Bell palsy recovery

Overview

Bell palsy is a condition that causes sudden weakness or paralysis on one side of the face. It happens when the nerve that controls your facial muscles becomes swollen or compressed. Most people start to get better within a few weeks, and many fully recover within a few months.

Bell palsy is fairly common. About 1 in 60 people will have it at some point in their life.

It can affect anyone, but it is most common in people between the ages of 15 and 60. It happens slightly more often in pregnant women, people with diabetes, and those with a weakened immune system.

Symptoms

Common symptoms

• Sudden weakness or paralysis on one side of your face – you may not be able to close your eye, smile, or frown on that side.
• Drooping of the mouth or eyelid on the affected side.
• Difficulty making facial expressions, like raising your eyebrow or pursing your lips.
• Pain around the jaw or behind the ear on the affected side.
• Increased sensitivity to sound in one ear.
• Dry eyes or mouth, or trouble tasting food.

Symptoms in children

• Children with Bell palsy have the same symptoms as adults, but they may not be able to describe them clearly.
• You might notice that your child’s face looks lopsided when they cry or smile, or that they cannot close one eye completely.

Symptoms in older adults

• Older adults may have more pain in the ear or jaw before the facial weakness appears.
• Recovery can take a little longer in older adults, but most still recover well.

Causes

Main causes

• The exact cause is not always known, but it is often linked to a viral infection, such as the herpes simplex virus (the virus that causes cold sores).
• Swelling and inflammation of the facial nerve (the nerve that controls muscles on one side of your face) are the main problems.

Risk factors

• Having a viral infection, like a cold or flu, shortly before symptoms start.
• Being pregnant, especially in the third trimester or the first week after giving birth.
• Having diabetes, high blood pressure, or a weakened immune system.
• Having a family history of Bell palsy.

When to see a doctor

See a doctor urgently if:

• If you have sudden facial weakness and any signs of a stroke – call emergency services immediately.
• If you cannot close your eye at all – see a doctor urgently to protect your eye.

Book a routine appointment if:

• If you notice new facial weakness that is not accompanied by other stroke symptoms, see your GP or family doctor within 24 to 48 hours.
• If your symptoms are not improving after 2 weeks, follow up with your doctor.

Diagnosis

Doctors usually diagnose Bell palsy by asking about your symptoms and doing a physical exam. They will check your facial muscles and look for other possible causes, like infections or tumours.

Tests that may be done

• No specific test is needed for Bell palsy. Your doctor may do a simple test, like asking you to smile, close your eyes, or raise your eyebrows.
• In some cases, your doctor may order blood tests or an imaging scan (like an MRI or CT scan) to rule out other conditions such as a stroke or a tumour.

What to expect at your appointment

Your doctor will take a history and examine your face, head, and neck. They may ask about recent illnesses and check your hearing, taste, and eye movements. The diagnosis is usually straightforward based on your symptoms and exam.

Treatment

Treatment for Bell palsy focuses on reducing inflammation, protecting your eye, and helping your facial muscles recover. Most people get better on their own, but treatment can speed up recovery and prevent complications.

Self-care at home

• Protect your eye: If you cannot close your eye fully, use lubricating eye drops during the day and an eye ointment at night. Wear sunglasses or a patch to keep out dust and wind.
• Rest your face: Avoid straining your facial muscles. Eat soft foods and chew on the unaffected side if needed.
• Use a warm, moist cloth on your face to relieve pain and relax muscles.
• Try gentle exercises for your face – but check with your doctor before starting any facial exercises.
• Take over-the-counter pain relievers (like paracetamol or ibuprofen) for any discomfort – ask your pharmacist or doctor for advice.

Medical treatments

Your doctor may prescribe a short course of steroid medication (like prednisolone) to reduce inflammation of the facial nerve. Starting steroids within 72 hours of symptoms can improve your chances of a full recovery. Sometimes antiviral medication is added if a viral cause is suspected. Never take any medication without a doctor’s prescription. Your doctor will decide what is best for you.

When is surgery considered?

Surgery is rarely needed for Bell palsy. In very rare cases where recovery does not happen after a long time and the face remains weak, some people may consider cosmetic procedures (such as eyelid lifts or nerve grafts). This is a personal decision that should be discussed with a specialist.

Living with this condition

Living with Bell palsy can be frustrating, but most people adapt quickly. You may need to adjust how you eat, drink, and speak. Use a straw if liquids dribble. Take small bites and chew slowly. Tape your eyelid closed at night if needed. Most symptoms improve within weeks.

Lifestyle tips

• Get plenty of rest – your body needs energy to heal.
• Avoid stress as much as possible – stress can slow recovery.
• Keep your face and eyes protected from sun, wind, and dust.
• If you wear contact lenses, switch to glasses until your eye can close fully.

Diet and exercise

There are no special diet or exercise requirements, but eating a balanced diet rich in vitamins (especially B vitamins) may support nerve health. Gentle facial exercises, like smiling in a mirror, can help you regain muscle control – but only after your doctor says it is safe.

Mental health and emotional wellbeing

Bell palsy can affect your confidence and how you feel about your appearance. It is normal to feel self-conscious, anxious, or sad. Talking to friends, family, or a counsellor can help. If you feel very low or withdrawn, speak to your doctor – they can direct you to support services.

Prevention

There is no sure way to prevent Bell palsy because the exact cause is not fully understood. However, reducing your risk of viral infections – by washing your hands often and staying healthy – may help. Managing conditions like diabetes and high blood pressure can also lower your risk.

Vaccines

There are no vaccines specifically for Bell palsy, but staying up to date on routine vaccines (such as the flu shot) may help prevent viral infections that could trigger it.

Screening programmes

There is no screening test for Bell palsy. It is not a condition that can be predicted before symptoms start.

Complications

If left untreated

• Damage to your eye – if you cannot close it, the cornea (clear front part of the eye) can become dry and infected, leading to vision problems.
• Long-term facial weakness – very rarely, some people do not recover fully and may have permanent drooping or twitching.
• Synkinesis – unwanted muscle movements, like your eye closing when you smile. This happens if the nerve heals incorrectly.

Long-term outlook

The outlook for Bell palsy is excellent. Most people begin to improve within 2 to 3 weeks and make a full recovery within 3 to 6 months. Even if recovery is incomplete, the condition is not dangerous and does not affect your brain or overall health. With proper eye care and supportive treatment, you can expect a good outcome.

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