See a doctor straight away: steroid treatment works best when it starts within 72 hours. Protect your eye if it does not close, rest as much as you can, and do not force your face into expressions or exercises. Most people recover fully within 2 to 3 weeks. If the nerve damage is deeper, the first movements can take up to 4 months, but they do return.
Table of Contents
Key Facts
- Bell’s palsy is a sudden weakness or paralysis of one side of the face, caused by a damaged facial nerve.
- Steroids such as prednisone are advised within 72 hours of the first symptoms (AAO-HNS guideline).
- About 7 to 8 out of 10 people recover fully within 2 to 3 weeks.
- The nerve regrows at most about 1 mm per day. No pill or exercise can speed it up beyond that.
- Forcing movements, facial exercises and electrical stimulation can make complications such as synkinesis more likely.
Is it Bell’s palsy or a stroke?
Call emergency services straight away if you also have weakness in an arm or leg, trouble speaking, confusion, or if your forehead still moves normally on the affected side. These can be signs of a stroke. Read Bell’s palsy vs stroke.
What happens to your face during Bell’s palsy
The facial nerve runs from the brain to the facial muscles through a long, curved channel in the skull, just behind the ear. If the tissue around it swells, for example because of an infection, the nerve gets squeezed in this narrow channel. It stops passing signals to the muscles, and one side of your face stops moving. Read more in What is Bell’s palsy? and What causes Bell’s palsy?
Think of the nerve as a cable full of insulated wires. What happens next depends on how deep the damage goes:
- Only the insulation (myelin) is damaged. It repairs within 2 to 3 weeks, and you usually recover fully. See the quick recovery timeline.
- The wires themselves (axons) are damaged. They need to regrow, so the first movements take from about 3 weeks to 4 months. Some lasting effects are more likely. See the long recovery timeline.
Deeper damage is more common in Ramsay Hunt syndrome and in facial palsy after surgery, trauma or a tumour. Read How long does Bell’s palsy last?
What to do in the first days: 7 steps
- See a doctor straight away. See your GP, an ENT doctor or a neurologist. Guidelines advise starting steroids such as prednisone within 72 hours of the first symptoms. An antiviral may be added, but not on its own. Your doctor will also check for other causes.
- Protect your eye. If your eye does not close fully, use lubricating eye drops (artificial tears) during the day and an eye ointment at night. Tape or patch the eye closed for sleep, and wear glasses outdoors against wind and dust. See a doctor at once if the eye becomes red or painful.
- Rest. Stay home from work for at least a few days, sleep a lot and avoid heavy physical activity. Your body needs all its resources to fight the cause and start repairing the nerve.
- Stay calm. Panic and fear suppress the immune system, which your body needs for recovery. The repair starts the moment the damage happens, and the movements will return.
- Massage gently and keep warm. A soft massage of the face, neck and head, twice a day for 10 to 15 minutes, with a few drops of oil. Stroke slowly from the middle of the face outwards and from the lower face upwards, on both sides at once. A warm compress behind the ear can help. Avoid cold.
- Take photos every week. Use our neurological tests, a set of 9 photos, once a week. They show progress the mirror hides. If your doctor can arrange it, a nerve test (EMG or nerve conduction study) shows how deep the damage is.
- Be patient. The nerve regrows at most about 1 mm per day. If the damage was deep, the first movements may take 2 to 3 months. Nothing can speed this up beyond what your body allows, but a healthy body recovers at its best pace.
Video: what to expect from acute Bell’s palsy
What not to do
- Do not force your face. Do not practise smiles or expressions in front of the mirror. While the nerve is still healing, forcing only strains the few fibres that work and teaches the brain to overdo every signal.
- No facial exercises or electrical stimulation. In our experience, they make synkinesis and tight muscles more likely. Read why in Facial exercises for Bell’s palsy.
- Do not massage hard. Strong pressure does not help the nerve and can irritate the tissue.
- Do not wait. Seeing a doctor after the first 72 hours means missing the best window for steroids.
Other questions people often ask in the first weeks:
- Can vitamin B12 help?
- Is chewing gum good or bad?
- Which side should I sleep on?
- What is the first sign of recovery?
When to seek more help
If you see little or no movement after 3 weeks, your recovery is most likely following the long path. Guidelines advise seeing a facial nerve specialist if your face has not fully recovered 3 months after the onset, or straight away if your eye gives problems or new symptoms appear.
If complications start, such as synkinesis, tightness or facial pain, they can be reduced. Read Is Bell’s palsy permanent?
Recovery taking longer than expected? In a video consultation, Dr. Alex Pashov looks at your photos and progress, and tells you what to do now and what to avoid, wherever you live.
See a doctor straight away. Guidelines advise starting steroids such as prednisone within 72 hours of the first symptoms. Protect your eye if it does not close, and rest.
Do not force your face into expressions, do not do facial exercises, and avoid electrical stimulation. In our experience they make synkinesis more likely. Also avoid hard massage and cold.
Most people recover fully within 2 to 3 weeks. If the nerve damage is deeper, the first movements return between about 3 weeks and 4 months.
Not beyond what your body allows, because the nerve regrows at most about 1 mm per day. Early steroids, rest, sleep, good food and staying calm help your body recover at its best pace.
Use lubricating eye drops during the day and an ointment at night. Tape or patch the eye closed for sleep, and wear glasses outdoors. See a doctor at once if the eye becomes red or painful.
If there is little or no movement after 3 weeks, the recovery is likely to be long, but movements usually still return. See a facial nerve specialist if your face has not fully recovered after 3 months.
