Emotional Issues

Self Esteem

We know from research and people’s stories that those living with facial palsy show great resilience in managing the day-to-day challenges. However, if you have noticed a decrease in your self-esteem since developing facial palsy then you are not alone. People with facial palsy often experience a reduction in self-esteem. This can be a consequence both of how you feel about yourself, but also how other people react to you. People can experience a sense of loss, especially since appearance and speech are often a large part of peoples’ identity. People often find themselves making comparisons with the appearance of not only other people, but also their own appearance, or what their appearance should have been, prior to the onset of facial palsy. Such comparisons can have a negative impact on our mood.

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.

Further information and advice on building self esteem can be found here: Psychological Interventions.

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. One way that people cope with feeling anxious is to become socially withdrawn. In the short term this can help them to feel less anxious, but in the longer term this can lead to them feeling 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. The Clinical Psychology team at the Oxford Facial Palsy Unit have developed some self-help guides informed by cognitive behavioural therapy to help people with facial palsy to manage anxiety and their mood.

Further information can be found here: Psychological Interventions.

Stigma

As children grow older, feelings of difference can be more challenging and as their peers become more aware of difference (normally around the age of 6-8 years of age), children with facial palsy may experience more stigmatising behaviour. Adults may experience stigmatising behaviours, such as unkind comments at work, or exclusion from certain situations. Children should never feel like they need to cope on their own. It is important to educate others about facial palsy and to ensure children and adults 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.

Connecting with Others

Smiling is key to how people communicate and build relationships and can be a universal greeting that people recognise all over the world, no matter where you come from, or what language you speak.

Living with facial palsy can impact our social interactions in a number of ways. In certain cases, for example where facial paralysis affects both sides of the face, such as Moebius syndrome, it is not possible to demonstrate emotions through facial expression. Difficulties with showing emotion can make it more challenging to form new relationships.

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. If people feel self-conscious of their facial palsy they sometimes change the way they socialise, trying to hide their smile, reduce eye contact or avoid drawing attention to their face by angling their body away. However these can have an impact on the quality of our social interaction and the ease in which conversations occur. It can make a person appear unfriendly or uninterested in the conversation and this in turn, makes it harder to make new friends.

However many people with facial paralysis learn to communicate in alternative ways, such as through direct eye contact, through speech and by being more demonstrative (e.g. through gestures and non-verbal communication). 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.

For further information about managing comments and questions and for tips for communicating with confidence, please see the psychological self-help resources developed by the psychology team at the Oxford Facial Palsy Unit. Further information can be found here: Psychological Interventions.

Intimate Relationships

New relationships

Whether a person is born with facial palsy or develops it later in life, it can be difficult when first meeting a new partner. People often worry about being judged negatively or are concerned about how their new partner may react when they first meet them.

If you are finding it hard to take steps to dating, it can be helpful to gradually build up your confidence in other social areas first. Improving your own self confidence through time spent on self-care, spending time noticing your positive qualities and self -compassion can all help in shaping the response of others around you.

Some people are unsure how to introduce the topic of facial palsy and at what point to do this during the early stages of dating.  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. Whilst we can not always control other people’s reactions, they will look to you for a gauge on how to respond. Having a practise before hand can often be helpful. Introducing the topic could be overtly done before meeting or through more general conversations streams on meeting, which you can use as a way in (e.g. “Yes I love these glasses, I have to wear them more now as facial palsy can impact my eye..”). You can consider if you want to use humour or more factual information to help communicate what want to say. Further information about talking to others about facial palsy can be found here: Psychological Interventions.

Developing facial palsy when in a relationship

For people who develop facial palsy later, it can be 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. Further information and advice for carers regarding supporting someone with facial palsy can be found here Psychological Interventions. Please also see our page for Partners of people with facial palsy.

Intimacy

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

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. Furthermore, a person with facial palsy and their partner can explore additional ways of being intimate together, for example through the use of touch. Spending time re-connecting as a couple, doing the things you value and building in fun times together can all help re-build intimacy.