Clinically reviewed by What is facial paralysis
Facial paralysis is weakness, or complete loss of movement, in the muscles of one side of the face. The mouth droops, the eye will not close properly and the face looks uneven. In Urdu it is laqwa.
The commonest cause by far is Bell's palsy, where the facial nerve becomes inflamed, and it has its own page on this site. Facial weakness can also come from a stroke, shingles of the nerve, an ear infection, injury or a tumour.
So the first job is not exercises. It is working out which of those it is, the same day the weakness appears.
Symptoms you might have
- One side of the mouth drooping, with food and drink escaping from that corner
- An eye that will not close fully, including during sleep
- An uneven smile, and difficulty speaking clearly
- With a nerve cause such as Bell's palsy, the forehead will not wrinkle
- With a stroke, the forehead usually still wrinkles and the eye still closes, but the lower face droops, often with a weak arm or slurred speech
- Pain behind the ear, changed taste, or sounds seeming too loud on that side
- Blisters or a rash in or around the ear, pointing to a shingles infection
Why it happens
- Bell's palsy, inflammation of the facial nerve, the cause in the large majority of cases
- Stroke, which is the one that has to be ruled out first
- Ramsay Hunt syndrome, shingles of the facial nerve, with ear pain and blisters. It needs antiviral treatment from a doctor urgently
- Middle ear infection, particularly in children, often with ear discharge and fever
- Injury to the face or base of the skull, and nerve damage during ear surgery
- A tumour pressing on the nerve. The clue is weakness building gradually over weeks, or weakness that keeps worsening
- Diabetes, which raises the risk of facial nerve palsy
- Weakness on both sides of the face at once, which always needs hospital assessment
When you should see a physiotherapist
Go to a hospital the same day that facial weakness starts, not to a physiotherapist first. A doctor needs to separate a stroke from a nerve problem, and stroke treatment is counted in hours.
Two quick checks tell you how urgent this is. Try to raise both eyebrows and wrinkle the forehead, and try to close the weak eye tightly. If the forehead and eye still work but the mouth droops, think stroke and go now. If the whole side including forehead and eye is weak, Bell's palsy is more likely, but you still need to be seen today.
Call for emergency help if there is also a weak arm or leg, slurred speech, confusion, loss of vision or a sudden severe headache.
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How it is treated
What physiotherapy does depends on the cause, so treatment begins once the diagnosis is clear. For nerve causes the work is facial retraining. After a stroke, the face is treated as part of stroke rehabilitation.
- Facial muscle re-education in front of a mirror: small, slow, symmetrical movements, with attention on control rather than effort
- Eye protection advice, the most urgent part of all. An eye that cannot close dries out, and the surface can be damaged within days
- Gentle facial massage to keep the tissue mobile and maintain circulation
- Electrotherapy where the assessment supports it, chosen case by case rather than used routinely
- Neck and posture work, because the neck and shoulder on the weak side are usually held guarded
- A short daily home programme, several brief sessions rather than one long one
- Photographs and a grading scale at each visit, so progress can be seen rather than guessed at
Forceful exercise is the commonest mistake. Chewing gum all day, blowing up balloons and hard grimacing teach a recovering nerve to fire the wrong muscles together, and that pattern can become permanent.
Exercises, and what to avoid
What helps
- Mirror practice: a small even smile, a gentle eyebrow lift, soft eye closure, each held a few seconds
- Supporting the weak cheek lightly with a finger while you practise, so movement stays symmetrical
- Short sessions, three or four times a day, a few minutes each
- Chewing on both sides at meals, so the strong side does not take over completely
What to avoid
- Forceful grimacing, puffing the cheeks hard, blowing up balloons, or chewing gum for hours
- Electrical stimulation to the face applied without assessment
- Exercising until the face feels tired. A tired facial muscle pulls in the wrong muscles, and the nerve learns that pattern
- Checking the mirror every hour. Photographs every few days show change far better
What you can do at home
Protect the eye first. Lubricating drops through the day, ointment at night, and tape the lid closed while you sleep if it does not shut on its own. Wear sunglasses outdoors.
Do not rub the eye, and see a doctor if it becomes red or painful.
Sleep on your back, or on the unaffected side.
Take a photograph every few days in the same light, attempting the same expression. Recovery is too slow to see day to day.
Take smaller mouthfuls while the mouth does not seal properly.
Heat and ice are not treatments here. Keeping the face warm in cold wind is for comfort.
How long it takes
Recovery depends on the cause, which is why the diagnosis matters more than anything else here.
Bell's palsy has the best outlook. Around seven in ten people recover completely, the first movement usually returns within two to three weeks, and full recovery takes three to six months.
Ramsay Hunt syndrome recovers less completely and more slowly, and early antiviral treatment from a doctor makes a real difference.
Facial weakness after a stroke improves along with the rest of the stroke recovery, mostly in the first three to six months. If there has been no movement at all by four months, go back to the doctor: that pattern means the diagnosis needs reviewing.
Urdu / Roman Urdu
Choose your reading script / اپنی پسند کا رسم الخط منتخب کریں
اردوUrdu script
لقوہ میں چہرے کے ایک طرف کی حرکت کمزور یا ختم ہو جاتی ہے۔ منہ ٹیڑھا ہو جاتا ہے اور آنکھ بند نہیں ہوتی۔
سب سے ضروری سوال: لقوہ ہے یا فالج۔ دو چیزیں چیک کریں: ماتھا چڑھتا ہے یا نہیں، اور آنکھ سختی سے بند ہوتی ہے یا نہیں۔ اگر یہ دونوں ٹھیک ہوں لیکن صرف منہ ٹیڑھا ہو، تو فالج کا شک ہے، فوراً ہسپتال جائیں۔
اگر بازو یا ٹانگ بھی کمزور ہو، بولنے میں لگن ہو، یا سخت سر درد ہو، تو یہ ایمرجنسی ہے۔
آنکھ کی حفاظت سب سے پہلے۔ دن میں قطرے، رات کو مرہم، اور اگر آنکھ بند نہیں ہوتی تو پلک ٹیپ کر کے سوئیں۔
ورزش نرمی سے کریں۔ زور لگا کر منہ بنانا یا دن بھر گم چبانا نقصان دیتا ہے۔
Roman Urdu
Laqwa mein chehre ke ek taraf ki harkat kamzor ya khatam ho jati hai. Muh tedha ho jata hai aur aankh band nahi hoti.
Sab se zaroori sawal: laqwa hai ya falij. Do cheezen check karen: maatha chadhta hai ya nahi, aur aankh sakhti se band hoti hai ya nahi. Agar ye dono theek hon lekin sirf muh tedha ho, to falij ka shak hai, foran hospital jayen.
Agar bazu ya taang bhi kamzor ho, bolne mein lagnat ho, ya sakht sar dard ho, to ye emergency hai.
Aankh ki hifazat sab se pehle. Din mein drops, raat ko ointment, aur agar aankh band nahi hoti to palak tape kar ke soyen.
Warzish narmi se karen. Zor laga kar muh banana ya din bhar gum chabana nuqsan deta hai.
Treatment at the clinic, and online
INFORMATION → INDIVIDUAL CARE
A plan built around you.
Talk with Dr. Zahra Fatima, DPT. Understand your next steps, with guidance for your own symptoms and daily routine.
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Discuss your symptoms, what you find difficult and what you want to get back to.
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Use the consultation to discuss which care and exercises fit your situation.
Take your plan with you
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Questions people ask
How do I know if facial weakness is a stroke or laqwa?
What is the most common cause of facial paralysis?
Should I see a doctor or a physiotherapist first?
Can facial paralysis be permanent?
Can children get facial paralysis?
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- Bell's palsy treatment and exercises
- Sciatica treatment and exercises
- Diabetic neuropathy treatment
- Numbness and tingling in the hands and feet