What is Bell’s Palsy?
Bell’s Palsy (BP) is a neurologic condition that causes weakness of the face. A handful of celebrities, like Angelina Jolie and George Clooney, have brought increased awareness to BP by sharing their experiences with the condition. BP related facial weakness typically affects one side of the face, starting suddenly then progressing to complete or partial weakness over 24 to 72 hours.
While the exact cause of BP is still not known, it is important to see a doctor right away to make sure you are not experiencing a life-threatening condition. BP is diagnosed only after other, more serious conditions have been ruled out. BP is quite common. Somewhere between 1 in 60-70 people will experience BP in their lifetime. The majority of people recover without issue, but some suffer long-lasting effects. It is possible to get BP more than once and on more than one side of the face, though this is much less common.
What is the link to pregnancy?
Pregnant women are 2-4 times more likely to get BP than the general population. Women in their third trimester and in the first 2 weeks post-partum are at greatest risk of developing BP. The reasons for this increase in risk are unclear, but a few theories exist. To start, BP is more common in women of child-bearing age. Also, immune and hormone changes during pregnancy may make women more susceptible to development of development of BP. Fortunately, the treatment for BP involves medications and therapies that are safe during most pregnancies.
Who should you see?
If you experience new onset facial weakness you should seek medical evaluation immediately. BP is not the only cause of facial weakness. Stroke, infection, cancer, trauma, auto-immune diseases and certain genetic syndromes can also cause facial weakness. The other causes of BP need to be ruled out before a diagnosis of BP is made. If BP is determined to be the cause of your facial weakness it is important to get early treatment. Early treatment has been shown to improve long-term recovery and outcomes. Treatment usually consists of steroids either with or without anti-viral therapy. Treatment may also include physical therapy, stress reduction, and alternative therapies.
The good news
Most patients with BP recover complete or near-complete facial motion over the course of a few months. Most people will start to notice improvement in facial motion within a few weeks. This is true even for patients who were maybe diagnosed late and/or didn’t receive any early treatments. Even if you are diagnoses several months after the onset of weakness, treatments like physical therapy may still provide some benefit.
Long-term effects and synkinesis
Most patients who get BP recover fully and do not get it again. Some patients who recover from BP may develop uncoordinated movements of the face called, synkinesis. Synkinesis can become more of a problem than the facial weakness itself. Patients with synkinesis commonly complain of face and neck tightness or spasm, and excessive eye closure with eating, talking, or other facial expressions.
Treatment for synkinesis usually takes many months and sometimes years. There are new surgeries available to help with this, however most people find enough relief from injections and physical therapy with a specialist. If you or someone you know has experienced this but hasn’t seen a specialist recently, it may be worth another visit as many more options exist today compared to even just a few years ago.
Roxana Moayer, MD is a facial plastic and microvascular reconstructive surgeon. Her clinical specialties include treatment of facial nerve disorders and synkinesis, facelift and neck lift, rhinoplasty, blepharoplasty, brow lift, cosmetic facial skin treatments including microneedling and PRP, facial reconstruction (following trauma and cancer), hair restoration, facial feminization, and otoplasty. She is dedicated to helping patients look like the best version of themselves, driven by a strong belief that such work is inextricably linked to their self-confidence and overall health. Her attention to detail and aesthetic eye, paired with advanced training in cutting-edge techniques, allows her to deliver reliable, safe and natural-looking results.
After completing her medical doctorate at the Keck School of Medicine of USC, Dr. Moayer continued to the University of California, Los Angeles to complete her internship and residency. From there, she moved to Philadelphia for an additional year of training at one of the highest volume, AAFPRS-accredited fellowship training programs in the country, Jefferson Facial Plastics. She is currently an assistant professor on faculty at the Keck School of Medicine in the Department of Otolaryngology Head & Neck Surgery.
Dr. Moayer is also involved in the Face-To-Face program, an organization affiliated with The Break the Silence Foundation against domestic violence that provides plastic surgery treatment for survivors of domestic abuse.