, MD
Niagara Falls Dermatologic Surgeon

Botox does tend to work long-term for Hemifacial Spasm

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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

Mark J. Lucarelli, MD
Madison Oculoplastic Surgeon
5.0 out of 5 stars 13 reviews

Botox for hemifacial spasm

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I would not be concerned unless Botox stops working. That surgery has significant risks. One of my patient had the surgery and ended up with complete hearing loss on that side.

Peter T. Truong, MD
Fresno Oculoplastic Surgeon
4.9 out of 5 stars 42 reviews

Botox has only been used since 1988.

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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.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

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