Management of Synkinesis (Tight Face)

Synkinesis means the development of linked or unwanted facial movements. It is common and occurs in the majority of people who are recovering from prolonged facial palsy. For a bespoke exercise plan you will need guidance from a specialist therapist. The videos in this set demonstrate stretches and massage techniques which may be helpful. They should not be done by anyone who has had their facial palsy less than three months. Please listen carefully to the instructions. If you have facial palsy due to Stroke please consult your health care team for further advice because these videos relate to facial nerve injury.

Important: The best way to prevent synkinesis occurring is to massage your face daily as demonstrated in the flaccid video and also to avoid the urge to ‘push’ your face to move faster. Nerve recovery takes time and patience. If you can use your face as gently as possible throughout your recovery rather than as hard as possible you are likely to get a better recovery with less side effects. This is why these exercises should not be done by anyone who has had facial palsy for less than three months.

If you require subtitles, please click the cog on the YouTube video (this displays after you click play next to the YouTube logo) and select Subtitles English (United Kingdom).


Stretches for the tight side

Important notes: If you follow the video above your full set of stretches are going to take you approximately 30 minutes. The priority is technique so you need to follow the video carefully making sure you are copying them exactly. You will need to follow the video for the first five or six times so that you memorise them correctly. Thereafter just follow the video once a week to check that you are not cutting corners. It is a good idea to do the entire routine at least once daily. If you don’t have time to work on them all in one go then work on individual areas, e.g. all the stretches for the brow and around the eyes, then all the stretches around the cheek and lips, and finally all the stretches for the chin and neck. If your arms feel tired, rest your elbows on the table for support. If you want to do your stretches more than once a day that’s fine but just be careful with the skin inside your mouth (mucosa), as it is very delicate. You may want to do all the tightest areas twice daily but do the full range of stretches just once daily. If you wake up with a very tight face then do them in the morning. If your face tightens up over the day then do them in the evening. However, if this doesn’t fit with your routine then do them when best suits you.

Frequently asked question: I’ve been given movement exercises to do by my specialist facial therapist, when should I do these?

Answer: If you are practicing movement exercises, we suggest these are done after your stretches and massage. Please note that Facial Palsy UK cannot give individual advice about movement exercises. Movement exercises should be prescribed only by a specialist facial therapist because they are bespoke to each individual. Be cautious about movement exercises advocated online, there is a lot of misinformation on the internet which can cause greater problems.

We strongly recommend that you finish your routine with 15 minutes of relaxation and/or five minutes of massage.


Important note: Ensure you are using firm pressure with the pads of your fingers so you are mobilising the muscles ‘beneath’ the skin and not just moving the skin.

Frequently asked question: How often should I massage?

Answer: This can be done twice daily.


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Link to previous video – management of paresis

Link to next video – calming practice for the face and neck (audio only)

Link to all self-help videos

Last reviewed: 03-05-2022    ||    Next review due: 30-09-2023