A young woman holds the side of her face in pain.
A young woman holds the side of her face in pain.
A young woman holds the side of her face in pain.

Bell's Palsy: When Facial Paralysis Doesn't Get Better

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Bell’s palsy  is a rare condition that affects the facial nerve and muscles. It may appear after a cold sore or other viral illness such as the flu or a cold. You might notice a headache and pain, or twitching or weakness in one side of your face.

Over the next 48 hours or so, one half of your face may start to droop. Your smile may look lopsided. One of your eyelids may sag, or you may have trouble closing that eye. You may also notice a loss of the sense of taste, dizziness, ringing in your ear (tinnitus) or other symptoms that point to a problem with the facial nerve.

The facial weakness that accompanies Bell’s palsy can be similar to that seen in a stroke patient. An urgent evaluation by doctors will distinguish between a true Bell’s palsy and facial palsy from a stroke.

How long does Bell’s palsy last?

In the majority of cases, facial paralysis from Bell’s palsy is temporary. You’re likely to notice gradual improvement after about two weeks. Within three months, most people have recovered full motion and function of their face. A delay in recovery is often accompanied by some form of abnormal facial function.

But if facial paralysis from Bell’s palsy doesn’t get better, there are effective treatment options.

When should I see a doctor for Bell’s palsy?

Kofi Boahene, M.D., is a professor of otolaryngology–head and neck surgery and the director of the Facial Plastic and Reconstructive Surgery at Johns Hopkins. He’s an expert in facial reanimation — surgery to help restore motion and expression to the face after Bell’s palsy, stroke or other conditions.

He notes that, once diagnosed with Bell’s palsy, it is important to consult a facial nerve expert. “Not all that looks like Bell’s is indeed Bell’s palsy,” Dr. Boahene says. “I have seen several patients who had been diagnosed with persistent Bell’s palsy who had something else on closer look.”

He notes that for persistent facial paralysis, it’s best not to wait too long before consulting an expert.

“There’s an ideal period after an initial facial nerve injury when the facial muscles are still viable,” Boahene says. “If we can intervene early and time it well, we can save the native muscles of facial expression and restore that ability to smile and blink.” Beyond this ideal window, the facial muscles become irreversibly paralyzed. Dr. Boahene says, “With facial paralysis, time lost is muscle lost.”

What are some treatment options?

“Over the past decade our understanding of the recovery pattern of facial muscles after nerve injury has significantly improved. This guides our philosophy of a systematic approach when treating the sequelae of Bell’s palsy,” Boahene says.

He and his team of therapists, behavioral psychologists and surgeons treat Bell’s palsy and facial palsy in general in a comprehensive and multidisciplinary manner. They use a number of different approaches, including physical therapy and injection of neuromodulators, to train and guide the injured facial nerves and muscles during their recovery after Bell’s palsy. Doctors can move a branch of nerves from elsewhere in the face and use it to replace the damaged one.

In a procedure called highly selective myectomy and selective neurolysis, tight muscles and abnormal nerves can be divided to relax the face and allow better movement. If the muscles in the face are frozen and no longer function, the surgeon can transplant small pieces of muscle called the gracilis from the inner leg to restore smile or from the neck to restore blink or eyelid closure.

Restoring Facial Function and More

“The Facial Nerve Center at Johns Hopkins is a terrific place for patients with facial paralysis,” Boahene says, “because we have so much experience and expertise. We’re one of the busiest centers in the world, and have pioneered or refined some of the current techniques used in treating facial palsy.”

Boahene adds that his patients get a lot more than highly skilled facial plastic surgery. “We have a true team approach. In addition to surgeons, we also have a comprehensive research program that studies outcomes in facial paralysis. We combined the expertise of physical therapists and behavioral psychologists to get the best results. We are always innovating to solve our patients’ problems. We are unique in that regard.”

The group also supports recovering patients with speech therapists, neurologists for facial motor testing and a facial retraining expert: a dedicated physical therapist who works with people affected by facial paralysis.

He says that the team excels in both microsurgery (the knitting together of delicate blood vessels, using a microscope) and facial aesthetic surgery (surgery to restore beauty and balance to the facial features).

“We can choose from a range of techniques to restore a near-normal smile and a more beautiful, natural-appearing face.”

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The world-renowned facial plastic and reconstructive surgeons of Johns Hopkins are now offering cosmetic and reconstructive services at Green Spring Station – Lutherville, Pavilion III, with free parking and easy access to I-695 and I-83.

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