The Paretic stage after 4 weeks

The paretic stage refers to the point in time when a person experiences early signs of nerve recovery and some improvement in muscle tone.

You may feel quite low because recovery is taking longer thank you’d hoped, and your symptoms may be wearing you down.  This is a normal reaction and totally understandable especially if you have been told that most people make a full recovery within the first 4 weeks.

If you remain paretic beyond 4 weeks, recovery is still possible.  It simply means the nerve is taking longer to regenerate.


  • Your facial muscles will remain weak and your affected side will lack the normal contours.
  • Early signs of movement will remain small and may be inconsistent.  This may be due to muscle fatigue, as facial muscles will fatigue very easily during the paretic stage.
  • The fatty ‘myelin sheath’ that covers the facial nerve and speeds up the transmission of electrical messages to the face may be taking more time to build up.  This means that electrical messages from the brain to the muscle will travel slowly and arrive at the muscle with insufficient energy to power movement.
  • You may find that the unaffected or uninjured side of your face becomes even stronger and more dominant.  This is because the period of trying to compensate for lack of movement on the affected side is prolonged.
  • When will this improve? 

It is impossible to know how long each individual will take to pass through the paretic stage.  It can last for a few weeks or several months.  The degree or severity of nerve damage will determine how long it will take for the nerve to recover.

The general rule of thumb, for those people who have more severe nerve damage, is that paresis will persist up until 12 – 16 weeks, before signs of synkinesis (involuntary movements) appear and you enter the synkinetic stage of your recovery.

What you should do 

  • Follow your Recovery Plan and form a routine.
  • Take regular assessments in this app to identify any symptoms of synkinesis.
  • Look after your eye, including regular use of eye lubrication and eye taping especially at night.
  • Massage your face on both sides of the face. This will allow you to assess how the muscles feel on the unaffected side compared to the affected side.  It will help track or feel changes in muscle tone.
  • Relax both sides of your face
  • Do muscle releases for the unaffected side to prevent it from tightening up and pulling the weak side across to the strong side.
  • Do gentle movements. Remember that all movement should be slow, gentle, symmetrical and performed with very low effort.

What to avoid

  • Never practice asymmetric movements.
  • Never try to force movements. If you do you will encourage incorrect movement patterns which will be difficult to change.

No change after 12 weeks

If you are still in the paretic stage, at 12 – 16 weeks following the onset of your symptoms, and your recovery feels static (i.e. you haven’t seen any further encouraging signs of progress, for example, more spontaneous movement or firmer muscles), you should go to your GP.

If you continue to have problems with eye closure and blink, and your eye feels continually dry, sore, red or irritated you should ask your GP to refer you to an Ophthalmologist.  An Ophthalmologist will be able to examine your eye in great detail and recommend any further interventions to help keep your eye healthy.  You can also go to your local Optician if you have any concerns. They can carry out similar tests and can also recommend a referral to a specialist if there are concerns about your eye health.

Read more

What happens to the unaffected side? 

How can I speed up my progress?