Facial Palsy – Part 2 – The “Right” support.

Facial Palsy is a debilitating condition that affects over 20,000 people annually in the UK, with an incidence of 70 cases per 100,000 population (Norris, 2019). It is unknown how many people are affected by Facial Palsy in Ireland, but if we apply the UK incidence rate here, it would equate to almost 3,500 people annually.

Facial Palsy is a general medical term that refers to weakness of facial expression, usually on one side of the face, as a result of damage to the facial nerve, caused by either swelling or pressure on the nerve.

Communication and expressions

Facial Palsy does not only affect one’s appearance. It impacts on many aspects of a person’s life.

A debilitating consequence of developing Facial Palsy is how it impacts the ability to communicate and express emotions and feelings. Somewhere between 50-80% of human communication is non-verbal. The facial muscles which are powered through the facial nerve control the movement of lips and mouth which also affects speech. Many people with Facial Palsy find their speech is altered.

Expression of emotions

We use our facial muscles to express emotion and feelings. Many with Facial Palsy find they mask their emotions as often when trying to express them they are asymmetric and a “smile can resemble a grimace”. As Darwin pointed out, if you don’t express your emotions, in the long-term you will feel less of them. So, if you experience something nice but don’t smile, you will feel less happy. This has a massive long-term effect on a person’s mental health and well-being. Studies are repeatedly demonstrating higher rates of depression and anxiety in people with Facial Palsy than in those without.

Social interaction

Our face is also our starting point of social interaction. The asymmetry caused by Facial Palsy disturbs this process and so the person feels they have lost “their face” and in a way themselves and their self – worth. Research has shown that the severity of Facial Palsy does not determine the burden of this loss. It is a grieving process for their “normal face”. This can result in people withdrawing from social situations, which unfortunately will negatively affect both their mental health and well-being but also their potential recovery from Facial Palsy.

Facial Functions

Facial palsy also affects many functions of the face – the ability to open/close the eye; the dampening down of loud sounds; breathing through the nose; chewing; retaining food in the mouth; drinking; creating a seal around a cup; speaking and many more.

A person with Facial Palsy can feel either an uncomfortable pull of heavy floppy muscles in their cheek or an even more uncomfortable pull of stiff tight muscles on the affected side of their face. A person with Facial Palsy is constantly aware that they have Facial Palsy. They cannot simply “forget about it”.

If you are a person with Facial Palsy reading this, you already know of these many serious negative consequences of having Facial Palsy. If you know someone who has Facial Palsy have you ever thought about it being anything other than a cosmetic condition? After reading this I hope you will.

“Treat Me Right”

The theme of this year’s Facial Palsy Awareness Week March 1st – 7th is “Treat Me Right”.

This blog is aimed at family, friends and work colleagues of someone who is affected by Facial Palsy. In an effort to “Treat Me Right” we should firstly try to understand both the functional difficulties and the issues regarding communication, expression, self-esteem, anxiety and depression associated with Facial Palsy. And secondly use practical solutions to help support someone with Facial Palsy.

Our words are important

In an effort to support your friend or family member, be conscious of what you say and how you say it. For example, if someone had lost a limb, you wouldn’t say “sure you would barely notice”, however a recurrent theme amongst people with Facial Palsy is that although people mean well, sayings such as “You would barely notice” or “it’s not that bad” or even worse having pity on someone with Facial Palsy is common place.

Remember they are grieving the loss of their “normal face” and to hear comments like this can be incredibly hurtful and damaging. Also remember that although you might not notice the asymmetry that much, the person with Facial Palsy has a constant reminder either via a pulling sensation in their face or an eye that is constantly tearing due to dryness. Be compassionate but remember the person with facial palsy is still the same person and treat them so. Acknowledge their Facial Palsy and ask them how they are feeling. Ask what you can do to help.

Encouraging social interaction

Many people with Facial Palsy have issues with eating and drinking and are incredibly self-aware of eating or drinking in public. They might drool if the cup rim is too thick or if the food is too dry or too fluid it might spill from their mouth. Ask the person with Facial Palsy where would they like to go. Often drinking from a take-away cup is more manageable than a regular one so that might have an influence on where you go.

Also, in a social setting a person with Facial Palsy is also no longer “anonymous” in the crowd, they are the person with a Facial difference and so might attract unwanted attention. Be gentle in your suggestions as to where you go for a social setting. Maybe initially meeting somewhere that is quiet or calling over to someone’s house is best before heading into larger crowds.

Photos and videos

In our age of social media photos and videos of social occasions are a mainstay. Think about how uncomfortable this makes someone with Facial Palsy. Even the thoughts of going out is filled with dread in case someone takes a photo or video. Ask if the person with Facial Palsy would like to have a photo. Or suggest that they take the selfie, as this way they can prepare their smile and control when the photo is taken. This is one area of Facial Palsy that people struggle with the most. Be gentle on them.

Going for a walk

If going for a walk (which is always a nice idea) think of the wind exposure or sun glare for the person who may not be able to close their eye fully, and certainly does not blink as often as they should. Pick a route that is sheltered rather than a blustery hill or beach for example. Also think of practical things you can offer to do such as drop them to an appointment etc.

Managing other people’s reactions

A person with Facial Palsy often struggles with what to say when someone asks about their appearance or Facial Palsy. In this situation you could help them come up with a prepared short phrase to explain their condition that they can use. For example: “Facial Palsy makes it hard to close my eye. I use drops to help the discomfort and I am receiving more treatment in the future”.


With Facial Palsy one’s speech is often affected. Give the person extra time to slow their speech to make it more intelligible.

Firstly, they can usually see themselves on their camera all day long in the corner of their screen. This image of their (to them) undesirable appearance simply reinforces negative thoughts and hacks away at their self-esteem even further. Allow that person to turn their camera off during meetings or have IT use an option to hide their own camera on screen. This option is available on Zoom nowadays.

Secondly, in Facial Palsy, the blink reflex in the eye is altered and slowed, meaning the eye does not receive adequate lubrication during the day. A person with Facial Palsy is advised to take regular screen breaks and where possible limit screen time during the day. Accommodations should be made in the work setting to make this possible.

More resources

The tips above are literally the tip of the iceberg and not exhaustive by any means. There are some fantastic resources available online via NHS website that give further advice on how to help someone living with Facial Palsy.

PMC Physio Dunboyne recommendation

If you have been affected by Facial Palsy or wish to gain more information regarding this condition book your appointment or call us on 018253997. Caitriona is our Facial Therapy Specialist and is a member of Facial Therapy Specialists International.

Although it is normal to have a certain amount of anger, grief and anxiety following Facial Palsy, if it persists too long or has too much impact on daily life encourage your friend or family member to seek psychological support. (Letske Siemann, Psychologist, 2023)


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