Facial Nerve Recovery

In some cases of facial palsy, the facial nerve can recover, but this very much depends on the cause of the facial paralysis. Examples of causes where a full recovery is possible are Bell’s palsy, Ramsay Hunt syndrome and Guillain-Barré syndrome, although all cases are different and the degree to which the facial nerve will recover is difficult to predict. Complete recovery cannot be guaranteed.

When a baby is born with facial palsy (congenital facial palsy) this is usually due to underdevelopment of the facial nerves or muscles, which can be mild or severe. Alternatively it may be one of many symptoms associated with rare genetic syndromes. Facial palsy can occur during delivery often due to pressure or trauma to the facial nerve. In these cases there may be some recovery within the first few days and weeks after birth. There is often a “wait and see” approach before more tests are carried out, to see if the palsy resolves naturally.

In more rare cases, the facial nerve may have been cut or severed (for example, during surgery to remove a tumour or through trauma such as a road traffic accident). In these instances there will be no natural recovery and treatment from health care professionals will be required to help restore some facial function.

Please see comprehensive list of causes for more information.

What happens to the face when you have facial palsy?

When facial palsy suddenly occurs, the affected side(s) of your face will feel and look floppy as there are no nerve signals telling the muscles to contract. There are many different symptoms associated with facial palsy which vary depending on the cause.

What happens to the facial nerve when recovery is expected?

Bell’s palsy and Ramsay Hunt syndrome

  • Spontaneous recovery will take place for the majority of people within one – three weeks after onset of their symptoms.
  • Others will make a good recovery within the first three months but may continue to experience a few mild symptoms.
  • A minority of people will have persistent symptoms of weakness beyond three months.

Other causes

It is more difficult to predict the rate of recovery in other conditions as there is so much variation from person to person and individual circumstances.

Here we will discuss in general terms what you may experience when there has been incomplete recovery of your facial nerve. As your face starts to recover, nerve signals will begin to reach the muscles and you may notice some of the following:

  • Some muscles begin to work before others: for example, your eye might start to close properly but your smile may still be weak.
  • Your face will begin to look more symmetrical when you are relaxed because the muscles will regain their tone and no longer look or feel so floppy.
  • People will start to tell you how much better you are looking but your movements may still be very weak.
  • A tingling sensation in your face (can be a sign of nerve recovery – your therapist may test using Tinel’s sign)
  • If you have any twitches you should always mention these to your healthcare professional as this can mean a number of things, some positive (in relation to recovery) and some negative (if signs of nerve compression).

As you progress you may notice other changes taking place in your face, for example:

  • The affected eye may seem smaller
  • The corner of the mouth may seem raised on the affected side.
  • The affected cheek may feel tight and stiff.
  • You may notice that some of the muscles move together instead of separately, for example, your eye may close when you smile. Your cheek may contract or tighten when you raise your eyebrows. This is called synkinesis.

These are common symptoms during facial nerve recovery, regardless of the cause.

The facial nerve has five branches supplying each of the following areas:

  1. Brow
  2. Eye
  3. Cheek
  4. Chin
  5. Neck

During the recovery process you may notice muscles recovering at different rates so the facial muscles are unbalanced.

What should you do if your face has not recovered?

  • Seek help and advice to ensure that your eye is protected if your eye closure and blink has not fully recovered.
  • Ask your GP to refer you to a physiotherapist or speech and language therapist for assessment and treatment. They should have specialist experience in the management and treatment of facial palsy.
  • Do not attempt to carry out exercises without professional help as you may do more harm than good. Most people want to do something but trying too hard may lead to problems later on in your recovery. Refer to our self-help videos for safe ways you can help yourself.
  • Try and relax and allow nature to take its course.
  • Don’t be eager to force weak muscles to move. Allow them to recover in their own time whilst waiting for professional help.
  • Advice from the internet, especially watching videos on treatment exercises, may be totally inappropriate for your individual case. Please seek professional help and guidance.
  • If in doubt do nothing except simple massage and eye protection until you are assessed by a health care professional.
  • Gentle facial massage is very good for the face. Using the pads of your fingers gently massage the brow, temples, cheek, chin and neck.

Remember every case of facial palsy is unique, so what works for one person may be totally inappropriate for another.

Last reviewed: 08-06-2020    ||    Next review due: 08-06-2024