A long recovery from Bell’s palsy happens in about 20 to 30% of people, when the facial nerve fibres themselves are damaged and need to regrow. The first movements then return between week 3 and month 4, most others follow within 4 to 8 weeks, and the result settles after about 10 to 14 months. Complications such as synkinesis are likely, but they can be reduced.
If you are not sure which recovery you are on, start with our overview: How long does Bell’s palsy last?
The contents of this article are based on our experience with numerous patients that visit our clinic for rehabilitation, sign up for a video consultation, or contact us for more information on their cases. The information below is meant to describe the most typical scenario. Each facial palsy case is unique and will unfold in an individual way. Nonetheless, you can reasonably expect your recovery to follow the direction described here.
Key Takeaways
- Long Bell’s palsy recovery can take a significant time, often 10 to 14 months after initial symptoms appear.
- Recovery depends on the extent of facial nerve damage; deeper damage leads to longer recovery periods.
- The first signs of movement usually occur between weeks 3 and 12, but regeneration can be slow.
- Complications, like synkinesis, may arise during long recovery, but proper rehabilitation can help reduce their effects.
- Seek medical attention promptly after symptoms start to improve your recovery chances and minimize nerve damage.
Table of contents
When to expect a long recovery?
The length of recovery after Bell’s palsy depends on the scale of damage the facial nerve had sustained.
Bell’s palsy takes long to recover if the damage to the facial nerve was deep
Our facial nerve is made up of motor neurons to the most part, as well as some sensory neurons and parasympathetic fibres. The main task of a motor neuron is to transmit electrical signals from our brain to the muscles. In our case – the facial muscles. Once the signal reaches the muscle, the muscle fibres will contract, and when the signal from the brain is absent, they relax.
The electrical signal produced by the brain will travel along the axon of the motor neuron. To be able to transmit the signal, the axon is insulated by myelin sheath – just like any electrical wire has to be insulated in order to conduct electricity properly.
When Bell’s palsy happens, the facial nerve becomes damaged and its ability to transport electrical signals is compromised. Under the impact of damaging factors, both the myelin sheath and the axon may sustain damage.
The stages of facial nerve damage during Bell’s palsy
In general, peripheral facial palsy is caused by swelling of tissues surrounding the facial nerve or by a disrupted blood supply. When the swelling develops, it will compress the facial nerve (Stage 1 on the image below), reducing the supply of oxygen and damaging the tissues.
Following the compression, the myelin sheath will be damaged first (Stage 2). Without the insulation of the myelin sheath, the facial nerve cannot conduct the electrical signals, so the brain loses connection with the facial muscles. This is called a conduction block.
If at this early point the compression is eliminated with the help of steroids or natural mechanisms of our body, the fibres of the facial nerve will remain undamaged. In this case, you will most likely follow a quick recovery timeline that will result in a full spontaneous return of facial movements.
However, if the compression remains for a longer time (5-6 days or more), not only the myelin sheath but also the fibres of the facial nerve will sustain damage (Stage 3).
This leads to degeneration of the facial nerve fibres (Stage 4).
This is what causes your recovery to be long. To re-establish the connection between the brain and the facial muscles, your body needs to regenerate both the degenerated facial nerve fibres and myelin sheath.
The facial nerve fibres will regenerate, in the most optimal conditions, at the rate of not more than 1mm per day. Having to regenerate around 80-100mm of distance, it may take at least several months before the first movements will appear. Some nerve branches can regenerate sooner, while others might need more time. For example, you might notice some movements in your forehead but will need to wait a few more weeks before you can see some movements in your mouth corner.
If the recovery takes a longer time (several months), the probability of developing some form of complications, such as synkinesis, facial asymmetry, crocodile tears, contractures of facial muscles, and others, is quite high. The good news is that in most cases, these complications and residuals can be reduced with the help of proper rehabilitation, as evident from the experience of our patients.
What can be done to avoid a long recovery?
The most important first step, when you realize that you have facial paralysis, is to go to your doctor as soon as possible. This is a time-sensitive issue, and the sooner your doctor will establish the damaging factor, the sooner you can begin any required medications to help you reduce the compression of the nerve trunk.
Unfortunately, there are very limited steps we can take to reduce the possibility of extensive damage to the facial nerve fibres. To a large extent, the damage depends on the factors that caused facial palsy in the first place.
In cases such as Ramsay Hunt Syndrome – where the facial palsy is caused by a Herpes Zoster virus – the recovery will usually take a longer time. That is because viral or bacterial infections that cause local swelling around the facial nerve and result in facial palsy can take at least a few days to be cured. Until the infection is taken care of, the swelling cannot be reduced effectively, so the facial nerve will sustain extensive damage.
Long Bell’s palsy recovery timeline
Here we are describing the average recovery scenario. Although the length of each stage might vary from person to person, the stages will generally follow the same pattern and order.
In this timeline, we use photos of a fellow Bell’s palsy sufferer – Jay – who documented the whole recovery process from day 1 using Neurological tests. He has kindly given permission to Crystal Touch Clinic to use his photos to illustrate the recovery process. Please, do not reuse these photos without Jay’s permission. For illustrative purposes, the dates of Jay’s progress were adapted to fit the scenario described.
Day 1
Your facial palsy begins and the full paralysis of one side of the face takes place. Paralysis occurs due to compression of the facial nerve.
What to do: go to your doctor or the ER as soon as possible. The damaging factor that causes the swelling (such as local overcooling, viral or bacterial infection, etc.) has to be eliminated as fast as possible to prevent heavier damage to the facial nerve. Follow your doctor’s instructions, take a lot of rest, and sleep enough.
This period can be very hard emotionally, but please do not panic or despair. Your face will not remain like this forever. Knowing what is happening to you will help you to stay calmer, so look through our Bell’s Palsy Knowledge Base to educate yourself.
Week 1
Most likely, there will still not be any visible movements.
What to do: continue following your doctor’s advice and take any prescribed medications. Be patient, the recovery may take some time. Do soft facial massages, protect your eye from drying, apply a warm compress and refrain from stress (emotional and physical).
Week 2
If you notice some form of recovery signs (some tingling, tickling or vibrating sensations in your facial muscles) during these days, then most probably you are following a quick recovery scenario.
If both the myelin sheath and the facial nerve were damaged, it will take some time until the first recovery signs might appear. From now on until the first recovery signs you will not see any changes. It should not be getting worse, but it will also not improve until the facial nerve regenerates enough to be able to reconnect with the fibres of facial muscles.
Be patient. It is a hard journey, but remember that your body is doing all it can to recover the damaged facial nerve. You need to support it by avoiding wasting its resources through stress. Follow a healthy lifestyle, do facial relaxations, and also try to balance your emotions.
What to do: continue what you were doing before. It is extremely important to avoid forcing your face into facial expressions to see if you can make it move. Keep your facial muscles relaxed as much as possible. The movements will come when the facial nerve recovers sufficiently. Until then, no matter how much you try, you will not be able to force your muscles to move (the signals from the brain cannot reach the facial muscles, no matter how strong the signals are). Check our Bell’s Palsy Knowledge Base for more recovery tips.
Important note: during any peripheral facial palsy (as long as it was not caused by injury to the head), your facial muscles remain healthy. They are not involved in the facial palsy process and do not suffer from atrophy. You can read more about it in a dedicated article – “Can facial muscles atrophy during Bell’s palsy?“.
From week 3 through week 12
Somewhere within this time, the first movements should appear. Depending on the scale of initial damage and regenerative capacity of your body, the first movements tend to manifest themselves somewhere between week 3 and week 12. It may still take some time for the facial nerve and the myelin sheath to recover fully. After you see the first movements, most of the remaining movements should return within the next 4-8 weeks approximately.
What to do: continue what you were doing before, with the emphasis on more regular facial massages and relaxation.
At this stage, the forming of complications such as synkinesis and excessive tone of facial muscles is to be reasonably expected. After 8-9 months since the onset, both positive and negative changes will slow down. All the changes after that will be happening very gradually.
By the end of 10-14 months since the onset, your recovery will stabilize and reach its final result. After this mark, to achieve any further improvements, you will need to follow professional rehabilitation and guidance. Without any help, further improvements may be very marginal and barely noticeable.
Still no movement after 4 months?
If the damage to the nerve was heavy, the first movements can take 2 to 3 months to return, and in some cases up to 4 months. Most people see at least some movement between month 2 and month 3 and a half. Until then, the face should not get worse, even if it does not improve.
Once movements start, they keep improving little by little. After about 8 to 9 months, the recovery reaches a plateau. It does not stop, but further changes become much slower. At that point, the nerve needs extra stimulation to keep regenerating. This is the work we do with our patients in the clinic, using specialized rehabilitation techniques.
What to do while you wait:
- Stay calm. At 4 months, it is too early to judge the final result. Panic and despair slow down healing.
- Keep your face relaxed. Do not force expressions to test for movement.
- Avoid checking the mirror every day. It feeds worry and can build unwanted movement patterns. Read why to use an “internal mirror” instead.
- Record your progress once a week with the same photos, so you can spot the first return of muscle tone.
- Get a professional prognosis if you are worried. In a video consultation, Dr. Alex Pashov reviews your history and explains what to expect.
Bell’s palsy does not last forever.
It is very important to remember that Bell’s palsy does not last forever. Since the time when the first movements appear, your facial palsy ends. From now on, you are not suffering from Bell’s palsy any longer. Your recovery may be incomplete, and you may experience complications and residuals, but it is no longer Bell’s palsy itself – it is the complications after a long recovery period.
After the first movements appear
After a long-term recovery, when the movements begin to return, it is most likely, that at the end, your mimetic functions on the affected side will not go back to the same way they were before. There are a few reasons for this:
- some of the facial nerve fibres have not (yet) regenerated fully,
- you developed complications and residual effects during the long recovery period.
The most common complications that may form after a long Bell’s palsy recovery process are synkinesis, asymmetric smile, chronic facial pains and tensions, increased tone of facial muscles, crocodile tears, and others. Still, this is not a reason to despair.
In most cases, it is possible to reduce their manifestation, including synkinesis, by following a well-guided rehabilitation program and working on improving your facial condition every day. Some of our patients have shared their recovery journeys to give you hope and make you believe that it does not have to stay this way.
It is not an easy journey, but if you are motivated to bring your smile back, we are ready to share our knowledge and guide you to the best of our abilities. Speak with us.
A long recovery happens in about 20 to 30% of people, when the nerve fibres themselves are damaged and need to regrow. The first movements return between week 3 and month 4, and the result usually settles after about 10 to 14 months.
When the recovery takes months rather than weeks, it means the nerve fibers themselves (axons) were damaged and need to regrow. During this prolonged regrowth process, complications such as synkinesis, facial tightness, and involuntary movements can develop.
Quick recovery (2 to 3 weeks) happens when only the myelin sheath is damaged, and typically results in full recovery. Long-term recovery (months) happens when the nerve fibres (axons) are damaged and need to regrow, and carries a much higher risk of complications like synkinesis.
Long-term recovery often leaves complications, but they are not permanent paralysis. Specialised facial rehabilitation, such as the Neuro-Proprioceptive Rehabilitation method, can significantly improve facial function and reduce synkinesis, even years after the onset.
