Bell's palsy exercises: what helps your face recover, what to avoid, and staying active

A drooping face: call 999 first if it could be a stroke

Call 999 if a face droops on one side with weakness in an arm or trouble speaking: these can be signs of a stroke. Only a medical expert can tell a stroke from Bell's palsy.

Sources 1, 2

Then get help quickly: steroids work best within 72 hours

For any new weakness of the face, ask for an urgent GP appointment or call NHS 111. In a trial of 551 people, prednisolone, a steroid, started within 72 hours raised full recovery at 9 months from 82% to 94%.

Sources 1, 3, 4

Most people recover

In 1,701 people with Bell's palsy who weren't treated, recovery began within 3 weeks for 85%, and 71% regained normal movement. Facial Palsy UK says around 70% to 85% recover with no specialist help beyond early steroids.

Sources 5, 1, 6

Protect your eye while it doesn't close

Use drops by day and ointment at night, tape the eye closed for sleep, and wear glasses outdoors and for sport. The Canadian guideline strongly recommends eye protection when the eye doesn't close fully.

Sources 7, 8, 9

Early on, gentle massage rather than exercises

Facial Palsy UK advises gentle face massage every day and no forceful facial exercises while the face is floppy. That's expert advice: the one trial of early exercise, a low-quality study, found fewer unwanted linked movements with it.

Sources 10, 3, 11

Gentle practice later, specialist help if it stalls, and keep active

Slow, gentle movement practice belongs to the recovering stage, at least 3 months in. Ask for a specialist referral if there's no improvement at all after 3 weeks, or recovery is incomplete at 3 months. Nothing in the guidance stops ordinary exercise, with your eye protected.

Sources 12, 13, 14

Call 999 for these signs

The NHS says call 999 if any of these happen, because they can be signs of a stroke, which is a medical emergency:

• somebody's face droops on one side (the mouth or eye may have drooped)
• a person can't lift up both arms and keep them there
• a person has difficulty speaking (speech may be slurred or garbled)

Sources 1, 2

How Bell's palsy usually differs

In Bell's palsy, the whole of one side of the face is usually affected, including the forehead and the blink, with no weakness in the arms or legs and no trouble understanding or finding words. A stroke usually spares the forehead. But a stroke in the brainstem can affect the eye, and Facial Palsy UK says only a medical expert can tell which it is, so don't wait to see. Our stroke guide explains the FAST signs (face, arms, speech, time to call 999).

Sources 3, 2

Bell's palsy still needs urgent help

If you think you have Bell's palsy, the NHS says ask for an urgent GP appointment or call NHS 111, because treatment works best if it starts within 72 hours. Facial Palsy UK says see your GP or go to accident and emergency (A&E) as soon as possible.

Sources 1, 3, 6

What happens

The NHS describes Bell's palsy as a temporary weakness or lack of movement that usually affects one side of the face. Facial Palsy UK explains that inflammation around the facial nerve causes the paralysis, and that the cause isn't known, though links with viruses have been suggested. It comes on over hours to a few days, and is at its worst by about 72 hours.

Sources 1, 3, 14

The symptoms

The NHS and Facial Palsy UK list:

• weakness or no movement on one side of your face
• a drooping eyelid or corner of your mouth
• drooling, and a dry mouth
• loss of taste
• a dry or watering eye that may not close
• pain around your ear
• sounds seeming louder
• rarely, weakness on both sides

Sources 1, 3, 15

How common it is

About 20 to 30 people in every 100,000 get Bell's palsy each year, about 1 in 60 people over a lifetime, and it accounts for about 80% of facial palsy. It's more common in pregnancy, mostly in the last 3 months or the first week after the birth: about 45 in every 100,000 births, against 17 in 100,000 women of the same age who aren't pregnant.

Sources 3, 9, 16

How it recovers

In a Danish study of 1,701 people with Bell's palsy who weren't treated, movement began to come back within 3 weeks for 85%, and after 3 to 5 months for the rest; 71% regained normal movement, and 4% were left with severe after-effects. The NHS says most people get better within 6 months. Recovery is less likely after complete paralysis (61% recovered, against 94% with partial weakness, in one study), over 60, with severe pain, with diabetes or high blood pressure, in pregnancy, or with no recovery by 6 weeks.

Sources 5, 1, 9, 3

The three stages

Facial Palsy UK describes three stages. Floppy (flaccid): the muscles are weak and droop, and the eye may not close. Recovering (paretic): the muscles regain shape and small movements come back, often with tingling, though they tire easily. Tight (synkinetic), if recovery takes longer: unwanted linked movements appear, such as the eye narrowing when you smile, and the muscles feel tight and short. People who recover quickly pass through the first two stages within weeks.

Source 17

Treatment

The NHS lists a 10-day course of steroids, sometimes with an antiviral medicine, eye drops and ointment, and tape to keep the eye closed at night. Steroids work best started within 72 hours. Facial Palsy UK says antivirals are for suspected Ramsay Hunt syndrome (a facial palsy caused by shingles), and a Cochrane review found that adding them to steroids may make little difference. Take what your doctor prescribes, and talk to them before changing it.

Sources 1, 18, 6, 19

Who can help

Your GP or A&E at the start; an eye specialist if your eye doesn't close; a facial nerve specialist, such as an ear, nose and throat (ENT) surgeon; and a specialist facial therapist, a physiotherapist or speech and language therapist with facial palsy training. Facial Palsy UK says there are very few facial nerve specialists in the UK, and your GP can contact the charity if they're unsure where to refer you.

Sources 13, 20

The Cochrane reviewMixed evidence

A Cochrane review of physical therapies (12 studies, 872 people) found "no high quality evidence to support significant benefit or harm from any physical therapy". There was low-quality evidence that tailored facial exercises help, mainly for moderate and long-lasting weakness: in a study of 34 people with long-standing palsy, exercise improved a disability score by about 20 points out of 100. Two trials with a high risk of bias found no difference in recovery at 6 months.

Source 11

Newer reviewsEmerging evidence

Reviews since then are more positive, but the evidence is still low quality. One found 7 new trials from 2011 to 2020, with all 4 high-quality ones positive. In another, covering facial palsy from several causes, physical therapy roughly halved the chance of not recovering (4 trials, 418 people) and added about 12 points on a 100-point facial grading scale. A third found 12 small studies, all positive but limited.

Sources 21, 22, 23

Specific methodsEmerging evidence

Small trials, some with weak designs: individual neuromuscular re-education improved symmetry more than usual therapy (59 people); Kabat facilitation, a hands-on technique, added to steroids helped severe palsy recover faster without more linked movements (94 people); mime therapy, which combines massage, relaxation and expression exercises, improved long-lasting weakness, and the gains held a year later (50 people); practising keeping both eyes open evenly in a mirror while moving the mouth reduced linked movements after complete palsy (27 people); and mirror and imagery practice added to mime therapy helped (22 people).

Sources 24, 25, 26, 27, 28, 29

What the guidelines sayStrong evidence

The American Academy of Otolaryngology Head and Neck Surgery Foundation's guideline makes no recommendation on physical therapy for Bell's palsy. The Canadian guideline makes no recommendation on exercise physiotherapy in the early stage, and suggests it for persistent weakness (a weak recommendation, with very low confidence in the evidence).

Sources 14, 9

Not forcing your face early: expert advice, not a trial findingMixed evidence

Facial Palsy UK says it's important not to try to make your face move with forceful facial exercises early on, because this may encourage unwanted linked movements (synkinesis) and make the strong side even stronger. International facial therapists agreed to leave gross strengthening out of their recommended care. That's charity and expert advice: the one trial of early exercise in the Cochrane review, a low-quality study of 145 people, found the opposite, with fewer linked movements in the group that exercised. The two may fit if early work means gentle, guided practice rather than forceful repetitions (our reading).

Sources 3, 10, 30, 11

Electrical stimulationMixed evidence

In the Cochrane review, electrical stimulation did no better than a placebo in a moderate-quality trial of 86 people, and in a low-quality trial function was worse with it at 3 months. The Canadian guideline suggests against it, Facial Palsy UK doesn't recommend it routinely, and facial therapists left it out of their recommended care. One trial of 60 people found better grades with it, another of 16 people found no clear difference, and a 2026 review of 6 studies found no clear extra risk of linked movements.

Sources 11, 9, 31, 30, 32, 33, 34

The first 72 hours

Get an urgent GP appointment or call NHS 111 (999 first for any sign of a stroke), take steroids if they're prescribed, start protecting your eye, and rest while you feel unwell.

Sources 1, 3, 6

Floppy stage: the first weeks, longer if severe

Massage your face gently every day, make your normal everyday expressions without forcing exaggerated ones, look after your eye day and night, and keep generally active as you feel able. Facial Palsy UK says that if in doubt, do nothing except simple massage and eye protection until a health professional has assessed you.

Sources 10, 13, 17, 7

Not improving after 3 weeks

See your GP again if you're not getting better after 3 weeks. Ask for a facial nerve specialist if there's been no improvement at all after 3 weeks of treatment, and for an eye specialist if your eye still doesn't close after 2 to 3 weeks.

Sources 1, 13

Recovering stage: at least 3 months in

Once your face is more symmetrical at rest, the muscles are no longer floppy and you've noticed small flickers of movement, gentle movement practice can start, ideally with a specialist facial therapist: very low effort, slow and matching on both sides, about a minute per movement, a few times a day. Thinking of something that makes you happy as you practise a smile can help, as in mime therapy. Keep up the massage, and stop if another part of your face moves at the same time.

Sources 12, 13, 35, 36

Incomplete recovery at 3 months

Ask for a referral to a facial nerve specialist or a specialist facial therapist. The US and Canadian guidelines agree.

Sources 14, 13, 9

Tight stage: synkinesis

Specialist therapy: soft tissue release and stretches (about 30 minutes, at least once a day), firmer massage twice a day, relaxation and retraining, and botulinum toxin injections for some people. No chewing gum and no generic strengthening exercises.

Sources 37, 38

Day and nightStrong evidence

Use lubricating drops through the day and ointment at night, as prescribed; Facial Palsy UK suggests preservative-free drops if you use them more than 4 times a day. Tape the eye closed for sleep if it doesn't close, or use a contoured sleep mask. The US and Canadian guidelines strongly recommend eye protection when the eye doesn't close fully.

Sources 7, 1, 9, 14

Outdoors and in sport

Facial Palsy UK suggests sunglasses on sunny days, wraparound glasses for sport and going outdoors, and plain glasses on windy days. Blink more and take breaks from screens, cut down on air conditioning and central heating, and drink at least 1.2 litres a day. Keep using your drops even if your eye waters a lot: watering can be a sign that it's too dry.

Source 7

Eye patches

Be careful with eye patches: Facial Palsy UK says they can scratch the clear front of the eye (the cornea) if your eyelids are partly open underneath.

Source 7

When to get it checked

If your eye still doesn't close properly after 2 to 3 weeks, ask for a referral to an eye specialist. Get help promptly for a painful, gritty, red or sore eye, or blurred vision. Some people can't feel pain in the eye, which makes damage more likely to go unnoticed.

Sources 13, 14, 7

What it is

Synkinesis means unwanted linked movements as the nerve recovers: your eye narrows when you smile, your cheek lifts when you close your eye, or your eye closes when you chew. Facial Palsy UK says it's common in people recovering from a prolonged facial palsy; overall, up to about 16% of people with Bell's palsy develop it. It can feel worse with stress, anxiety, tiredness, and cold or windy weather.

Sources 37, 9, 5

What helpsEmerging evidence

A specialist facial therapist can build you a home programme of soft tissue release, stretches, massage, relaxation and movement retraining, sometimes alongside botulinum toxin injections to relax overactive muscles. Facial Palsy UK says that with diligent, guided practice most people reach somewhere between 70% and 90% of their previous function.

Sources 37, 38, 13

What to avoidEmerging evidence

Facial Palsy UK advises avoiding chewing gum, which can increase muscle tightness, and generic facial-strengthening exercises, which tend to encourage the same mass movement pattern. It says movement exercises should come from a specialist therapist, and warns about misinformation online.

Sources 37, 38, 30

Botulinum toxin injections

They wear off in 3 to 5 months, so they work best alongside therapy. Skip massage on the day of the injections and start again the next day.

Sources 13, 12

Keep exercisingEmerging evidence

Nothing in the guidance stops ordinary exercise. Facial Palsy UK suggests rest at the start, and time off work may be needed. Once you feel well, the usual guidelines apply: build towards 150 minutes a week of moderate activity, plus strength exercises on 2 days.

Sources 3, 39

The gym, running and cycling

Protect your eye from wind, grit and sweat: wraparound glasses for sport, sunglasses outdoors, and drops before and after. An indoor bike avoids wind and grit in the eye (our suggestion).

Source 7

Swimming

Our suggestion: wear well-fitting goggles while your eye doesn't close fully, put your drops in afterwards, and take care with water and soap near the eye. Facial Palsy UK notes that an eye that doesn't close makes everyday things such as showering harder.

Sources 7, 15

Pregnancy

Bell's palsy is more common late in pregnancy and just after the birth. Tell your midwife or maternity team as well as your GP: Facial Palsy UK says steroids are generally safe in pregnancy, to be discussed with your obstetrician. Our pregnancy guide covers exercise in pregnancy.

Sources 16, 18

Relaxation and mood

Facial palsy can affect confidence and mood, and anxiety or low mood isn't necessarily linked to how weak the face is. Relaxation is part of Facial Palsy UK's routines. The NHS says speak to a GP if Bell's palsy is affecting your mental health.

Sources 40, 38, 1

Forceful or exaggerated face exercises

Especially in the floppy stage: wide smiles, tight eye squeezes and lots of repetitions. Facial Palsy UK says you can still make your normal facial movements, but don't try to force exaggerated ones.

Sources 3, 13

Mouth exercises meant for other conditions

Our mouth stretches move, for a tight mouth with scleroderma, is wide, forceful stretching, the opposite of early facial palsy advice, and the mouth and throat exercises for sleep apnoea weren't designed for facial palsy. Facial Palsy UK says don't do exercises without professional help.

Sources 17, 13

Chewing gum and face yoga

Facial Palsy UK advises avoiding chewing gum and generic facial strengthening. We found no trials of face yoga for facial palsy.

Source 37

Home electrical stimulation machines

Facial Palsy UK doesn't recommend electrical stimulation routinely, and the Canadian guideline suggests against it.

Sources 31, 9

Expensive treatments sold with before-and-after photos

Facial Palsy UK says such photos almost certainly show natural recovery, and advises against paying large sums for unproven treatments in the early stage.

Source 6

Call 999 first

For a face drooping on one side with weakness in an arm or trouble speaking: these can be signs of a stroke. Our stroke guide explains the FAST signs.

Sources 1, 2

Get an urgent GP appointment or call NHS 111

For any new weakness of your face: treatment works best if it starts within 72 hours.

Sources 1, 3

Tell your GP

Facial Palsy UK says tell your GP about:

• face pain severe enough to keep you awake at night
• a rash in or around your ear or in your hairline, or sores in your mouth
• a recent tick bite, or a bull's-eye rash anywhere on your body
• balance problems or vertigo
• hearing loss, or ringing in your ears (tinnitus)
• weakness down one side of your body, or trouble thinking
• swelling of your face, or folds or furrows in your tongue

Sources 13, 14

Your eye

Ask for an eye specialist if your eye still doesn't close properly after 2 to 3 weeks, and get help promptly for a painful, red or gritty eye, or blurred vision. Keep using your drops even if your eye waters a lot.

Sources 13, 7, 14

Go back to your GP

See your GP again if:

• you're not getting better after 3 weeks
• there's no improvement at all after 3 weeks of treatment, or recovery is incomplete at 3 months: ask about a facial nerve specialist
• the weakness came on slowly, over weeks or months: Facial Palsy UK says that's highly unlikely to be Bell's palsy

Sources 1, 13, 14, 16

During face exercises

Stop movement exercises if unwanted linked movements appear, and get face-to-face advice from a specialist facial therapist.

Source 12

Your mood

The NHS says speak to a GP if Bell's palsy is affecting your mental health. Our depression guide says where to get urgent help.

Sources 1, 40

"Facial exercises speed up recovery"Mixed evidence

Most people recover on their own, steroids within 72 hours are the treatment shown to improve recovery, and the evidence on facial exercises is low quality, with no high-quality evidence of benefit or harm. Gentle, guided exercise may help a slow or incomplete recovery.

Sources 5, 4, 41, 11

"The harder you work your face, the faster it comes back"Mixed evidence

Facial Palsy UK warns that forceful exercise may encourage unwanted linked movements, and its recovering-stage practice uses 2 out of 10 effort. That's expert advice rather than a trial result, and no trial supports forceful exercise either.

Sources 3, 30, 12, 11

"Electrical stimulation will get the nerve working"Mixed evidence

It did no better than a placebo in a moderate-quality trial and worse in a low-quality one. The Canadian guideline suggests against it, and Facial Palsy UK doesn't recommend it routinely.

Sources 11, 9, 31

"Chewing gum or face yoga strengthens your face"Emerging evidence

Facial Palsy UK advises avoiding chewing gum, which can increase muscle tightness, and generic facial strengthening. We found no trials of face yoga in facial palsy.

Source 37

"A drooping face is just Bell's palsy, so there's no rush"Strong evidence

A drooping face with weakness in an arm or trouble speaking needs a 999 call, because it can be a stroke. Bell's palsy itself needs an urgent GP appointment or NHS 111, because steroids work best within 72 hours.

Sources 1, 2, 3

"Before-and-after photos prove a treatment works"Strong evidence

Most people recover naturally, so Facial Palsy UK says such photos almost certainly show natural recovery.

Sources 6, 5

"You should stop exercising until your face recovers"Emerging evidence

No guidance restricts ordinary exercise. Rest while you feel unwell at first, then use the usual activity guidelines, protecting your eye.

Sources 3, 39, 7

"If it isn't better in 3 weeks, it never will be"Strong evidence

In the large Danish study of people who weren't treated, 15% began recovering only after 3 to 5 months. No improvement at 3 weeks is a reason to see your GP again, and incomplete recovery at 3 months a reason to ask for a specialist referral.

Sources 5, 1, 13