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What happens to the unaffected side?

When you first develop facial palsy, the brain starts to neglect the affected side because it isn’t moving.  The brain cannot see your face unless you look in the mirror so without the sensation of movement it will begin to ignore the immobile side.  The uninjured side becomes:

  • Dominant or bossy
  • It overworks to try and compensate
  • It makes lots of effort and its movements become exaggerated
  • It may find it difficult to relax when you are not moving because of all the overactivity

What are the consequences?

  • The muscles start to shorten and thicken because they are working so hard – a bit like going to the gym and doing lots of repetitions, for example, leg raises to tighten the tummy muscles.
  • The muscles may feel tense and painful
  • The brow may stay in a raised position
  • The corner of the nose may become lifted
  • The cheek muscles may have shortened and lifted the corner of the mouth
  • Your face can start to feel tired and exhausted because of all the extra work it is going
  • You may develop facial pain on the uninjured side of the face

All of these factors will exaggerate the asymmetry because the uninjured side is moving much more than normal, and the injured side is either not moving at all or only a small amount.

Impact on the recovery of facial expression

  • The dominant side will cast the injured side in shadow.  The brain is, therefore, less likely to attend to it as movements start to return.
  • When recovery is slower (link to stages of recovery) the injured side finds it difficult to locate the correct muscle required for a movement.  This is more likely to happen if the injured side is overshadowed by the dominance of the uninjured side.
  • The more the dominant side moves the less likely the injured side will move.
  • Making too much effort when practicing facial expression will encourage the development of unwanted movement on the injured side called synkinesis.

What can help?

  • Massage both sides of the face from the start of your recovery.  This will maintain the feeling of movement on the injured side of the face so that the brain continues to attend to it.  Massage will help maintain muscle suppleness and help relieve muscle tension on the uninjured side.
  • Carrying out muscle releases on the uninjured side of the face will help maintain muscle length and elasticity.  If you have not made a full recovery within the first 3 -4 weeks, then you should start muscle releases on the uninjured side to prevent the muscles becoming tight and short.
  • Facial relaxation will help reduce overactivity of the facial nerve on both sides of the face.  General relaxation will teach the nerve to rest when the face is not moving, and only a low level of nervous energy is required.
  • When you notice early signs of movement returning (the paretic stage of recovery), remember ‘less is more’.   Enthusiasm and a desire to get better as quickly as possible often leads people to work too hard.  At this point it is essential that all movement practice is slow, gentle and symmetrical.  The uninjured side of the face should move the same amount, at the same time and at the same speed as the recovering side of the face.  Never practice asymmetric facial expressions.

If you can follow these guidelines and the links to the videos and articles, you will be maximising all your potential to make the best recovery you can.  You may also help minimise the development of synkinesis if you take great care in the early weeks and months.

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