Patients travel to Los Angeles for hemifacial spasm surgery

More patients are seeking microvascular decompression in Los Angeles as a durable option for hemifacial spasm, a condition often treated first with Botox. Dr. Aaron Cohen-Gadol says the procedure can address the underlying nerve compression, and many patients now seek remote second opinions before traveling.

Why it matters: - Hemifacial spasm can disrupt daily speech, social life, and confidence even when it is not medically dangerous. - Microvascular decompression offers a potential one-time fix for patients who want a lasting solution instead of repeat injections. - The growing travel pattern reflects demand for surgeons with deep experience in cranial nerve disorders.

What happened: - More patients are traveling across the U.S. and internationally to Los Angeles for microvascular decompression surgery for hemifacial spasm. - Dr. Aaron Cohen-Gadol, a Los Angeles-based neurosurgeon, has performed more than 600 microvascular decompression procedures for hemifacial spasm and trigeminal neuralgia. - Dr. Cohen-Gadol performs these surgeries at Cedars-Sinai Medical Center and Saint John's Health Center. - Dr. Cohen-Gadol leads the ATLAS Institute of Brain and Spine in Los Angeles.

The details: - Hemifacial spasm is caused in most cases by a blood vessel compressing the facial nerve near the brainstem. - Botox and medication reduce symptoms but do not correct the underlying vascular compression. - Botox relief typically lasts three to six months, which can require ongoing injections. - Repeated Botox use can lead to facial weakness, cosmetic asymmetry, and irritation from repeated injections. - Microvascular decompression moves the compressing vessel away from the facial nerve and places a permanent cushion between them. - More than 80% of appropriately selected patients experience complete, lasting relief after microvascular decompression. - Many patients improve within days to weeks, and results can last for years. - In experienced centers, temporary facial weakness can occur but usually resolves, and serious complications are uncommon. - Most patients spend a few days in the hospital and return to non-strenuous activity within one to two weeks. - Dr. Cohen-Gadol said the main risk comes from inexperience, not the operation itself.

Between the lines: - Hemifacial spasm is frequently misdiagnosed or overlooked for years, which can delay referral to the right specialist. - The emphasis on surgery before repeated Botox reflects a push to frame microvascular decompression as a primary option for good surgical candidates. - Dr. Cohen-Gadol's high-volume practice and teaching role appear to be a major part of the appeal for travel patients. - Dr. Cohen-Gadol is one of a small number of neurosurgeons worldwide to receive the Vilhelm Magnus Medal from the Scandinavian Neurosurgical Society. - The Neurosurgical Atlas, founded by Dr. Cohen-Gadol, is used by more than 70,000 physicians and surgeons worldwide. - Dr. Cohen-Gadol said patients should get accurate information rather than fear-based assumptions when choosing between repeat injections and surgery.

What's next: - Dr. Cohen-Gadol's practice offers virtual and in-person second-opinion consultations. - The practice reviews imaging and symptom history before patients book travel to Los Angeles. - Patients can contact the office at (310) 626-1312 or through the practice website. - The practice also directs patients to its social channels on Instagram, Facebook, and X. -