Bell's palsy in the acute phase: answers to frequently asked questions

Bell's palsy often appears unexpectedly. Within a few hours, the smile can become asymmetrical, the eye may fail to close completely, and simple everyday movements become more difficult.

In the early days, many questions arise: Will I recover? Should I exercise? Can I massage my face? Is there anything I should avoid?

These are some of the questions that come up most often during the sessions.

What is Bell's Palsy?

It is a peripheral facial paralysis of sudden onset, usually on one side of the face.

The facial nerve is compromised, reducing or preventing the movement of the muscles of facial expression.

What should I do when it appears?

Seek medical evaluation as soon as possible.

It is important to confirm the diagnosis and rule out other causes of facial paralysis. When indicated, treatment with corticosteroids should ideally be started within the first 72 hours after the onset of symptoms.

My eye won't close. What should I do?

Eye protection is a priority.

When the eye does not close completely, the cornea is more exposed and must be protected according to medical or ophthalmological advice.

If pain, significant redness or a change in vision occurs, you should seek medical evaluation.

Will I recover?

In most cases, the outlook is favourable.

However, the recovery time varies from person to person and depends on the degree of facial nerve involvement.

The first movements may appear in the first few weeks, but not always. Some people recover earlier and in others the process takes longer.

Should I start exercising right away?

Not necessarily.

If there is still no movement, making faces, trying to smile repeatedly or shutting the eye tightly will not make the nerve recover any faster.

So the face doesn't need to be strengthened?

Not in the way it is often thought.

In the acute phase, the problem is not simply a lack of muscle strength, but an alteration in facial nerve function.

Therefore, the approach should not be based on forcing it or increasing the number of repetitions, but rather on respecting the recovery phase and, at the appropriate time, introducing facial neuromuscular re-education.

What is facial neuromuscular retraining?

It is one of the foundations of physiotherapy specialised in facial palsy.

It seeks to recover selective, coordinated and functional movements, respecting what the nerve is already able to do at each stage.

When the first movements appear, we work on their precision and control, rather than simply looking for larger or stronger movements.

Current scientific evidence supports an individualised approach, centred on movement quality and neuromuscular re-education.

Does this mean doing lots of exercise at home?

No.

In neuromuscular re-education, the quality of movement is more important than the quantity of repetitions.

Generic facial mime exercises, repeated grimaces or forcefully executed movements, without guidance, are not recommended.

Forcing a movement that does not yet happen does not accelerate nerve recovery.

Should I chew chewing gum? And blow up balloons or blow through a straw?

No.

Chewing gum primarily works the chewing muscles and does not constitute a specific workout for the muscles of facial expression.

Inflating balloons or blowing through a straw are also not recommended as generic facial recovery exercises.

The goal is not to make the muscles work harder, but to recover proper and coordinated movements.

Can I massage my face?

There may be an indication for manual therapy, but not with the aim of “waking up” the nerve.

The technique and intensity must be adapted to what is observed in the first session assessment.

What about electrostimulation?

Electrostimulation is not recommended in the rehabilitation of facial palsy.

The most recent international consensus among facial palsy rehabilitation specialists excludes electrical stimulation from the recommended modalities, including in the flaccid phase.

Triggering a muscle contraction via an electrical current does not mean improving nerve recovery. The approach should favour individual assessment and, when movement is present, facial neuromuscular re-education.

What then is the role of physiotherapy in the acute phase?

At this stage, physiotherapy does not consist of handing over a list of exercises.

During the sessions we evaluate facial function, eye closure, tissue mobility and movement evolution.

From there, we advise on what should be done at home, what should be avoided and the most appropriate care for that phase.

When the first movements appear, neuromuscular re-education is introduced and adapted to the evolution of the face, focusing on the quality and selectivity of movement.

Is it normal not to notice improvements every day?

Yes, facial nerve recovery does not happen in a linear way. There may be periods with very few visible changes and others when small progress begins to appear.

Therefore, it is not necessary to constantly check your face in the mirror.

After all, what should I avoid during the acute phase?

Avoid forcing movements, making grimaces repeatedly, performing dozens of repetitions, using chewing gum or balloons as “facial exercise” and starting techniques or devices on your own initiative.

The current approach favours an individualised intervention, adapted to the stage of recovery and focused on movement quality, rather than generic facial strengthening programmes.

In the acute phase of Bell's palsy, the most important thing is not to do more, but to do what is appropriate for each stage of recovery.

Early medical assessment, eye protection when necessary and specialist follow-up make it possible to guide the evolution of facial function and avoid strategies that bring no benefit.

As movement begins to emerge, the approach should be adjusted, focusing on quality, control and coordination of movement.

If you have doubts about the progression of your facial palsy or do not know what you should do at this stage, a specialist assessment can help you understand what stage of recovery you are at and which care measures are most appropriate.