The efficacy and optimal frequency of acupuncture for hemifacial spasms (HFSs) in patients unresponsive or averse to standard treatment methods remains unestablished. Here, we administered acupuncture to a patient with HFSs who was dissatisfied with the outcomes of botulinum toxin (BoNT) injections as symptomatic treatment. A man in his 60s, experiencing frequent spasms in his left facial muscles since 2015, had received several BoNT injections without receiving microvascular decompression or medication; however, the treatment results were not satisfactory. In 2020, he visited our clinic for acupuncture. His entire face twitched involuntarily, and the other Babinski sign was observed. The spasm severity was 5 on the numerical rating scale (NRS). Acupuncture was performed on the gallbladder meridian (GB) 2, stomach meridian (ST) 7, and triple energizer meridian(TE) 17 along the facial nerve and GB14, GB1, small intestine meridian (SI) 18, ST4, ST5, and ST9 on the affected (left) side. In the fourth session, 1 Hz electroacupuncture at ST7 and TE17 reduced the NRS score to 1. As his spasms were well managed, we initially continued with biweekly acupuncture sessions. However, by the 10th session, a worsening of symptoms led to a revert to weekly treatment, which maintained a decreased NRS score until the 21st session. Our findings suggest that weekly acupuncture may be a viable treatment modality for patients with HFSs unresponsive or averse to conventional treatments. Future prospective clinical trials are required to verify the efficacy of acupuncture for HFSs.