How to Tell If Facial Paralysis Is Improving: Key Signs to Watch
Facial paralysis, often caused by inflammation of the facial nerve (also known as Bell's palsy), can be a distressing condition. However, with proper treatment and time, many patients experience significant recovery. One of the most common concerns during recovery is determining whether improvement is actually taking place. Recognizing the subtle yet meaningful signs of healing can provide reassurance and help guide ongoing care.
Monitor Reduction in Ear Pain
During the acute phase of facial paralysis, swelling and inflammation of the facial nerve are common. This often leads to pain behind the ear—a hallmark symptom of nerve irritation. If this discomfort begins to lessen or disappears entirely after starting treatment, it's a strong indicator that the condition is moving in the right direction. Pain relief typically reflects reduced inflammation and improved nerve function, signaling early recovery.
Observe Forehead Movement and Wrinkle Recovery
In cases of peripheral (or lower motor neuron) facial paralysis, one of the most telling signs of improvement is the return of forehead movement. If you notice that your forehead wrinkles are gradually reappearing and becoming more symmetrical compared to the unaffected side, this suggests nerve regeneration.
Why Forehead Symmetry Matters
The ability to raise your eyebrows or wrinkle your forehead relies on the facial nerve's upper branches. When these functions return, it indicates that the nerve is healing properly. In contrast, central (upper motor neuron) paralysis usually spares forehead movement, so this sign mainly applies to peripheral cases.
Assess Eyelid Closure and Eye Comfort
Weakness in eyelid closure is common during the initial stages of facial paralysis. This can lead to excessive tearing, dryness, and visible white of the eye when trying to close it (a phenomenon called "whitening" or lagophthalmos).
As recovery progresses, you may notice stronger blinking, less tearing, and better eyelid closure—meaning the muscles around the eye are regaining strength. These improvements not only enhance comfort but also reduce the risk of corneal damage, making them crucial milestones in the healing process.
Check for Improvement Around the Mouth
The muscles controlling facial expressions around the mouth are often affected in facial paralysis. Early symptoms include drooping at the corner of the mouth, difficulty smiling symmetrically, and involuntary drooling.
When you start noticing that you no longer drool while brushing your teeth or rinsing your mouth, and the smile becomes more balanced, it's a clear sign of progress. Gradual restoration of muscle control around the lips and cheeks demonstrates ongoing nerve recovery.
Evaluate Taste Sensation Recovery
Another important but often overlooked indicator involves taste. The facial nerve carries taste sensations from the front two-thirds of the tongue.
In peripheral facial paralysis, if you begin to regain the ability to taste food properly—especially sweet and salty flavors—it suggests the nerve is healing. This sensory return is a positive prognostic sign and further confirms functional recovery.
Note the Difference in Central vs. Peripheral Paralysis
It's important to distinguish between central (brain-related) and peripheral (nerve-related) facial paralysis. Central cases typically do not affect forehead movement or taste sensation, so improvements in these areas are generally not expected. Monitoring other facial movements, especially in the lower face, becomes more relevant in such cases.
Key Takeaways: What to Look For During Recovery
To summarize, several observable changes can help determine whether facial paralysis is improving:
- Reduction or disappearance of pain behind the ear
- Gradual return of forehead wrinkles and eyebrow movement
- Stronger eyelid closure with less tearing and whitening
- Improved control around the mouth—no drooling during oral hygiene
- Restoration of taste in the front two-thirds of the tongue (in peripheral cases)
Tracking these signs over time provides valuable insight into the healing process. Always consult with a healthcare provider for an accurate assessment and personalized recovery plan.