Have you had a stroke (cerebrovascular accident, CVA) and are experiencing facial droop? This is something that occurs quite regularly, especially in the case of an ischemic stroke.
In this article, I address the main questions that people with facial paralysis, often occurring after a stroke, commonly have: How long does it last? What exercises should be done? What kind of rehabilitation is necessary? Is there a risk of lasting effects? Is it temporary or chronic?
I draw on my experience as a physiotherapist and my research in the international medical literature for this information.
At the end of the article, you will find references to the studies I have relied on, as well as a comment section for sharing your own experiences or asking questions.
Happy reading 🙂!
Last update: September 2023
Disclaimer: No direct financial connection to the subject. Complete disclosure in legal notices.
Is facial droop common after a stroke?
When a stroke (or “mini stroke) occurs, it can lead to various symptoms and problems in the days and weeks following the event. These can include loss of muscle strength, motor skills, and loss of feeling.
Sometimes, these effects can be localized, particularly in the face, resulting in facial palsy (also known as facial hemiplegia, facial droop): half of the face is temporarily paralyzed.
Medial term for facial drooping is: facial palsy or facial paralysis.
A significant proportion of stroke patients experience facial droop, accounting for approximately 45% of cases (Volk 2019).
In some instances, the palsy may be partial, referred to as facial paresis. This means that there is still some sensation and movement in the affected part of the face, although it may not be as pronounced as on the unaffected side (or as it was before if both sides are affected). In everyday language, this is often described as a “mild facial paralysis” or “slight facial paralysis.”
The brain is divided into two hemispheres: the right hemisphere and the left hemisphere. In most stroke cases, only one of the hemispheres is affected.
In the vast majority of cases, only one side of the face is impacted, either the right or left side, depending on which hemisphere of the brain the stroke occurred.
|Location of the Stroke in the Brain||Side of Facial Droop|
|In the right hemisphere||Left side of the face|
|In the left hemisphere||Right side of the face|
There are other situations where facial droop can occur. The most well-known is peripheral facial paralysis, also called Bell’s palsy, or idiopathic facial paralysis.
On the contrary, facial palsy (=facial droop) related to a stroke is a central palsy (not peripheral), because the problem originates in the brain.
A central facial palsy may not progress or require the same treatment as a peripheral facial paralysis such as Bell’s palsy. Hence the importance of researching specifically about central facial paralysis (which you are currently doing 🙂), typical after a stroke.
Why can the face be paralyzed after a stroke?
A stroke can damage the part of the brain that controls facial movements, facial sensitivity, and the tone of facial muscles.
More specifically, a stroke can damage a segment of the facial nerve (also called cranial nerve VII), which originates in the brain. This nerve is responsible for controlling the muscles and sensitivity of the face.
We have two facial nerves, one on each side. Therefore, in the case of a stroke, usually only one of these two facial nerves is affected.
The stroke can disrupt the transmission of messages from the brain to one side of the face (and vice versa). As a result, our body may not react when we try to make movements on one side of the face or when that side is touched.
Let’s take a closer look at the specific symptoms of facial droop.
What are the symptoms of facial paralysis after a stroke?
When experiencing facial droop, the most noticeable change is the asymmetry of the face. The affected side of the face may exhibit the following symptoms:
- The corner of the mouth and eye may droop or sag.
- The mouth may have difficulty remaining closed.
- Fewer wrinkles are visible, particularly on the forehead.
- The face may appear stretched on the paralyzed side, and the forehead wrinkle may not lift even with facial expressions.
- The affected eye may not fully close or blink less frequently.
- When smiling, the lips may not pucker as usual.
Other symptoms of facial palsy after a stroke include:
- Difficulty moving one side of the face, usually affecting the lower part of the face more prominently.
- Loss or decreased sensitivity on the affected side of the face.
- Difficulties with drinking or eating, chewing, and retaining food and liquids in the mouth.
- Speech difficulties, such as dysarthria, characterized by slurred or unclear speech, often referred to as “slurring words.”
- Difficulty retaining saliva in the mouth.
- Trouble closing one eye, leading to eye itching or dryness.
- Difficulty producing voluntary or spontaneous facial expressions on the affected side, resulting in reduced expressiveness.
- Headaches and fatigue (which are more likely related to the stroke itself rather than the facial paralysis).
- Stress and anxiety as a consequence of the condition.
- Diminished sense of taste.
When consulting a physical therapist or speech therapist for this problem, the goal is to identify the primary symptoms related to facial palsy and the stroke. This evaluation helps determine what can be done to address each specific symptom.
What is the treatment for facial palsy after a stroke and its duration?
Here is some general information about the management of facial droop after a stroke.
No medication for facial droop after a stroke
After a stroke, you may have medications to take, but they do not directly address facial palsy.
There is no medication for facial droop after a stroke that would help regain facial symmetry, motor function, or sensitivity more quickly.
However, doctors, physical therapists, or speech therapists may “prescribe” certain measures based on your symptoms:
- Eye drops to moisturize and lubricate the eye (if it remains open) or saline solution.
- An eye patch to be worn at night, for the same purpose.
These measures are not intended to accelerate healing but rather to alleviate symptoms.
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Physical Therapy, Rehabilitation, and Exercises for Central Facial Palsy
Some research teams hypothesize that without rehabilitation, the symptoms of facial palsy do not improve (Schimmel 2017).
However, this is just a hypothesis, as we do not have high-quality comparative data to be certain of this. Additionally, many physical therapists and doctors have counterexamples of people who have fully recovered from facial paralysis after a stroke without specific rehabilitation.
At the very least, I believe it is relevant to have an assessment with a physical therapist or speech therapist who is knowledgeable about facial paralysis and strokes.
This assessment can serve the following purposes:
- Evaluate your symptoms, their impact, and their probable progression.
- Provide personalized advice on dealing with swallowing difficulties (position, types of food), eye dryness (physiological saline drops, gently closing the eye with your hand to rest it), or other similar issues you may encounter.
- Offer reassurance about potential recovery.
- Answer your questions.
- Provide exercises tailored to your specific motor deficits. These exercises can be done in front of a mirror if you are comfortable with it.
In rehabilitation, the aim is to maintain or awaken the contraction of paralyzed muscles. This can be achieved by either inhibiting the contraction of muscles on the opposite side or by facilitating it.
Usually, we begin by targeting the muscles that are most problematic (for example, those involved in eating) compared to those that are less problematic (such as the forehead muscles). However, this approach should be adapted based on your main complaints and what matters most to you, as well as what you are willing to incorporate into your routine.
Here is a video with examples of exercises. These exercises are relevant for both cases of facial palsy, whether caused by Bell’s palsy or after a stroke.
There is no demonstrated benefit of adding electrotherapy or electrical stimulation.
Sometimes, you may see specifics techniques mentioned on your prescription such as massage, application of heat or cold, transcutaneous electrical nerve stimulation (TENS), therapeutic ultrasound, shockwave therapy, and electrotherapy. From my experience and the literature, none of these techniques have shown significant benefits for facial palsy, whether it’s after a stroke or not.
Natural remedies for facial droop after a stroke?
There is no natural treatment that can accelerate the healing of facial palsy.
Of course, you will always find people, magazines, and websites that claim that acupuncture, massage with certain oils, dietary supplements based on vitamins or omega-3, aromatherapy, homeopathy, or herbal medicine can help.
However, these suggestions are not based on solid theoretical grounds, and there is no study showing effectiveness beyond a placebo effect.
Nevertheless, you can do certain natural things to relieve the symptoms of facial palsy, such as using eye drops or wearing an eye patch, as I mentioned earlier.
How long does facial droop last after stroke? Prognosis
Based on my experience (seeing a few dozen people with facial palsy after an AVC over the past 11 years), facial palsy improves (but not completely) within 2 months for those who recover.
Unfortunately, some people retain varying degrees of facial droop in the long term.
What do the more precise figures from clinical studies, which are more reliable than my own experience, say? There are not many of them.
Here are the conclusions from a small study conducted at a rehabilitation center in Denmark in the 1990s (Svensson 1992) on 35 people with facial palsy after a stroke:
- Facial droop decreased in everyone during the first month.
- After 6 months, two-thirds of the patients had fully recovered or had only a slight facial droop.
- Patients with facial droop on the right side had better recovery than those affected on the left side.
- Only half of the patients were aware of facial asymmetry.
In a German study of 111 people after a stroke(Volk 2019), the research team found that 60% of patients had persistent deficits more than 41 days after the stroke.
The recovery time for facial palsy after a stroke is at least a few weeks. It usually disappears within a few months. In a minority of people, it remains in the long term.
What are the sequelae after central facial palsy?
The majority of people fully recover from facial paralysis after an stroke and do not have any lasting sequelae. However, some people never fully recover (remember, this is a minority).
In such cases, all the symptoms can persist (aesthetic, motor, sensory, and functional). But often to a lesser extent.
Here’s what I wanted to tell you about this! I wish you a very good recovery! Do you have any comments or questions? Your comments are welcome 🙂 !
You may also like:
Volk GF, Steinerstauch A, Lorenz A, Modersohn L, Mothes O, Denzler J, Klingner CM, Hamzei F, Guntinas-Lichius O. Facial motor and non-motor disabilities in patients with central facial paresis: a prospective cohort study. J Neurol. 2019 Jan;266(1):46-56. doi: 10.1007/s00415-018-9099-x. Epub 2018 Oct 26. PMID: 30367260.
Svensson BH, Christiansen LS, Jepsen E. Behandling af central nervus facialis parese med elektromyografisk biofeedback og plastring af kind. En klinisk kontrolleret undersøgelse [Treatment of central facial nerve paralysis with electromyography biofeedback and taping of cheek. A controlled clinical trial]. Ugeskr Laeger. 1992 Dec 7;154(50):3593-6. Danish. PMID: 1471279.
Vaughan A, Gardner D, Miles A, Copley A, Wenke R, Coulson S. A Systematic Review of Physical Rehabilitation of Facial Palsy. Front Neurol. 2020 Mar 31;11:222. doi: 10.3389/fneur.2020.00222. PMID: 32296385; PMCID: PMC7136559.
Schimmel M, Ono T, Lam OL, Müller F. Oro-facial impairment in stroke patients. J Oral Rehabil. 2017 Apr;44(4):313-326. doi: 10.1111/joor.12486. Epub 2017 Mar 1. PMID: 28128465.
Zapata-Soria M, Cabrera-Martos I, López-López L, Ortiz-Rubio A, Granados-Santiago M, Ríos-Asín I, Valenza MC. Clinical Characteristics and Rehabilitation Strategies for the Stomatognathic System Disturbances in Patients with Stroke: A Systematic Review. Int J Environ Res Public Health. 2022 Dec 30;20(1):657. doi: 10.3390/ijerph20010657. PMID: 36613028; PMCID: PMC9819907.
Rééducation spécifique de la dysarthrie. Chiaramonte R, Vecchio M. Dysarthria and stroke. The effectiveness of speech rehabilitation. A systematic review and meta-analysis of the studies. Eur J Phys Rehabil Med. 2021 Feb;57(1):24-43. doi: 10.23736/S1973-9087.20.06242-5. Epub 2020 Jun 9. PMID: 32519528.
Image: Seo JH, Kim DK, Kang SH, Seo KM, Seok JW. Severe Spastic Trismus without Generalized Spasticity after Unilateral Brain Stem Stroke. Ann Rehabil Med. 2012 Feb;36(1):154-8. doi: 10.5535/arm.2012.36.1.154. Epub 2012 Feb 29. PMID: 22506250; PMCID: PMC3309321. / Onder H, Albayrak L, Polat H. Frontal lobe ischemic stroke presenting with peripheral type facial palsy: A crucial diagnostic challenge in emergency practice. Turk J Emerg Med. 2017 Sep 6;17(3):112-114. doi: 10.1016/j.tjem.2017.04.001. PMID: 28971160; PMCID: PMC5608613.
By Nelly Darbois
I love to write articles that are based on my experience as a physiotherapist and extensive research in the international scientific literature.
I live in the French Alps 🌞❄️ where I work as a physiotherapist and scientific editor for my own website, where you are.