To investigate the incidence of delayed facial palsy (DFP) after microvascular decompression (MVD) for hemifacial spasm (HFS), identify the most important factors affecting the occurrence of DFP, and establish a prediction model for DFP occurrence. Methods: A total of 400 patients with HFS were admitted to our hospital and underwent MVD between September 2015 and June 2020. Among them, 48 patients (12% ) developed DFP. The clinical data of the patients were collected, and a prediction model was established by LASSO-Logistic regression analysis. The discrimination, calibration, and predictive performance of the prediction model were assessed using C index, receiver operating characteristic (ROC) curve, and calibration curve. Results: The predictive factors in the prediction nomogram included age, sex, presence of facial nerve pressure trace, symptom laterality, hypertension, and diabetes mellitus. Internal validation of the model revealed a C index of 0.869 (95% CI 0.805～0.933), indicating good discrimination of the model; the calibration curves of both the modeling and validation groups were extremely close to the standard curves, indicating good calibration performance. Conclusion: Hypertension and facial nerve pressure trace may be risk factors for the occurrence of DFP after MVD. The nomogram-based risk prediction model of DFP after MVD has good discrimination and accuracy.