It usually starts with one eyelid.
A small flutter, mostly in the evening or when you’re tired. You think it’s screen time, or not enough sleep, or too much chai. Everyone gets an eyelid twitch, so you ignore it.
Then it doesn’t go away. A few weeks later the cheek starts pulling too. Sometimes the corner of the mouth. Always the same side of the face. That’s the part people notice first when they finally come to a doctor: it’s only one side.
That is typically hemifacial spasm. And if you’re searching for hemifacial spasm surgery, you’ve probably been dealing with it for a while.

What’s actually going on

Not stress. Let’s get that out of the way, because many people are told exactly this for months.
In most cases, a blood vessel is sitting against the facial nerve, right where the nerve leaves the brainstem. The vessel pulses with every heartbeat. The nerve gets irritated, misfires, and the muscles on that side twitch without your permission.
So the problem is mechanical. Something is pressing on a nerve. Sleeping more or doing breathing exercises won’t move a blood vessel, which is also why it rarely goes away on its own. It usually stays, or slowly gets a bit worse.
(Occasionally a tumour or a cyst is the reason. That’s one of the reasons we get an MRI before anyone talks about surgery.)

What people try first

Almost everyone starts with Botox injections, and honestly, that’s reasonable. The injections weaken the muscles a little, the spasms settle, and life goes on.
The catch is that it wears off. Usually in three to four months. Then you go back and repeat. Some people are completely fine with that for years, and for them Botox is the better choice. It’s simple, it’s quick, and there’s no surgery involved.
Others get tired of it. The relief gets shorter, or the face feels heavy or droopy after the injection, or they just don’t want to plan their life around the next appointment.
That’s really the whole difference between the two. Botox manages the symptom. MVD goes after the cause. Neither is “the right answer” for everyone.
Tablets exist too. Results are mixed, and the side effects (sleepiness, mostly) put a lot of people off.

So when does surgery make sense?

MVD (microvascular decompression) is usually considered when:

• Botox is no longer giving enough relief, or it’s wearing off faster than before
• The side effects from injections or medicines bother you more than the spasm
• The spasms are interfering with your eyes, your speech, your work, or driving
• You don’t want to keep injecting for the next 20 years
• The MRI shows a vessel pressing on the nerve
• You’re otherwise healthy enough for a brain surgery

You don’t need to tick every box. One or two are often enough to start the conversation.
And it’s a conversation, not a decision made in one visit. Some people come in with mild spasms that barely bother them. We tell them to wait. Surgery isn’t a hurry. You choose it when the spasm has started costing you more than the surgery would.

What MVD involves

A small opening behind the ear, under general anaesthesia. The surgeon reaches the facial nerve, finds the vessel pressing on it, and gently moves it away. A tiny cushion is placed so the vessel doesn’t go back.
Nothing is cut away from the nerve and nothing is destroyed. The aim is just to take the pressure off.
Same idea, by the way, is used in MVD surgery for facial pain. In trigeminal neuralgia, a vessel presses on a different nerve, and the result is sharp, electric-shock kind of pain instead of twitching. Different nerve, same principle.
Most patients stay in hospital for a few days. Full recovery takes a few weeks, and you’ll be told to take it slow in the beginning.

Relief, risks, and what nobody should oversell

For many patients the spasm settles well and stays away. But not always on day one. Sometimes the twitching carries on for a few days, even a few weeks, and then fades. The nerve needs time to calm down. Don’t panic if that happens.
A small number of patients don’t get complete relief. In some the spasm comes back later. It’s rare, but it happens, and we’d rather you hear it from us.
And yes, it’s a brain surgery, so it needs to be taken seriously. Hearing changes on that side, temporary facial weakness, balance issues, a CSF leak, infection. These are uncommon in experienced hands, but they aren’t zero. Anyone who tells you surgery has no risk is not being straight with you.

Before you decide anything

Get a proper MRI done, ideally a high-resolution one that looks closely at the nerve and the vessels around it. A regular brain MRI sometimes misses the detail.
Then sit down with a neurosurgeon and ask the boring questions. How many of these surgeries do you do? What are my chances, for my case, not in general? What happens if it doesn’t work?
A lot of people google “best neurosurgeon for MVD in India” at this stage. Fair. But there’s no official ranking, and a lot of what shows up is just marketing. What actually matters is how many MVDs the surgeon does regularly, and whether they’re upfront about results and risks. Ask for that, and compare two opinions if you can.
At Dr Deep Parmar’s clinic, this is how consultations usually go. We look at the scan, listen to how the spasm is affecting your day, and tell you honestly if surgery makes sense now, later, or not at all.
If the spasm has been with you for a long time and Botox is starting to feel like a loop, get your MRI looked at by someone who does MVD regularly. You can book a consultation with Dr Deep Parmar and take it from there.