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What Is Facial Paralysis?

Facial paralysis occurs when a nerve that controls your facial movements becomes damaged. As a result, a portion of your face may feel weak, or you may be unable to move it. Some types of facial paralysis may resolve on their own without invasive treatment, while others require surgery.

Facial Paralysis Symptoms

You may experience a range of symptoms with facial paralysis. Symptoms vary depending on the cause of the paralysis and how long you’ve had it.

Symptoms are usually concentrated on one side of your face. You may experience one or more of the following symptoms:

  • Weakness in your facial muscles
  • Spasms or twitches in your facial muscles
  • Unintentional facial movements
  • Excessive tearing in your eye
  • Eye or eyebrow drooping or sagging
  • Inability to close your eye
  • Inability to smile
  • Nasal obstruction from a collapsed nostril
  • Drooling
  • Sound sensitivity
  • Taste changes

If you have any of symptoms of facial paralysis, see a doctor within 72 hours.

Some facial paralysis symptoms are similar to those of a stroke. With a stroke, you may have numbness on one side of your face and other symptoms. Seek medical attention right away if you are experiencing stroke symptoms.


Some people develop a condition called synkinesis following facial paralysis. It causes involuntary movement in part of your face when you try to move another part. For example, you may unintentionally smile when you try to close an eye or close your eye when you are trying to smile. Synkinesis usually begins a few months after facial paralysis symptoms start. However, it can even start 2-3 years later. It typically does not improve without treatment.

What Causes Facial Paralysis?

You have two facial nerves: one on the left side of your face and one on the right side. An injury to the left facial nerve will impact movement on the left side of your face and the right nerve affects the right side of your face. The facial nerves start in the brain and divide into five branches near your ear. The nerves as a whole control facial expression and some tear and saliva production as well as some taste function.

The most common cause is Bell’s palsy, which suddenly causes paralysis on one side of your face. Doctors aren’t sure what causes Bell’s palsy, but they suspect a virus causes the facial nerve to swell, which affects its blood supply and function. It may be weeks or even months before you recover. Most people regain complete use of their face, although up to 30 percent may have some continued misfunction.

Other medical conditions can cause paralysis:

  • Autoimmune diseases
  • Bacterial infections like Lyme disease
  • Birth defects
  • Cancer
  • Injuries, surgery, or trauma
  • Noncancerous tumors called neuromas
  • Stroke
  • Viral infections

Facial Paralysis Treatment

Your provider will recommend treatment based on your symptoms and how long you’ve had facial paralysis:  

  • Medication—High-dose steroid medication may help reduce the nerve swelling from Bell’s palsy. Taking the medication soon after symptoms begin (ideally within 72 hours) may speed your recovery. If your symptoms don’t improve within two weeks, you should be evaluated by an otolaryngologist (ear, nose, and throat doctor). Medication may not help after that time.
  • Botox for facial paralysis—Neuromodulators like Botox®, Dysport®, or Xeomin® can block the chemical signal that tells specific muscles to tighten. You’ll need to repeat the treatment every three or four months. However, unlike cosmetic uses, insurance often covers these injections for facial paralysis.
  • Physical therapy—Facial neuromuscular retraining therapy, a specialized type of physical therapy, helps you relearn to stretch, strengthen, and move your facial muscles.

Facial Paralysis Surgery

A range of surgical options may improve permanent facial paralysis or synkinesis symptoms.

For inability to close the eye, your surgeon may place a platinum weight in your upper eyelid to help pull the eyelid down and close the eye. This procedure can be performed either in the operating room or with local anesthesia in your doctor’s office. You may also need surgical treatment for sagging eyelids or brows that block your vision or cause facial deformity and asymmetry.

For asymmetrical smile, your surgeon may cut the active muscle on the lower side of your mouth to improve lip symmetry. This outpatient procedure can be performed in the operating room or under local anesthesia in the clinic.

To further restore your smile, your surgeon may recommend a number of surgical interventions. These interventions may be on the nerves that feed your smile muscles or on the muscles that improve your smile. Your surgeon might perform one of the following procedures:

  • Transfer nerves from other areas of your face
  • Graft nerves from elsewhere in your body to the paralyzed nerve
  • Transfer a nerve to the muscle used in chewing 
  • Transfer a muscle from your leg to your face to replace one of the main smile muscles

To help you breathe, your surgeon may open a collapsed nostril by transferring cartilage from elsewhere in the nose or ear to your nostril.

To improve overall facial symmetry, your surgeon may use tissue from the lining of a thigh muscle  to help stop sagging and improve the resting appearance of your face.

Find a Facial Nerve Disorder Specialist

Schedule an Appointment

To make an appointment at the Facial Nerve Center, please call 801-585-3223 or request an appointment online. You don’t need a referral from your primary care provider to make an appointment. However, your insurance plan may require you to get a provider referral. Ask about your policy’s requirements before making an appointment.

Use our online form to refer a patient or call 801-587-8368 to speak to a patient referral specialist.

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