Providing support and promoting respect for everyone with a visible difference

Support line: 0300 012 0275Donate

Bell’s palsy

Information about Bell's palsy, as well as guidance about what support is available from Changing Faces and other organisations.

What is Bell’s palsy?

Bell’s palsy is caused when inflammation of the seventh cranial nerve (known as the facial nerve), causes partial or complete facial paralysis, usually on one side of the face. In around 1% of cases, both sides of the face are affected. The condition takes its name from Sir Charles Bell, a 19-century Scottish doctor, who discovered that severing the facial nerve causes facial paralysis.

Bell’s palsy is the most common form of acute facial paralysis, accounting for up to 80% of cases. It affects between 20 to 30 per 100,000 people every year. Most people will recover fully within the first three weeks following the onset of their symptoms. Approximately three out of 10 people will experience a delayed recovery and their symptoms may persist for several months. People who have a delayed recovery may experience long-term effects, such as problems with blinking and closing the eye for sleep, loss of expressiveness and involuntary movement or muscle twitching on the affected side (synkinesis).

If you are affected by Bell’s palsy, you may feel self-conscious about your appearance. There is support available from us here at Changing Faces and other organisations to help you manage these challenges. On this page, we look at causes and symptoms of Bell’s palsy as well as possible treatments. We’ll also take you through the ways we can help you manage the impacts it may have on your life. You may also find this page useful if you are affected by another form of facial palsy.

Important: If you suspect a stroke, call 999 immediately. With Bell’s palsy, seek medical advice within 72 hours of onset, as this way it is more likely to respond to treatment.

My visible difference has really helped me care less about what people think about me. I just focus on being the best version of me that I can be! I now use my experiences to mentor others with confidence issues in the workplace – including someone who also has a visible difference.

Emma, who has Bell’s palsy

Facial palsy

On this page we focus on Bell’s palsy, the most common cause of facial palsy. It is not the only cause of facial palsy and typically a diagnosis is reached if no other reason for facial weakness or paralysis is identified. Other, more common causes of facial paralysis are:

  • Ramsay Hunt Syndrome: A complication of a shingles infection whereby the shingles infection occurs on the facial nerve near to the ear. It is the varicella zoster virus which causes chicken pox in children and shingles in adults. Commonly the facial palsy is accompanied by a rash usually in or around the ear, hairline and/or mouth. It can occasionally occur without a rash and is more common in people over the age of 60.
  • Lyme Disease: A bacterial infection caused by a tick bite. A blood test can identify the presence of infection.

The presentations are very similar which may occasionally result in a misdiagnosis. However, a clinician who takes a good history and does a full examination will be able to distinguish between the different diagnoses and order further investigations.

You can contact the charity Facial Palsy UK for information about these and other causes of facial palsy/paralysis.

You may find this guide useful if you are affected by another form of facial palsy and you are struggling with the impacts of a change in your appearance.

What is the difference between Bell’s palsy and a stroke?

It is important to differentiate between facial paralysis caused by Bell’s palsy (a lower motor neurone condition affecting the nerve only), and one caused by a stroke (damage to the brain itself). A thorough clinical examination can help differentiate between the two conditions. A facial paralysis, as the result of a stroke, tends to affect the lower part of the face only and usually involves weakness or paralysis of the arm and/or leg on the affected side. This mean that the person is still able to close their eyes, blink and raise their eyebrows but the lower part of the face is weak. In contrast, Bell’s palsy affects the whole side of the face resulting in an inability to blink, close the eye, and raise the eyebrow as well as loss of movement lower part of the face. There is no limb weakness associated with Bell’s palsy as it is a condition that affects the facial nerve only and not the brain itself.

If you suspect you may have Bell’s palsy, seek medical advice immediately either from your GP or your local Accident and Emergency Department. It is important to be seen as soon as possible so that a diagnosis can be made, and the appropriate medication prescribed. Treatment for Bell’s palsy is a course of steroid tablets which should be commenced within 72 hours of the onset of your symptoms to maximise their effectiveness. If you are in any doubt, call 999.

Signs and symptoms of Bell’s palsy

Bell’s palsy is a paralysis or weakness commonly on one side of the face.  Paralysis of the facial muscles typically causes a facial droop on the affected side. The following symptoms are a result of muscle weakness or paralysis of the facial muscles.

Bell’s palsy causes an inability or difficulty:

  • Closing the affected eye, blinking, or squinting against the sun
  • Raising the brow or looking surprised
  • Smiling
  • Whistling/blowing
  • Some sounds may be hard to make because the lip is weak, for example, p and b
  • Eating and drinking may be harder due to weakness in the lip and cheek

At the onset of paralysis, you may notice a sharp pain in the inner ear or around the ear itself. You may also be recovering from a cold- or flu-like illness.

Other Bell’s palsy symptoms include:

  • Altered taste or change in sense of taste
  • Sensitivity to loud noises
  • Dry mouth
  • Dry/sore eye due to lack of blink or inability to close the eye for sleep

Causes of Bell’s palsy

The cause of Bell’s palsy is still unclear and is described as an idiopathic condition, meaning no conclusive cause has been identified. Research suggests links with viral causes, for example, herpes, influenza, and respiratory tract infections. It is also associated with a weakened immune system and a period of stress.

Is Bell’s palsy genetic?

Bell’s palsy tends to be caused by a viral infection. However, some evidence suggests that there may be a genetic element in between 4 and 14% of cases. Recurrence of Bell’s palsy is rare but when it does recur, there is often a family history of episodes of Bell’s palsy, suggesting that there may be a genetic dimension.

How is Bell’s palsy diagnosed?

To diagnose Bell’s palsy, a doctor will carry out a neurological examination. They will ask you to make different expressions such as closing your eye, pinching your lips, raising your eyebrow and smiling. They should look in your ear to identify the existence of a rash or any infection. You should be asked about your hearing and whether it has been affected. It is likely they will be able to make a diagnosis based on your symptoms and by bedside observation.

Bell’s palsy treatments

Bell’s palsy often clears up on its own and most people will make a full recovery within the first few weeks. Bell’s palsy treatment includes:

  • Oral steroids are prescribed if the diagnosis is made within the first 72 hours of the onset of symptoms. The purpose is to reduce inflammation around the facial nerve and relieve the pressure which causes the symptoms described.
  • Antivirals are sometimes used when a viral infection is suspected. People diagnosed with Ramsay Hunt Syndrome should receive both anti-viral medication and steroids.
  • Lubricating eye drops are prescribed when the person is unable to blink or close their eye for sleep. This is to prevent the development of a dry, sore eye.
  • Eye tape to tape the eye closed at night and special night-time ointment for the eye.

Bell’s palsy and my appearance

Whether your Bell’s palsy disappears after a few weeks or symptoms remain for longer or permanently, you may feel self-conscious about your appearance. You may notice people looking at you or staring. Some people may ask questions about the way you look or make comments.

I’ve had people say nasty comments and I’ve had nowhere to turn. My friends and family have always said you look fine, but they don’t really get it.

Sheila, who has Bell’s palsy

What Bell’s palsy support can we offer?

All of this can be difficult to manage – but there are steps you can take to help you cope and we are here to provide support if you need it.

At Changing Faces, we offer a counselling and wellbeing service, providing confidential, one-to-one support to help adults and young people with visible differences improve their social, emotional and psychological wellbeing. Our trained practitioners will support you over a series of sessions. Many people find it helpful to discuss their thoughts, feelings and experiences.

We also have a range of self-help guides designed to help you deal with the impacts of living with a visible difference. Our guides cover topics such as mental health and wellbeing as well as advice on coping with work life, relationships and other people’s reactions.

There are a number of other ways we can support people with Bell’s palsy:

  • Online Community: A forum moderated by Changing Faces staff, giving you the opportunity to talk to other people with visible differences.
  • Peer Group Chat Service: An online support group of up to eight people, which takes place on Zoom or in a chatroom facilitated by Changing Faces staff.
  • Workshops for children and young people and their parents: Meet others and discover ways to manage challenges brought about by living life with a visible difference.
  • Real stories: Hear from others affected by visible differences, including Bell’s palsy.

Please contact our Support and Information Line if you would like to access our services. As well as providing information about our services, our team can offer support calls for you to talk through the impacts of Bell’s palsy on your life.

Other organisations

Facial Palsy UK logo

Facial Palsy UK

Facial Palsy UK provides information about all forms of facial palsy, including Bell's palsy. It provides guidance for those affected as well as organising local support groups, family days, supporting research and advising health professionals.

Outlook logo


A national, highly specialist psychological service based at North Bristol NHS Trust, supporting adults (16+) with appearance-related distress. They can provide face-to-face and remote support via NHS Attend AnyWhere. Please speak to your GP or healthcare professional to discuss a referral.

Hands typing on a MacBook keyboard


Please have a look at the NHS conditions page for official guidance on Bell’s palsy, more information about treatment options and guidance on when to see a GP. You will also find out what treatments are available on the NHS and how to seek help.