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Bell’s Palsy

Sudden weakness or drooping on one side of the face when the facial nerve becomes inflamed. Most people recover over weeks to months — but a drooping face can also be a stroke, so get checked right away.

A drooping face can be a stroke. Call 911 right away — don’t assume it is Bell’s palsy. Sudden numbness or weakness of the face, arm or leg (often on one side), sudden confusion or trouble speaking, sudden trouble seeing, sudden dizziness or loss of balance, or a sudden severe headache are all stroke warning signs (CDC). Call 911 at once, note the time the symptoms started, and don’t drive yourself to the hospital — an ambulance crew can start treatment on the way (CDC).

  • Be especially worried if the facial droop comes with weakness of an arm or leg, trouble speaking, confusion or loss of vision (CDC, Merck Manual).
  • The forehead clue. Bell’s palsy usually weakens the whole side of the face, forehead included, so the person can’t wrinkle that brow. A stroke usually weakens only the lower face, so the person can often still raise the eyebrows and close the eyes tightly (Merck Manual). If the forehead still moves, treat it as a possible stroke — but don’t try to sort this out yourself: only a medical team can tell the difference safely.

Bell’s palsy and stroke can look alike (Cleveland Clinic), and the U.S. ear, nose and throat guideline warns that not everyone with facial weakness has Bell’s palsy (AAO-HNS guideline).

Protect the eye. If the eyelid can’t close fully, the eye can dry out, and a dry cornea can lead to sores, infection and even loss of vision (MedlinePlus). Lubricating drops by day, a thicker ointment at night and taping the eyelid closed for sleep are the usual protections (NHS, North Bristol NHS Trust). If the eye becomes painful, stings, or your vision changes, get urgent eye care — one NHS hospital tells patients to be seen at its eye emergency clinic within 24 hours (North Bristol NHS Trust), and guidelines advise a doctor recheck any new eye symptoms at any point (AAO-HNS guideline).

What is Bell’s palsy?

Bell’s palsy is sudden weakness or paralysis of the muscles on one side of the face. It happens when the facial nerve — the nerve that controls facial expression and also carries taste and some ear sensation — is injured or stops working properly. It is the most common cause of facial paralysis (NINDS). About 15 to 30 people per 100,000 develop it each year, and roughly 1 person in 60 will have it at some point in life (Cleveland Clinic).

Symptoms

Symptoms come on suddenly, often over a day or two, and reach their worst within about 48 to 72 hours (NINDS, Merck Manual). Pain behind the ear may come first (Merck Manual). Common signs include:

The face may feel numb or heavy, even though the sense of touch usually works normally (Merck Manual). Rarely, both sides of the face are affected (NINDS).

What causes it?

The exact cause is unknown. Swelling and inflammation of the facial nerve seem to be involved, but why the nerve swells is unclear (NINDS). Possible triggers include a dormant virus waking up — such as herpes simplex (the cold-sore virus) or the chickenpox virus — and lowered immunity from stress, lack of sleep, minor illness or autoimmune conditions (NINDS). Many cases have no clear cause (Cleveland Clinic).

Who is more likely to get it?

Bell’s palsy can affect anyone, but it is most common between ages 15 and 45. Risk factors include pregnancy, preeclampsia, obesity, high blood pressure, diabetes and upper respiratory illnesses such as colds (NINDS). It usually happens only once, but it comes back in about 5% to 10% of people (Cleveland Clinic).

How it’s diagnosed

There is no single test for Bell’s palsy. A doctor examines the upper and lower face, asks when symptoms began, and rules out other causes; if no other cause is found, the diagnosis is Bell’s palsy (NINDS). Conditions that can look similar include:

Routine blood tests and scans usually aren’t needed for a typical case (AAO-HNS guideline). Imaging may be used if the weakness came on gradually or if more than facial movement, taste and hearing sensitivity is affected (NINDS).

Outlook

Most people improve. Symptoms generally start getting better after a few weeks, and most people recover some or all facial movement within a few weeks to six months; for some, the weakness lasts longer or is permanent (NINDS). Up to 80% of people recover fully within three months (Cleveland Clinic). Recovery is more likely to be complete when the nerve wasn’t fully paralyzed and improvement starts within three weeks (MedlinePlus). Lasting effects can include taste changes, eyelid or muscle spasms and some facial weakness (MedlinePlus), and as the nerve regrows some people notice unwanted linked movements or tearing while eating (“crocodile tears”) (Merck Manual).

When to see a doctor: as soon as possible for any sudden facial weakness, once stroke has been ruled out. Steroid treatment works best when started within 72 hours (AAO-HNS guideline, NHS). Go back to your doctor if you haven’t improved after 3 weeks (NHS), if new or worsening symptoms appear, or if your face hasn’t fully recovered by 3 months — guidelines advise reassessment or referral to a facial nerve specialist (AAO-HNS guideline).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Ruling out stroke and other causes, oral steroids started within 72 hours, sometimes an antiviral added, eye protection, and referral to a facial therapist or specialist if recovery is slow. Doctor visit: cost estimate being researched. Physical therapy about $50–$350+ a session without insurance ($10–$75 copay with). Eye drops and ointment: cost estimate being researched. Steroids have strong evidence: in trials, fewer people were left with lasting weakness. Antivirals add little, if anything. Most people recover over weeks to months.
Chiropractic Being researched — coming soon.
Acupuncture A course of needle treatments, alongside — not instead of — prompt medical care. About $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90. Studies are mostly small and low quality, so it is not known whether it helps. Guidelines make no recommendation for or against it. Avoid electro-acupuncture on a weak face.
Herbal medicine No herbal remedy has been shown to help Bell’s palsy. Cost estimate being researched. Herbs can interact with steroids and other medicines, and some affect blood sugar. Never let a remedy delay steroid treatment in the first 72 hours.
Massage therapy Gentle facial massage, usually as part of a home program taught by a facial therapist. About $60–$120 for 45–60 minutes with a private therapist, or $50–$90 at clinics, gyms and spas. May keep muscles supple and feel soothing; evidence is limited to small, low-quality studies. Must be gentle — never force a weak face.
MBHA Wellness Coach A daily eye-care routine, easier eating and drinking, coping with changes in how your face looks, sticking with a therapist’s exercise plan, and watching blood sugar on steroids if you have diabetes. Cost estimate being researched. Supports — never replaces — medical care. Protects the eye and makes the weeks of recovery easier.

Approach 1 of 6

Conventional medicine (AMA)

Medical care for Bell’s palsy has two jobs: make sure nothing more serious is going on, and give the nerve the best chance to recover while protecting the eye.

1. The right diagnosis first

The U.S. ear, nose and throat (AAO-HNS) guideline strongly recommends that clinicians use a history and exam to rule out other causes of facial weakness before diagnosing Bell’s palsy. It advises against routine lab tests and scans for a typical new case, and against nerve tests when the paralysis is only partial; nerve testing may be offered when paralysis is complete (AAO-HNS guideline). Such tests can help show how serious the nerve injury is and the chances of recovery (NINDS).

2. Oral steroids — the best-proven treatment

  • Guidelines: the AAO-HNS guideline makes a strong recommendation that adults and teens 16 and older be prescribed oral steroids within 72 hours of symptoms starting (AAO-HNS guideline). The American Academy of Neurology says steroids are highly likely to be effective and should be offered for new Bell’s palsy (AAN guideline). Steroids reduce swelling of the nerve (NINDS). For children under 16, the decision rests with the child’s doctor.
  • The evidence: a 2016 Cochrane review of 7 trials (895 people) found that 17% of people given steroids still had some facial weakness six months or more later, compared with 28% of those who weren’t. Steroids also reduced unwanted linked facial movements (synkinesis), and side effects were no more common than with placebo (Cochrane review).
  • Diabetes and other conditions: steroids raise blood sugar; people with diabetes are advised to check their blood sugar more often for about the first five days of a new steroid (Cleveland Clinic). Tell your doctor if you have diabetes or high blood pressure, and about every herbal product you take (MedlinePlus). Some people can’t take steroids or don’t respond well to them (NINDS).

We don’t list doses here; your doctor will choose the medicine and course.

3. Antivirals — only possibly, and only with steroids

Because a virus may be involved, antivirals such as valacyclovir are sometimes added (MedlinePlus). The evidence is weak:

  • The AAO-HNS guideline strongly advises against an antiviral alone, but says one may be offered together with steroids within 72 hours (AAO-HNS guideline).
  • The neurology guideline says a benefit from adding antivirals hasn’t been established and, if there is one, it is modest at best (AAN guideline).
  • A 2019 Cochrane review found adding an antiviral to steroids may make little or no difference to full recovery (low-certainty evidence), though it probably reduced later problems such as synkinesis and “crocodile tears” (Cochrane review).

4. Eye protection

The AAO-HNS guideline strongly recommends eye protection for anyone whose eyelid doesn’t close properly (AAO-HNS guideline). That usually means lubricating drops or artificial tears during the day, a thicker ointment at night, and taping the eyelid closed or wearing a patch while sleeping (NHS, MedlinePlus, North Bristol NHS Trust). Don’t wear contact lenses until the eye is back to normal (North Bristol NHS Trust). See MBHA Wellness Coach below for a daily routine.

5. Pain relief

Over-the-counter pain relievers such as acetaminophen, ibuprofen or aspirin may ease pain around the ear or jaw. If you already take prescription medicines, check with your doctor or pharmacist first (NINDS).

6. Physical therapy and facial retraining

A therapist who specializes in facial palsy (often a physical therapist or speech therapist) can teach a home program of gentle massage, stretches and carefully controlled exercises, and help reduce unwanted linked movements (Facial Palsy UK). The evidence is encouraging but not strong:

7. Surgery

Surgery to relieve pressure on the nerve (decompression) hasn’t been shown to help most people (MedlinePlus), and the AAO-HNS guideline makes no recommendation about it (AAO-HNS guideline). In the uncommon cases that don’t recover, reconstructive or facial plastic surgery can improve a crooked smile or help an eyelid close (NINDS, Cleveland Clinic).

What it costs

  • Doctor visit: cost estimate being researched.
  • Physical therapy: about $50–$350+ a session without insurance, or a $10–$75 copay with insurance (CostHelper).
  • Eye drops, ointment and tape: cost estimate being researched.

Find a medical doctor in our directory

Approach 3 of 6

Acupuncture

Acupuncture is often a first-line treatment for facial paralysis in East Asian countries (review, Facial Plastic Surgery), and NINDS notes that physical therapy, facial massage or acupuncture may help facial nerve function and pain (NINDS). The research, however, is weak.

What the research says

  • Cochrane review (2010): six trials with 537 people were included, but their quality was too poor to draw any conclusion about whether acupuncture works. No harmful side effects were reported (Cochrane review).
  • A 2015 review of 14 trials (1,541 people) found acupuncture linked with better response rates, but the studies had a high risk of bias and varied widely, so the authors said there was not enough evidence to confirm it works or is safe (meta-analysis, PLoS One).
  • A 2024 review of 15 studies of acupuncture, herbal medicine and other Eastern approaches for facial paralysis found none worked better than Western medical treatment alone, and could not support recommending them (meta-analysis, Facial Plastic Surgery).
  • Guidelines: the AAO-HNS guideline makes no recommendation either way on acupuncture (AAO-HNS guideline).

In short: acupuncture has not been shown to speed recovery. If you choose to try it, use it alongside — never instead of — prompt steroid treatment and eye protection.

Safety

  • Few complications have been reported, but nonsterile needles and poor technique can cause serious problems, including infections. Needles must be sterile and single-use (NCCIH).
  • Facial Palsy UK advises avoiding acupuncture that passes electrical stimulation through the needles, as it can cause unwanted side effects in a weak face (Facial Palsy UK).

What it costs

Private sessions run about $125–$230 for a first visit and $90–$185 for follow-ups; community clinics about $50–$90 a visit (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

We found no herbal remedy that has been shown to help Bell’s palsy. A 2024 review that included herbal medicine for facial paralysis found no Eastern treatment, alone or combined, worked better than Western medical treatment alone, and noted serious quality problems in the studies (meta-analysis, Facial Plastic Surgery). The national guidelines on Bell’s palsy don’t include any herbal treatment among their recommendations (AAO-HNS guideline, AAN guideline).

Don’t let a remedy delay real treatment. Steroids work best when started within 72 hours of the first symptoms (AAO-HNS guideline). See a doctor first.

Safety with your medicines

  • Steroids: tell your doctor and pharmacist about every herbal product you take or plan to take; St. John’s wort is one product named as a possible interaction with prednisone (MedlinePlus).
  • Diabetes: steroids raise blood sugar (Cleveland Clinic), and some supplements can change blood sugar or diabetes medicines — for example, Asian ginseng may lower blood sugar, and goldenseal lowered levels of metformin in a study (NCCIH). Adding these to a steroid course makes blood sugar harder to predict.
  • Blood thinners: ginkgo taken with warfarin has been linked to a higher risk of major bleeding (NCCIH).

Talk with your doctor or pharmacist before trying any supplement, especially if you are pregnant or take other medicines. We don’t list doses here.

Approach 5 of 6

Massage therapy

Gentle facial massage is often part of facial rehabilitation. Facial Palsy UK says gentle massage helps keep the facial muscles flexible and supple (Facial Palsy UK), and a specialist therapist’s home program may include massage to keep muscles mobile and stretches for muscles that have become tight (Facial Palsy UK). NINDS lists facial massage among therapies that may help facial nerve function and pain (NINDS).

What the research says

  • We found no good-quality trial of massage on its own for Bell’s palsy. The 2011 Cochrane review of physical therapies found no high-quality evidence of benefit or harm from any physical therapy, with low-quality evidence for tailored facial exercises (Cochrane review).
  • A small, non-randomized Korean study of 70 people with facial palsy found that a facial exercise program that included facial massage improved facial muscle function and lowered depression scores compared with a control group, though paralysis-related symptoms didn’t differ (study, Journal of Korean Academy of Nursing, 2016).

Safety and how to use it

  • Gentle only. Forcing weak muscles can lead to tightness and unwanted movements, so work with, or check your routine with, a facial therapist (Facial Palsy UK). If you see a massage therapist, share your facial therapist’s advice with them.
  • Massage is generally low-risk, but rare serious problems have been reported, mostly with vigorous techniques. Don’t use it to put off seeing a doctor (NCCIH).

What it costs

About $60–$120 for a 45–60 minute session with a private therapist, or $50–$90 at clinics, gyms and spas (CostHelper). Sessions with a physical therapist, who can teach facial massage, cost about $50–$350+ without insurance (CostHelper).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

Recovery from Bell’s palsy can take weeks or months. An MBHA Wellness Coach can help you turn your care team’s advice into simple daily habits and keep your spirits up while the nerve heals.

A daily eye-care routine

Easier eating and drinking

Feelings and self-image

Shock, worry about recovery, self-consciousness and sadness are all normal reactions to a sudden change in your face (Facial Palsy UK). Bell’s palsy can bring on stress, anxiety or depression — tell your doctor if your mood is suffering (NHS). A coach can help you plan for social situations, find support and keep up the activities that matter to you.

Exercises — only with your therapist’s guidance

  • Facial Palsy UK advises against practicing movement exercises while the face is paralyzed or weak, and against chewing gum, forcing movements or squeezing the eye shut, which can cause unwanted effects (Facial Palsy UK).
  • As movement returns, a specialist therapist can set a gentle daily program, which may last many months (Facial Palsy UK). A coach can help you stick with it.

Patience, follow-up and steroids

Still being researched: Chiropractic. We add each approach once its costs and results are sourced. Are you a practitioner with experience treating Bell’s Palsy? Tell us.

Member stories

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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