Causes of facial droop concern

Overview

Facial droop is when one side of your face feels weak or looks uneven. It can happen suddenly or over time. Sometimes it is a sign of a stroke, which needs immediate medical help. Other times it may be due to a temporary condition like Bell's palsy or an infection.

Facial droop is not extremely common, but when it happens it can be very concerning. Bell's palsy affects about 1 in 60 people at some point in their lives. Strokes are less common but more serious.

Facial droop can affect people of any age. Strokes are more common in older adults and people with high blood pressure or diabetes. Bell's palsy can happen at any age, including children.

Symptoms

Common symptoms

• One side of the face feeling weak or heavy
• Difficulty smiling or closing the eye on that side
• Drooping of the mouth or eyelid
• Numbness or tingling on one side of the face

Symptoms in children

• A child may not be able to move one side of their face when asked to smile or puff out their cheeks
• They may drool more than usual
• Irritability or crying without a clear reason

Symptoms in older adults

• Sudden weakness on one side of the face, which may be accompanied by arm weakness or slurred speech
• Difficulty swallowing or a sudden headache
• Confusion or trouble understanding speech

Causes

Main causes

• Stroke – a blockage or bleeding in the brain that stops blood flow to part of the brain
• Bell’s palsy – inflammation of the facial nerve, often linked to a viral infection
• Infections – like Lyme disease from a tick bite, or shingles
• Head injury or surgery affecting the facial nerve
• Brain tumor or other growths (rare)

Risk factors

• High blood pressure, smoking, diabetes, or high cholesterol – these increase stroke risk
• Recent viral illness – can trigger Bell’s palsy
• Ticks or outdoor exposure in areas with Lyme disease
• Pregnancy – slightly higher risk for Bell's palsy in the third trimester

When to see a doctor

See a doctor urgently if:

• Any sudden facial droop – treat as a stroke emergency and call your local emergency number
• Facial droop after a head injury
• Difficulty speaking, walking, or moving one arm along with the droop

Book a routine appointment if:

• Facial droop that comes and goes over days or weeks
• Mild facial weakness without other concerning symptoms
• Facial droop that has been present for a while and is not getting worse

Diagnosis

A doctor will ask about your symptoms and do a physical exam. They will check your ability to move your face, arms, and speak. They may also check your blood pressure and listen to your heart.

Tests that may be done

• Blood tests to check for infection or inflammation
• CT scan or MRI of the brain – especially if a stroke is suspected
• Electromyography (EMG) – a nerve test if Bell's palsy is not improving

What to expect at your appointment

The doctor will first rule out a stroke using the FAST check (Face, Arms, Speech, Time). If it is not a stroke, they may diagnose Bell's palsy based on symptoms. In some cases, you may be referred to a neurologist (brain and nerve specialist) for further tests.

Treatment

Treatment depends on the cause. For a stroke, you need emergency care to restore blood flow. For Bell's palsy, the goal is to protect the eye and help the nerve heal. Infections are treated with medicines. Most people improve with time and care.

Self-care at home

• If you cannot close your eye fully, use artificial tears and a patch or tape to protect it while sleeping
• Gentle facial exercises can help keep muscles active, but ask a doctor or physiotherapist first
• Eat soft foods if chewing is difficult; drink plenty of fluids
• Get plenty of rest and avoid stress

Medical treatments

For Bell’s palsy, doctors may recommend a short course of steroid medicine taken by mouth to reduce nerve swelling. For confirmed Lyme disease, antibiotics are used. Stroke treatment may include clot-busting medicine or procedures to restore blood flow. Never take any medicine without a doctor's advice.

When is surgery considered?

Surgery is rarely needed for facial droop. It may be considered for tumors pressing on the nerve, or for severe Bell's palsy that does not improve. For stroke, surgery to remove a clot or repair a blood vessel is sometimes done but not for the droop itself.

Living with this condition

Living with facial droop can be challenging. If your eye does not close, you need to protect it from dryness and injury. You may notice changes in how you eat, speak, or show emotion. With time, many people adapt and regain function.

Lifestyle tips

• Use a straw for drinks if you have trouble swallowing
• Practice smiling in the mirror to stimulate nerve recovery
• Talk to family and friends about your condition so they understand
• Avoid driving if you have double vision or sudden weakness

Diet and exercise

Eat a balanced diet with plenty of fruits, vegetables, and whole grains to support healing. If you have high blood pressure, reduce salt. Gentle exercise like walking is fine, but avoid heavy exertion until cleared by a doctor. Facial exercises may help, but ask a specialist first.

Mental health and emotional wellbeing

Facial droop can affect your confidence and how others see you. It is normal to feel anxious, sad, or self-conscious. These feelings are valid. Talk to a counselor or support group if needed. Most people’s outlook improves as their face recovers.

Prevention

Not all causes of facial droop can be prevented, but you can lower your risk of stroke by controlling blood pressure, not smoking, staying active, and managing diabetes. For Bell's palsy, there is no known prevention.

Vaccines

The shingles vaccine may reduce the risk of shingles-related facial weakness. The Lyme disease vaccine is not widely available. Talk to your doctor about vaccines that are right for you.

Screening programmes

There is no routine screening for facial droop. Regular checkups for blood pressure and cholesterol can help prevent stroke, which is a major cause of sudden facial droop.

Complications

If left untreated

• Eye damage – if the eye cannot close, it can become dry, infected, or scratched
• Permanent facial weakness or muscle tightness
• Social and emotional problems from changes in appearance
• If caused by a stroke, untreated stroke can lead to permanent brain damage or death

Long-term outlook

The outlook depends on the cause. For Bell's palsy, most people recover fully within weeks to months. With stroke, early treatment gives the best chance of recovery. Even if weakness remains, rehabilitation can help you adapt and improve quality of life. Hope and support are key.

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