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Bell’s Palsy Live Q&A Recording: Feb ’22

When it comes to Bell’s palsy, each case will be very different from each other. Each recovery, although following a similar pattern, will happen and progress differently. That is why there is no “one-size-fits-all-solution” to recovery after unilateral facial palsy. Also, that is why we constantly receive very varied questions from all of you.

In order to help more Bell’s palsy sufferers to find the answers they are looking for, from time to time we organize Q&A livestreams. You can sign up to our newsletter (at the bottom of the page), or follow us on Instagram and Facebook to be notified of the next Live Q&A session.

Here you will find the recording of the Bell’s palsy Live Q&A session held on 17 February 2022. Below the video, you can find all the questions and answers in the written form. There is a total of 25 questions that were answered regarding facial palsy, Bell’s palsy, synkinesis, facial pains, and other issues experienced.

If you could not find the answers to the questions that bother you, or if you would like to receive a more detailed analysis of your current condition, you can reach out to us or register for a remote diagnostic session (ZOOM video call).

The Recording of Bell’s palsy Q&A

Recording of Bell’s palsy questions and answers

The questions and answers discussed

Below you can find the questions, their numbers and corresponding answers. You can navigate in the video to the questions that interest you by clicking on the circles in the video’s timeline.

Skip to the question:

1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 | 24 | 25

1. I was diagnosed with Bell palsy in March 2020, and I have recuperated a lot from it, but I lost strength on my right eye and I still get headaches and stiff neck. I can’t sleep on my right side because my nose gets stuffed, and I can’t breathe. What can I do?

It has been almost two years since your Bell’s palsy onset. It seems that the damage to your facial nerve has been pretty severe. Furthermore, it took you a long time to recover, and yet, your strength is not fully back. It is possible, that this is because the regeneration of the facial nerve has not been completed yet. Some nerve fibres have stopped regenerating before they could reach their respective facial muscle fibres.
Your headaches and sometimes the aches in the face, are most likely originating from the very thin layer of the muscles which covers our head. These muscles are also innervated through the facial nerve.

During the recovery process, some muscles may receive too much or too strong signals, and they may partly contract or have spasmodic contraction. That can be painful. This could be somewhat compared to the cramps that a person may experience when starting a very intense training on cold muscles.

These headaches usually start on the surface and then go deeper, involving the whole head, on both healthy and affected sides. To relieve them, I would recommend doing a very soft, gentle massage. Do it on both sides, starting from your scalp, continue on all of the head, very slowly. The goal is to improve circulation, and as a result increase the local temperature, which will reflexively make the muscles relax and provide some relief from your painful sensations.

The same is for the stiff neck. The signals coming from the brain towards this area may be too strong. So the same thing – do very gentle, very soft massages on the surface of the neck. Do not hesitate to massage with your fingers the backside of the head, the rear surface of the neck.

If it is difficult to do the massage on your own, ask someone to do it for you. There is no need for any special technique. Do what feels good, what makes you feel relaxed, balanced and relieves the tension, improves blood circulation.

Regarding the stuffed nose. On the tip of our nose there is a small muscle, called the alar muscle, that holds the nose open. It is also innervated by the facial nerve. It is possible that this particular branch of your facial nerve has not yet fully connected to the muscle. So it folds in, and cannot keep your nostril open. In this case, again, give it a gentle push with your fingers. Massage, touch the area around your nose and nostril, so the muscle reacts better to the signals that are provided through the facial nerve. Also, this can help the little branches that have not recovered fully, to function better.

2. Are there any vitamins or supplements you would recommend for someone 10 months post Bell’s palsy diagnosis?

Usually, vitamins B12, B6, and some other vitamins might be recommended for the patients in acute phase of the facial palsy. Those are strongly believed to facilitate the regeneration of the injured or damaged facial nerve or any other nerve tissue in general.

At 10 months post, I personally think that using vitamins at that stage will not make a lot of difference. Why? Because by the 10 months mark, an absolute majority of the regenerating facial nerve fibres have already connected, or reconnected, to their respective facial muscles. Those that have not, have probably already stopped regenerating without reconnection.

That is why eating vitamins, which is in general good for your health, will not make a particular difference for your recovery.

3. I cannot visit your clinic in the Netherlands, but I would like to know what are the practical ways I can do on my own, so I can reduce my synkinesis? I can feel stiffness in my affected area (cheeks, eyebrow) and involuntary movement in the mouth once I blink, what routine can I do to make sure that I don’t over force my facial nerves?

We have an article – “What you can do yourself to reduce Synkinesis” – which summarises the general advice we can give on what you can do to reduce synkinesis.

To reduce synkinesis, or at least to make them less pronounced, what we usually suggest, is to not force your face into facial expressions. Even when you are acting normally on the daily basis. It might seem counterintuitive, because mostly you would think that: “Well, if my muscles are not strong enough, or the nerve is not good enough, I should force my face, otherwise my facial expressions would be asymmetrical”.

It is not always so. The trouble is that the more you force your face, the more unwanted co-contraction of other facial muscles will be happening. Because when you force your face, then you engage the motor cortex, which is basically a mimetic amplifier. It is not specifically meant to move the face. The limbic system is created by evolution to provide the facial expressions. But motor cortex – voluntary system of facial movements – is not specifically created to do that. So that is why it is difficult to provide voluntarily natural facial expressions, and our motor cortex tends to always to over-amplify, to over-do, to overkill the efforts.

That is why the more you force your face, the more unwanted muscles may be contracting. Which will in turn increase the tension of your face and will result in involuntary contraction of your facial muscles, which is, in fact, synkinesis.

There is actually no one-size-fits-all magical exercise, or a magical solution that the patient can do to eliminate synkinesis or dramatically reduce their manifestation quickly. Working against synkinesis, or at rebalancing your facial movements, is a process. It takes quite a considerable amount of time, and considerable efforts. So if you want to improve your situation, you should be prepared for quite a long journey.

We do not use Botox, we do not use any invasive techniques. Our approach is to address your synkinesis at their core, at their source. We have several options which are available to the patients who cannot travel to the Netherlands. That is one of the possibilities which I would be happy to share with anyone who will find it necessary or interesting to contact us for more detailed assessment of your condition.

4. I had my attack on August 29th 2021. I was wondering how long I should wait before getting a gold weight put in my eye? My eye Doctor has recommended me doing it. I am 76 and wondering if my age makes recovery longer? I have really had no improvement since my attack. I have lost my hearing on my right ear, my balance is totally off and am dizzy a lot. My life has been turned upside down.

Gold weight, is sometimes a permanent and most of the time a temporary measure to help your eyelid to move down. Whether it is permanent or temporary, is usually decided by you and your doctor, depending on your condition.

At Crystal Touch, we prefer not to use any invasive solution, unless there is really no other way. So, the issue that you have described in your question – the eye fissure not closing fully, slow blinking, we usually work on those symptoms during the rehabilitation program.

The decreased amplitude of blinking or extra forceful blinking that is necessary to close your eyes is due to the fact that there is a resistance from antagonistic muscle. As you are closing your eye or blink, at the same time, or “synkineticaly”, “co-contractionally”, the muscle that lifts your upper eyelid will contract and work against the muscle that tries to close your eye. That is why it takes longer to close it because you need to overcome the involuntary resistance.

It is possible to make it better without putting the gold weights. In our rehabilitation program we have a way,  it is not a magical way, that we use to work together with our patients to solve this issue.

Nonetheless, if you are really anxious, and you want to take care of the issue fast, you can consider putting a gold weight after consultation with your doctor. If I were you, I would wait another 3 months, and then consider doing it, if there is no other way that you would like to proceed with otherwise.

“I am 76 and wondering if my age makes recovery longer?” 

Yes and no. Yes, in a sense that if your nerve has sustained severe damage, severe injury, then the recovery, for obvious reasons, takes longer time. Your body is not 25 any more. So all the processes of the recovery, regeneration of tissue, including the nerve tissue, takes a longer time.

On the other hand, the fact that you may be confronted with complications such as synkinesis, increased tone, pulling of your facial muscles, pulling sensation in your face somewhere above, or mostly in the mid-face and around the mouth area and the neck, surface muscle of the neck – platysma. Then, irrespective of age, it is more or less the same recovery dynamics for absolute majority of the patients who have experienced heavy damage and long recovery. In that specific area, your age does not play a big role. It matters only for the initial speed of recovery of the facial nerve, its regeneration.

“I have really had no improvement since my attack. I have lost my hearing on my right ear, my balance is totally off and am dizzy a lot. My life has been turned upside down.” 

The fact that you have no improvements since your attack, and that you have lost your hearing in your right ear, your balance is totally off, might be a sign of another underlying health issue. It may indicate that your hearing nerve or the hearing apparatus, which provides both the hearing and the sense of balance, has been affected. Either by an infection or it is possible that there is a little tumour developing that exerts pressure on your facial nerve and vestibulocochlear nerve, which provides for the hearing and balance.

It is not uncommon that, if there is a tumour, it would encircle the two nerves at the same time. Then the facial palsy would be accompanied by affected hearing or the affected sense of balance. I suggest letting your doctor take a closer look at the situation, see if there is any residual inflammation. Maybe it was an inner ear infection or bacterial, viral infection. Herpes virus usually affects the facial nerve and the hearing device. So I would advise investigating further the underlying cause that prevents your facial nerve to recover and also results in your loss of hearing.

5. Are Hemifacial spasms and facial Synkinesis the same?

No, they are not the same.

The Hemifacial spasm’s classical definition is that it is an involuntary nervous system disorder, in which the muscles on one side of the face twitch involuntarily. The example of Hemifacial spasm is that all of a sudden, without any attempt from your side, the half of your face, would twitch.

Synkinesis, on the other hand, is the involuntary contraction of certain muscles which contract together with the other muscles, that do not belong to that particular facial movements. For example, when you blink, your mouth corner would move. When you pucker your lips, your eye will involuntarily close.

The cause of this particular Hemifacial spasm is not due to the damage and subsequent recovery of the facial nerve, like in synkinesis, but what is called a neuromuscular conflict. It means that inside one’s skull, the nerve trunk, as it leaves the brain stem, sustains some pressure. This pressure can be either constant or pulsating from the pulse of a blood vessel or artery. It compresses the facial nerve from one side and results in creating sort of “parasitic” electrical signals inside the nerve. This results in involuntary spasm-like contractions of the facial muscles.

6. I am approaching week three since my Bell’s palsy diagnosis. I have been experiencing some hearing loss, outer ear tenderness, and ringing in the ear of my affected side. Does this align with Bell’s palsy, or is it possible I was misdiagnosed? Should I expect my hearing to return when other facial functions return to normal?

According to the official definition, Bell’s palsy is idiopathic peripheral facial paralysis. In other words, when a direct cause of the facial palsy cannot be established, then it gets a diagnosis “idiopathic facial paralysis”, that is also known as “Bell’s palsy”. Nonetheless, very often, it is possible to determine the cause. It could be trauma, surgical intervention, a tumour, it could be a very clear herpetic infection, etc. 

In the case you are describing, I would assume it is a pretty severe infection. Most likely, it is a viral infection that has not only affected the facial nerve, but also the hearing device in the inner ear. 

In our skull, everything is very close. The two nerves that provide the hearing and the sense of balance run very close together. If there is an infection near the nerves, then there is a possibility that it will not only impact the facial nerve, but also the hearing and vestibular nerve. Thus, the diagnosis is probably correct: unilateral peripheral facial palsy.

Since the inflammation is likely to be so severe that your other nerve has been impacted, the main task now is to combat the damaging factor. This means to clear the infection as soon as possible and facilitate the recovery process. If successful, you should expect your hearing to return during the regeneration process. The healing process of both these nerves are independent of each other. A quick recovery of one nerve does not necessarily indicate a quick recovery of the other. It will depend on each case individually.

7. I have regained some movement – but now have pain and balance issues, is this common?

It does not occur very often. Pain, especially behind the ear as well as balance issues, is an indicator of severe inflammatory process or infection, bacterial or viral. These can usually affect both the hearing nerve and the facial nerve (for more details, read Question 6 above).

Having those issues is not a very positive prognostic sign, which means that recovery may take extra time.

8. Can viewing pictures of one’s face prior to Bell’s palsy (seeing how it was before) help with recovery in any way?

Basically, yes. Although not so much viewing the pictures, but imagining and picturing in your mind your ideal face, ideal smile, ideal facial movement. Picturing them without trying to move your face. That is important.

If you are frantically trying to move your face, you are creating over amplified signals that are trying to get through your damaged facial nerve unsuccessfully because your facial nerve is not yet recovered.

Maintaining the mental image of your properly working face and well-balanced facial movements will maintain in your mind a proper image of your face, and also a “sensory imprint” that your face is producing when you make symmetrical facial expressions. When this imprint is sent to your brain, the brain will remember a proper and symmetric sensory images of both sides of your face. Imagining those will help to maintain them.

One of the causes, from our point of view, of imbalance of facial movements after long recovery is the fact that the sensory picture of the affected half of the face does not match the sensory picture from the healthy side. The brain becomes confused and starts to create different spectrums of signals to the affected side versus the healthy side. This in turn leads to all kinds of troubles and asymmetrical facial movements, as well as involuntary contractions. For example: muscles that provide for the smile tries to pull the mouth corner up, and the muscle that would pull down your mouth corner also become involved and tries to move it down. That is why, although you are putting a lot of effort into moving your face, your smile would not go as high as your healthy side because of the involuntary contraction of the antagonistic muscles.

So that is why we can have something like this at the later stage when the healthy side is moving normally and the affected side is not. A lot of efforts are being exercised that may also lead to the involuntary contraction of the eye. Which is in fact an oral ocular synkinesis.

9. I have had Bell’s palsy for two times. One of them was in 2002 (very severe, I had to make one year of physiotherapy every day) and the other one was in 2019. I am 60 years old. Am I likely to have this syndrome more frequent than other people?

Statistically speaking, relapse of a facial palsy on the same or opposite side is very seldom, yet possible. So I do not think you should be too worried about a relapse. 

Your sensitive area can sustain over cooling, and so, some simple measures can help to avoid a relapse. Take extra care of yourself and avoid over cooling of the area. Keep warm in cold weather, do not go out with wet hair, do not sleep under the air-conditioning, etc. It is not a guaranteed measure, as there may be many causes for your facial palsy, such as ear infection, viral infection, etc. More details are needed for a better answer.

10. When I eat, my eye tears up. Will this improve?

This is a question that requires a lot more details for a proper response, such as: How far are you in to your recovery? How long ago your tearing had started? Is it accompanied by other symptoms? So on.

If you are three to five months into your facial palsy, then your tearing probably will improve. It is not likely to stop entirely, but it will improve. If you are three to five years into your facial palsy, then the chances are high that the tearing, if you do not take action, will remain as it is. The same goes for synkinesis and other measures. If you leave them as they are, they are not likely to change dramatically. Time is a cure, but not if the issue is a habit. It is not actually a disease. From our point of view, it is amended mimetic habits. To answer this question more precisely, I need to speak with you directly and have more details about your case.

11. Can the program be completed online?

That depends on the case of your facial palsy. If you have regular Bell’s palsy, regular facial palsy with classical examples, we can work online.

We do encourage our patients to undergo a rehabilitation program in the clinic, as being face to face with your therapist and letting us actually touch your face will provide much better results. Nonetheless, for those of you who cannot travel, it is still possible to work online. 

It is possible to improve your condition greatly, also by working online. Whether it can be recovered fully, to be as before, depends on each case individually. That is why we always begin any rehabilitation program with a detailed one-on-one video diagnostics with you. We analyse your condition and let you know what would be a realistic recovery prognosis for you. If you are happy with that, we begin working with you on your rehabilitation. From our point of view, synkinesis and some other complications you might be experiencing are mimetic habits, which needs to be changed. As we all know, it is much easier to gain a habit than it is to change it. This process takes time. So you need to understand that patience is extremely important in this case.

12. Someone suggested isolating movements during delayed recovery to help prevent Synkinesis. What is it and is it a good idea?

You can isolate your movements only by using your voluntary centre of the brain. If it were possible, I would switch off this centre and leave everything in the able hands of your limbic system, which is our factory of emotions. The signals produced by the limbic system are always correct, always well-balanced, harmonious and always depend only on the nature and the strength of the experienced emotion. Nothing else.

All the imbalances in your facial movements, the involuntary contractions, the extra spasms, the tensions in your muscles, as well as some painful sensations just above your eyebrow, cheek bone or along the lower jaw, etc. They are an indirect result of excessive efforts that your brain, either consciously or unconsciously, exercises.

This is why in our programs, we do not use facial gymnastics or facial exercises, such as those that are aimed at pronouncing certain sounds, making certain movements with your lips, with your eyebrows, etc. We use other methods which are aimed to actually disengage that mimic amplifier (voluntary centre of the brain) and focus on relying on the limbic system to produce the mimetic signals.

13. ​It’s been over a year since Bell’s Palsy. I still can’t pout or push my lips forward or round them on the affected side. Could this be cured?

As it has already been some time, the acute stage of your Bell’s palsy finished, and we are not talking about disease any more. Thus, there is nothing to be cured. To have a cure, a disease is needed in the first place. Bell’s palsy is not a disease, and what you are experiencing now are the consequences or complications that developed during a long recovery process. You do not have paralysis any more, your muscles are moving. They are moving in out-of-harmony fashion, but the signals are still able to pass to your muscles, so the acute stage of the paralysis is over. 

Usually, as you try to move your lips forward, you contract the circular muscle of the mouth, and at the same time, involuntarily, the other muscles which are pulling your mouth corner on the affected side downward and outward are also being engaged. They should be relaxed, as they are on your healthy side. Thus, when you try to pout your lips, they will twist on the affected side as some muscles that are supposed to be relaxed, are not. The antagonistic muscles must be relaxed when the agonistic muscle is contracting to produce the correct movement.

It is possible to improve. We have a lot of our patients, with that specific facial expression, who achieved quite impressive results. So the simple answer to your question is yes, it is possible to reduce.

14. It’s been two years of Bells palsy, and I still have synkinesis. What to expect from now on?

If you do not do anything, you cannot expect any considerable changes. Your facial movements pattern is now a habit. It is something that your brain exercises automatically without further thinking or consideration.

It is like handwriting. When you write, you do not think about each letter individually. You simply think of the word, and due to the movement habit in the brain, it is done effortlessly. Your hand is just a tool your brain is using. In the same way, your brain is making your facial movements and your facial muscles are just tools, which follow the signal pattern that is formed in the brain.

If you do not actively try to change this pattern, you are not likely to see any improvements. Just like if you do not work to change your handwriting, you cannot wake up one day with calligraphic handwriting.

15. Will Botox help the unlearning of synkinesis by the brain (since synkinesis happens when the brain relates several muscles to a single movement during Bell’s palsy recovery)?

The general answer is no. Synkinesis is a mimetic pattern, which originates in the brain. Botox, Botulinum Toxin, is actually a poison that kills the place where the signal from your nerve jumps over to your muscle – the neuromuscular junction.

The electrical signal from the brain travels through the nerve, reaches its end and jumps over to the muscle through the neuromuscular junction. This makes the muscle contract. Botulinum toxin kills the connection site on the nerve ending, so the muscle cannot receive the signal from the nerve. So it does not address the core of the issue of synkinesis, which, in our perception, is in your motor cortex (in the brain). It just kills the connection site.

As an example: if a bulb is flickering due to a faulty switch, smashing the bulb does not resolve the issue. Once it is replaced, it still flickers. Only fixing the source of the issue will bring the results wanted. In this case, fixing the switch.

That is why Botox will not help to unlearn synkinesis. It will temporarily reduce the intensity of synkinesis. In two to five months the body will grow a side branch to reconnect with the muscle and the issue will return. That is why the effect of botulinum toxin injections is temporary, and it does not solve the problem for good.

16. What are the signs that synkinesis is getting better? Is it the contractions?

No, the sign of synkinesis improving is that when you do the same movement, the unwanted movement of the muscle becomes less pronounced. 

For example: when you blow your cheek, your eye that used to close completely, closes halfway. That is an improvement. When you blink your eyes, and the intensity of your mouth corner moving together with every blink, becomes less, it is also a sign of synkinesis getting better.

17. What is your opinion on surgery for someone who was Bell’s palsy for 6 years.

This is a general question, as there are a lot of options for surgical interventions. We do not recommend any of those, in a general case of Bell’s palsy. If you have a very severe case due to trauma, etc, then it is possible that surgery might give you some relief.

The process of surgical intervention in the form of muscle transposition is when a muscle would be transposed to the mouth corner connection. As a result, imitating the chewing movements would move the mouth corner.

Another option is a nerve graft. A part of your nerve will be taken from the calf muscle. Using that part, your healthy side will be connected to the nerve trunk on the affected side. They will cut off the trunk of your affected nerve completely, reconnect it to the graft from the opposite side, and then wait for 12 to 14 months and then hopefully part of this movement will return, if you have absolutely no movement of this area.

Another one is Selective Neurolysis. The surgeon opens a certain area and will selectively cut certain facial nerve fibres, so that the involuntary contraction signals produced in the brain, will not reach the muscles and cause the contraction. If you cut a complete section of the facial nerve, there will be absolutely no movement of the muscle.

In our practice, we do not recommend any surgical intervention for a few reasons. Firstly, you cannot undo the surgery. Secondly, success is not guaranteed. Thirdly, it does not address the cause, it addresses the symptom in a partial way.

18. I had facial paralysis in October 2016 and after 6 months of recovery I had facial synkinesis. Now is there hope that this synkinesis will disappear?

As discussed in previous questions (see Question 14), the hope that synkinesis will disappear by itself is not there. In our perspective, synkinesis is a habit. Habits, by themselves, do not disappear. You need to work on changing them.

19. ​Is it possible for the infection to persist for an extended time?

Yes, it is possible. An Infection can become chronic.

The question is too general for a more detailed response. I need details such as: What kind of infection? Where the infection is located? What has been affected by the infection? How long has the infection been there? Has it been established that it is the infection that causes certain disorders or certain symptoms that the patient is not happy with? We need to go over more details of your case before I can give any certain answer.

20. I recovered in about 1.5 months. However, it has been almost 9 months since, and I get muscle fasciculations in my legs and arms. Does the affected nerve cause that?

No, fasciculations in legs and arms are definitely not a symptom of Bell’s palsy or unilateral facial paralysis of any sort.

It may happen that sometimes the facial palsy is a result of certain other disorders or infections or some other neurological diseases. In this case, it could be related. The classical facial palsy, Bell’s palsy in folk’s mouth, is not related to fasciculations in arms and legs.

21. ​Is it possible to experience some tightness on the side that was affected even after months of recovering? I had Bell’s palsy about 9 months ago.

Yes, it is possible. It is one of the symptoms that often manifest after a long-term Bell’s palsy recovery. Tightness of the facial muscles is a result of increased contraction and tonal signals. They are directed from the brain to the affected side of the face. This increase in signals remains as a habit in your brain. This applies to both when you are trying to move the muscles, and when they are “resting” – the tonal signals. So you feel tightness in the face both when you are moving and not.

Massages and other relaxing manipulations or treatments can partly help you. If you need more detailed advice, you can take a look at our Bell’s Palsy Knowledge Base, which contains a lot of information. There are videos, pictures and text about what to do, what not to do and how to address the issues that patients are having during the long recovery period. Otherwise, we can schedule a video consultation to go over your condition in more detail.

22. Have patients developed asymmetrical skin sagging and slower response on the affected side over time? After palsy 20 years ago, I have noticed the palsy-affected side of my body responds differently.

Yes, it is possible that the ageing and the sagging of the affected side and the healthy side could be different. If there is a different level of contraction of facial muscles for a long period of time, it affects the condition of the skin, as well as forming of all the lines and wrinkles.

For example, if the muscles on one side are more contracted, the nasolabial fold on the affected side will be more pronounced. Another example: the muscles that would otherwise hold the eyebrows high when the frontal muscle is contracted, may be sagging on the affected side, thus the eyebrow will be sagging and partly closing.

I would not relate slow responses of your body, as in, your arms, your legs, your trunk muscles, etc., to that particular disorder.  If you do have issues in such areas, I would suggest that you go to a neurologist for a more detailed analysis of your condition. Possibly adding a nerve conduction study, electromyography, or any other modality of the test which may or may not be related to your particular condition.

23. ​I have bell palsy for 15 years now and when I get tired my eye gets smaller, my lips go to a side. Do you think there is anything I can do to heal myself completely?

Yes, when you are tired, your eye and any other muscles of your face on the affected side are also more tired than the muscles on the healthy side.

Any muscle on your affected side, especially the eye as it blinks twenty to thirty times per minute, exercises efforts. If those efforts are of very high intensity and the brain gives your muscles no time to relax, then you will get tired soon. That is why your eye gets smaller, as the circular muscles of the eye contracts extensively, and they become tighter. Therefore, your eye fissure involuntarily becomes thinner and narrower.

Your lips may also experience some extra tightness. As they are constantly fighting with the muscles that provide antagonistic contraction efforts. They are constantly overcoming resistance, so they get tired, and they can spasm. Therefore, they may lose their suppleness, their ability to relax and move freely. That is why by the end of the day, the patient may only be able to speak or to move the healthy side, as the affected side will be contracted all over again.

Spend some time on focusing on your face and relax. For more recommendations, you can read the article “Chronic facial pains and contractures after Bell’s Palsy”.

24. Does acupuncture help in relaxing the facial muscles and nerves after Bell’s palsy?

In muscles, yes, acupuncture does help to improve relaxation. You cannot relax a nerve as the nerve does not contract, the nerve just provides the signals.

What we have learned from the experience of our patients is that acupuncture does provide relaxation, but it does not last forever. It usually lasts one or two days.

25. When I wake up, my face muscles are very tight and pull on the affected side. Is there anything I can do to improve the quality of my sleep?

This is a common issue. When we sleep, we dream, when we dream, we experience emotions, when we experience emotions, our face moves and tenses.

The brain over amplifies every signal that goes in the direction of the facial muscles, also during your sleep. It is constant and cannot be influenced by your voluntary effort to relax your face as you are asleep. That is why you may wake up with a tense face.

What you can do to help yourself, is taking a 15-30 minute walk before sleep. Not for exercise. A simple slow walk to calm your nerve system and to be rid of any stress that you may have accumulated throughout the day. It is good to ventilate your bedroom before sleep, to have some extra oxygen in the room. Then, once you are in bed, do a gentle massage with symmetrical movements on the face. Either by yourself or ask someone to help you with it. It is important for the massage to be symmetrical, so your brain can receive symmetrical sensor signals from both sides of your face.

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Alex Pashov

Co-founder of Crystal Touch clinic and Bell's palsy expert.

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