Overview
Bell's palsy is a sudden weakness or paralysis of the muscles on one side of the face. It happens when the facial nerve, which controls movement of the forehead, eyelid, cheek, and mouth, becomes inflamed and swollen. Most people notice drooping, an uneven smile, and difficulty closing one eye over a period of hours to a day or two.
The exact cause is not fully understood, but it is often linked to a viral reactivation that irritates the nerve. Bell's palsy is considered a diagnosis of exclusion, meaning other causes of facial weakness, such as stroke, infection, or a tumor, should be considered before it is confirmed.
Many people with Bell's palsy recover well, and early evaluation matters because protecting the eye and starting appropriate treatment soon after symptoms begin can support recovery. At Norelle Health, evaluation focuses on confirming the diagnosis, protecting the affected eye, and creating a plan for therapy and follow-up.
Symptoms
Symptoms usually come on quickly, often over hours to a couple of days. People may notice facial drooping, an uneven smile, trouble closing one eye, drooling, changes in taste, or sounds that seem louder on the affected side.
Weakness that develops gradually over weeks, affects both sides, or comes with other neurologic changes is less typical of Bell's palsy and should be evaluated promptly.
Causes and risk factors
The facial nerve inflammation in Bell's palsy is often associated with reactivation of a common virus, though the precise trigger is not always identified. Pregnancy, diabetes, and recent viral illness may be associated with a higher risk.
Because the cause is not always clear, evaluation focuses on excluding other explanations such as stroke, ear infection, Lyme disease, or a tumor along the nerve.
Living with bell's palsy? The next step is a quiet, unhurried conversation.
How it is diagnosed
Bell's palsy is generally diagnosed from the history and a careful physical examination, including grading of facial movement and assessment of eye closure. There is no single confirmatory test.
Imaging, blood tests, hearing tests, or electrical nerve testing may be used when the diagnosis is uncertain, when recovery is delayed, or when findings suggest another cause.
Treatment options
Treatment is often most effective when started soon after symptoms begin:
- Protecting the eye with lubrication and nighttime taping
- A short course of oral corticosteroids when appropriate
- Antiviral medication in selected cases
- Facial physical therapy and neuromuscular retraining
- Botulinum toxin or procedures for lingering asymmetry or synkinesis
Many people recover substantially. When weakness persists, reconstructive and rehabilitative options can help restore symmetry and function.
When to seek care
Seek prompt medical attention for sudden facial weakness, especially if it comes with arm or leg weakness, trouble speaking, severe headache, vision changes, or confusion, because these can signal a stroke. Early care also matters for protecting an eye that cannot fully close.
Contact a clinician if weakness is worsening, has not begun to improve after several weeks, or is accompanied by ear pain, a rash, or hearing changes.
Living with bell's palsy? The next step is a quiet, unhurried conversation.
Medical review
This page is a patient-education resource reviewed by the responsible Norelle Health clinician before publication. It does not replace an in-person evaluation. If symptoms are severe or rapidly worsening, seek immediate medical care.
Common Symptoms
Living with bell's palsy? The next step is a quiet, unhurried conversation.
Treatment Approach
Treatment for bell's palsy is individualized based on the severity of symptoms, anatomical considerations, and patient goals. Our specialists may consider:
- 01Eye protection with lubricating drops, ointment, and nighttime taping
- 02A course of oral corticosteroids when started early
- 03Antiviral medication in selected cases
- 04Facial physical therapy and neuromuscular retraining
- 05Botulinum toxin for later synkinesis or asymmetry
- 06Procedures such as static suspension or eyelid surgery for incomplete recovery
Specialists who treat bell's palsy
Dr. Moustafa Mourad
MD, FACS
Double Board-Certified Head & Neck and Facial Plastic & Reconstructive Surgeon
Dr. Moustafa Mourad is a double board-certified head and neck and facial plastic and reconstructive surgeon who cares for the full range of cosmetic and complex conditions affecting the face, head, and neck.
- Facial plastic and reconstructive surgery
- Head and neck cancer surgery
- Microvascular free-flap reconstruction
- Facial trauma and reconstruction
Also caring for this area
Not sure who to see? Our patient coordination team can help match you with the right specialist.
(212) 444-8006Frequently Asked Questions
No, but they can look similar at first. Bell's palsy affects only the facial nerve and typically spares strength in the arms and legs as well as speech. Because a stroke is an emergency, sudden facial weakness with other neurologic symptoms should be evaluated urgently.
Many people with Bell's palsy recover meaningfully, often over weeks to months. Recovery varies, and some people have lingering weakness, tightness, or involuntary movement called synkinesis that can be addressed with therapy or additional treatment.
When the eyelid cannot close fully, the eye can dry out and become injured. Lubricating drops, ointment, and taping or a moisture chamber at night help protect the surface of the eye while the nerve recovers.
Corticosteroids and antivirals are generally most helpful when started within the first few days of symptoms, so early evaluation is encouraged. Eye protection and supportive care remain important at any stage.
Synkinesis is unwanted linked movement, such as the eye narrowing when smiling, that can develop months after Bell's palsy as the nerve heals. Facial physical therapy and botulinum toxin can help manage it.
Recurrence is uncommon but possible. Repeated episodes, or weakness that does not fit the usual pattern, may prompt additional testing to look for another cause.
Often none beyond a thorough examination. Imaging, blood work, hearing tests, or nerve testing may be added when the diagnosis is unclear or recovery is slow.
Consider specialist care if facial weakness is not improving, if the eye is difficult to protect, or if you develop synkinesis or persistent asymmetry that affects function or appearance.
Related Procedures
1 of 3 · Facial Physical Therapy
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