Oculofacial Plastics Practice of Dr. Kimberly Cockerham

BOTOX For Eyelid and Facial Spasms

A number of patients suffer from spasms of the eyelid and face. These are typically aggravated by voluntary facial movements. They are increased with fatigue and emotional stress, and they are suppressed with sleep, relaxation and hypnosis. It often begins with twitches and increases in frequency and severity over time. Eventually this results in a sustained spasm. Women are affected 3-4 times more often than men.

These spasms may be localized to a single muscle (eyelid) or involve multiple muscles of the face. Spasms that affect both sides of the face are typically caused by a chemical imbalance in the brain. Rarely the spasm is due to a brain stroke or multiple sclerosis. Spasms located to one side of the face are due to dysfunction of the facial nerve (called hemifacial spasm). In 85-100% of cases, the nerve is compressed by vessels located in the brain.

Botox is the most commonly used medical treatment for eyelid and facial spasms. When used correctly by a trained physician, 96.6% of patients will have a noticeable and sustained improvement after injection of Botox.

Possible side effects include inability to close your eyelid, eyelid drooping, tearing, and other less common side effects like a flu syndrome.

Depending of the cause of the spasm, the effect of the Botox typically lasts 12-15 weeks. Giving more Botox does not make the effect last longer. Similarly the effect does not get stronger or weaker over years of treatment. Your physician may need to adjust the dose of Botox to best treat your spasms.


What is BOTOX

BOTOX is a purified protein that is synthesized from the naturally occurring bacterium, Clostridium botulinum. There are seven known forms, which are similar but have distinct structures. The most commonly used are:

  • Botox, botulinum A (Allergan)
  • Dysport, botulinum A (Medicis)
  • Xeomin, botulinum A (Merz)
  • Myobloc, botulinum B (Elan)

Botox is most commonly used for Cosmetic Artistry. However, Botox is also an effective treatment for a number of medical conditions including eyelid and facial spasms, eyelid retraction (thyroid eye disease, facial nerve dysfuction), drooping eyelids, inturning of eyelids, and double vision.

The effects of Botox typically lasts weeks to months before it wears off. Over time the nerves that are affected by Botox recover and form new nerve endings. It is also possible that there is deactivation of the toxin itself. It is known that multiple injections are more effective than increasing the volume of the injection.

Bruising is the most common unwanted side effect of Botox injection. In order to minimize bruising there are a number of medications that patients should avoid two weeks prior to injection. These include:

  • Aspirin, motrin
  • Fish oil – Omega 3
  • Flaxseed
  • Vitamin C and E
  • Garlic tablets

Additionally, there is an herbal supplement called Arnica Forte, which can decrease bruising. This is taken by mouth and should be started two days prior to injection.

Other less common risks of Botox include numbness, double vision, drooping eyelids, headaches, flu-like symptoms, muscle weakness and death.

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