Purpose <p>Hemifacial spasm (HFS) and blepharospasm (BSP) impair motor function and psychosocial health. This study assessed anxiety, depression, and self-esteem changes following botulinum toxin A (BoNT-A) treatment.</p> Methods <p>In this prospective study, 158 adult patients (HFS: n = 112, BSP: n = 46) receiving ongoing BoNT-A treatment were recruited. Motor severity was assessed using the Hemifacial Spasm Grading Scale (HSGS) for HFS and the Modified Jankovic Rating Scale (MJRS) for BSP. Psychological status was measured using the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Rosenberg Self-Esteem Scale (RSES) at baseline and two months after injection. Paired and independent statistical tests evaluated within- and between-group differences, with significance set at <i>p &lt;</i>0.05.</p> Results <p>BoNT-A treatment significantly improved motor severity and anxiety in both HFS and BSP groups, with significant improvements in depression and self-esteem predominantly observed in HFS patients (all <i>p</i> &lt; 0.001). BSP patients exhibited higher baseline anxiety and lower self-esteem compared with HFS patients. Psychiatric comorbidity was associated with higher baseline anxiety and depression and larger psychological improvements in HFS patients, whereas change scores in the BSP group did not reach statistical significance. Correlation analyses revealed inverse associations between mood and self-esteem and between motor severity and self-esteem.</p> Conclusion <p>BoNT-A treatment provides significant dual motor and psychological benefits in hemifacial spasm and blepharospasm, highlighting the potential need for integrated psychotherapeutic assessment in patient management.</p>