Bilateral Hemifacial Spasm After Filler Injection

A 57-year-old woman presented for evaluation of spastic left eyelid closure that began 1 to 2 weeks after receiving injections of poly- l -lactic acid dermal filler to the bilateral temples and cheeks at a local Medspa. External examination revealed a left hemifacial spasm, but the ophthalmology exam was otherwise normal. MRI confirmed the presence of subcutaneous filler in the bilateral temporal and malar regions. The patient was started on oral gabapentin and the frequency of her spasms improved significantly. Months later, she developed a right hemifacial spasm. Her bilateral hemifacial spasm was presumed secondary to compression from persistent filler deposited adjacent to the temporal and zygomatic branches of the facial nerve, with retrograde activation of the other nerve branches. This is the first reported case of hemifacial spasm that may be associated with filler injection.