The treatment of hemifacial spasm with periorbital injections of higher doses of botulinum toxin can create disfiguring and undesirable weakness in the lower face during active facial movements. The use of asymmetric hyaluronidate filler injections to the lower face provides a refinement allowing for a lowered neurotoxin dose. The filler creates a ballasting effect and involuntary facial movement. The conventional filler effect also further reduces asymmetric nasolabial folds and marionette lines. Fifteen of 18 patients with lower facial spasms found the filler toxin combination an improvement over neurotoxin alone.