Emotional Issues

Smiling is key to how people communicate and build relationships, and when the ability to smile is taken away, the effect on a person’s emotional well-being can be quite devastating. Smiling is after all, a universal greeting that people recognise all over the world, no matter where you come from, or what language you speak.

People are often criticised for not looking cheerful enough. Being friendly is important in many different situations, not just in someone’s personal life, but also in their professional life. The key way to express “friendliness” is through smiling. Building confidence levels and encouraging self-acceptance is important for anyone with facial palsy, empowering them to make friends, strive for the career they want and meet new partners.

Forming friendships

When children become more aware of their facial palsy, they sometimes try to hide their smile in order to stop others noticing it. By not smiling they can appear unfriendly, making it harder for them to make new friends. When people get to know a person, they tend to accept the facial palsy as part of them and not notice it so much, but older children do not always understand this.

A facial difference is something very public, and can leave people permanently on their guard when it comes to showing emotion, whether it be smiling, laughing or crying. Some people with more severe facial paralysis find other ways of showing emotion, such as through direct eye contact, through speech and by being more demonstrative. In cases where facial paralysis affects both sides of the face, such as Moebius syndrome, once family or friends know the person well, they will still be able to pick up on their emotional cues.

Today’s world of social media places even more pressure on people with a facial difference; photographs have become a large part of our lives, particularly for the younger generation. A night out with friends might be spoilt by the worry of the photos that may appear later on the internet. Trying to find the right balance between looking like you are having fun, and at the same time trying to hide your facial palsy, means that people often do not fully relax in social situations.


Whether a person is born with facial palsy or develops it later in life, it can be difficult when first meeting a new partner. Meeting a new partner socially, or through work, means that the other person is already aware of the facial paralysis, but there are often still worrying thoughts such as,

What will they think when they first see me asleep and one eye is open?

Kissing can also present problems for people with facial palsy, especially for those who have facial palsy on both sides of their face. This may make it especially difficult when starting a new relationship and lead to reluctance or anxiety around dating for the first time.

When a person has facial palsy, their mouth may not move normally on one or both sides, which can make the action of kissing more difficult. It may be necessary for a partner to use their mouth to guide the mouth of the person with facial paralysis, particularly if that person has very little movement around the lips.

Many people use online dating to meet new partners, but it is always difficult to know how to broach the topic of facial palsy with someone you have not yet met in person. Many people with facial palsy feel they want to explain it first, so the other person is not surprised when they meet for the first time. It is difficult to explain something that is quite rare, and most people have no previous experience of facial paralysis. People with facial palsy can also be quite vulnerable, with a tendency to automatically blame an unsuccessful date on their face, when it perhaps didn’t work out for an entirely different reason.

Developing facial palsy when in a relationship

For people who develop facial palsy later, it is incredibly hard to accept the new face they see in the mirror. Once a person has developed facial palsy, if it makes them feel unattractive then they may worry that their partner feels the same way.

When we look at ourselves in the mirror, we do not always see what other people see. Other people see past our faces, taking in our personality and other body language at the same time. Meeting others with facial palsy can help people understand why their partners see them differently to the way they perceive themselves.

In relationships where someone has known the person with facial palsy for some time, the paralysis becomes just a small part of that person, and most friends or family will say they do not notice it anymore, or they might even say they think it has improved, often simply because they have just grown so used to it.

Anxiety and depression

People with facial palsy often suffer some level of anxiety or depression, which does not necessarily relate to the degree of facial paralysis. A natural reaction is to try and hide our differences; people with facial palsy can become socially withdrawn and isolated. Feeling unable to relax and laugh without being stared at makes a huge impact on people’s lives. People with a facial difference have to work hard to maintain confidence levels often having a fear of new situations and meeting new people. Different psychotherapies such as cognitive behavioural therapy can help.


Bullying can be a problem for children and adults with facial palsy. For a child, having facial palsy can be quite isolating, particularly as they become more aware of their facial difference. It is important to educate others about facial palsy and to ensure children receive relevant support, so they learn to express themselves confidently and openly. Please see our support section for more information about where to go for help and support.

Last reviewed: 31-07-2019    ||    Next review due: 31-07-2022