Facial paralysis is a condition that affects the facial nerve, causing weakness or loss of movement in the muscles of the face.
This condition may be central or peripheral in origin, and its treatment depends on the cause, severity, duration, and the patient’s individual characteristics.
Below are the main therapeutic options, organized by type of procedure.
Corticosteroids
Corticosteroids are the mainstay of treatment for acute peripheral facial paralysis, especially Bell’s palsy. They are preferably administered within the first 72 hours after symptom onset, as they help reduce inflammation and swelling of the facial nerve. Prednisone and methylprednisolone are the most commonly used. Dose and duration vary by protocol, but a 7–10 day course is typically prescribed.
Antivirals
When a viral cause is suspected—especially herpes simplex virus or herpes zoster (Ramsay Hunt syndrome)—antiviral therapy such as acyclovir or valacyclovir may be added. In these cases, combining corticosteroids and antivirals may improve functional prognosis.
Eye protection
In patients with incomplete eyelid closure, protecting the cornea is essential to prevent keratitis and ulcers. The use of artificial tears, lubricating ointments, and nighttime eye occlusion is recommended. In severe cases, temporary tarsorrhaphy may be indicated.
Other medications
Analgesics and anti-inflammatory drugs are used to control facial pain. In some cases, vitamin supplements (such as vitamin B) may be used to support nerve regeneration, although evidence is limited.
Physical therapy and physiotherapy
Rehabilitation is key in the management of facial paralysis. It includes facial exercises aimed at stimulating the affected muscles, improving facial symmetry, and preventing contractures. Treatment should be individualized and supervised by a specialized physical therapist. Techniques such as neuromuscular re-education, biofeedback, and massage therapy help optimize outcomes.
Electrical stimulation
Electrical stimulation uses low-voltage electrical currents to stimulate paralyzed facial muscles. Although its effectiveness is controversial and it is not universally recommended, it may be considered in selected cases as an adjunct to conventional physical therapy.
Complementary therapies
Some alternative therapies, such as acupuncture and occupational therapy, have shown benefits in functional recovery in certain patients, although scientific evidence varies.
Surgical decompression of the facial nerve
Indicated in cases of severe and progressive facial paralysis, especially when there is clear compression of the facial nerve (for example, fractures or tumors). Surgical decompression aims to release the nerve and improve functional recovery. This procedure requires specialized evaluation and is uncommon.
Reconstructive surgery and aesthetic procedures
Botulinum toxin
Botulinum toxin injections are useful in cases of synkinesis (involuntary movements) or residual facial spasm. They can also be used to improve facial symmetry by relaxing hyperactive muscles on the unaffected side of the face.
Facial fillers
The use of hyaluronic acid fillers or autologous fat grafting may help restore volume and improve aesthetic symmetry in patients with facial muscle atrophy secondary to paralysis.
Facial paralysis can have a strong emotional and social impact. Psychological support, group work, and family support are essential for the patient’s adaptation and overall recovery.
Facial paralysis treatment must be multidisciplinary and individualized, combining medical, rehabilitative, surgical, and emotional support options. The choice of therapies depends on the etiology, duration, severity, and the patient’s expectations. Early and coordinated care increases the chances of functional recovery and improves quality of life.