Bell’s palsy treatment centers on two priorities: starting oral steroids within 72 hours of symptom onset and protecting the eye on the affected side. About 80% of patients achieve a favorable outcome within six months, but acting quickly improves those odds and reduces the risk of long-term complications like involuntary facial movements or lingering weakness.
Corticosteroids Are the First-Line Treatment
Oral corticosteroids are the single most important medication for Bell’s palsy. Clinical guidelines recommend a 10-day course at a high dose, ideally started within 72 hours of when symptoms appear. The standard regimen is either a flat dose for 10 days or a slightly higher dose for 5 days followed by a 5-day taper. Steroids reduce the swelling around the facial nerve as it passes through a narrow bony canal in the skull. That swelling is what causes the paralysis, so bringing it down quickly gives the nerve the best chance of recovering fully.
Timing matters more than almost anything else. The sooner you start treatment, the better the outcome. If you wake up with one-sided facial drooping, difficulty closing one eye, or a sudden loss of taste on one side of your tongue, get medical attention that day rather than waiting to see if it resolves on its own.
Antivirals Are Often Added
Your doctor will likely prescribe an antiviral medication alongside steroids. The American Academy of Family Physicians recommends combination therapy for Bell’s palsy patients. While two higher-quality meta-analyses found that adding antivirals doesn’t clearly increase rates of complete recovery, the combination may reduce rates of incomplete recovery and lower the chance of developing synkinesis, a complication where facial nerves regrow in the wrong direction and cause involuntary movements.
One important point: antivirals alone have no effect on recovery. There is strong evidence on this. They only offer a potential benefit when paired with corticosteroids.
Eye Care Prevents Serious Damage
Protecting the eye on the affected side is the most important ongoing treatment you’ll manage at home. Because the eyelid can’t fully close, the eye is exposed to drying, dust, and accidental scratches. Left unprotected, this can lead to corneal abrasions, traumatic cataracts, or in severely neglected cases, blindness.
During the day, use lubricating eye drops frequently to keep the surface moist. At night, switch to a thicker eye ointment, which stays in place longer while you sleep. Wearing glasses during the day adds a physical barrier, and goggles or a soft eye patch at night prevent the eye from being scratched or poked against a pillow. If your eye becomes red, painful, or unusually sensitive to light, an eye doctor should evaluate it promptly.
Facial Exercises Support Recovery
Gentle facial exercises help encourage the muscles to work normally again, and they should be started as soon as possible. At first, you may see little or no movement on the affected side. That’s normal. The goal is to keep the muscles engaged and prevent stiffness while the nerve heals.
Sit in front of a mirror so you can watch both sides of your face and try to keep movements symmetrical. Work through these movements slowly:
- Eyebrows: Gently raise them, using your fingers to assist the weak side if needed. Then draw them together in a frown.
- Eyes: Place the back of your index finger on the closed eyelid to hold it shut, then use the opposite hand to gently stretch the eyebrow upward along the brow line. This relaxes the eyelid and prevents stiffness. Then try pressing both eyelids together, and narrow your eyes as if squinting into sunlight.
- Nose: Wrinkle your nose upward. Take a deep breath through your nose and try to flare the nostrils.
- Mouth: Gently move the corners of your mouth outward. Lift one corner, then the other. Use your fingers to guide the weak side into a smile position, then remove them and try to hold it.
Repeat these several times a day. A physical therapist specializing in facial neuromuscular retraining can tailor the program to your specific level of paralysis and adjust it as movement returns.
What Recovery Actually Looks Like
Most people with Bell’s palsy recover well. In a study of over 1,300 patients, about 81% achieved a favorable outcome by the six-month mark, meaning their facial function returned to normal or near-normal with only slight weakness visible on close inspection. Recovery typically begins within two to three weeks of onset and continues gradually over several months.
The severity of your initial paralysis is the strongest predictor of how fully you’ll recover. Doctors sometimes use a grading scale that ranges from mild dysfunction (slight weakness, eye still closes easily) to total paralysis (no movement at all). Patients with partial paralysis at onset almost always recover completely. Those with total paralysis face a higher risk of incomplete recovery. Electrical nerve testing can help gauge the extent of nerve damage in complete paralysis cases, which helps predict the timeline and likely outcome.
Managing Long-Term Complications
Up to 30% of Bell’s palsy patients develop some lasting effect, even with appropriate treatment. The most common is synkinesis, where regenerating nerve fibers connect to the wrong muscles. This creates involuntary movements paired with intentional ones. For example, your eye might close or narrow every time you smile, or your cheek and chin might tighten when you try to shut your eye firmly. The affected side of the face can also feel tight and fatigued, and the crease between your nose and mouth may become deeper than the other side.
Synkinesis is treatable. Botulinum toxin injections can improve facial symmetry and control the involuntary movements. These are typically covered by insurance for facial paralysis patients. Specialized facial nerve therapy, sometimes combined with targeted injections, helps retrain the brain to activate muscles independently rather than in unwanted patterns. In more significant cases, surgical options exist as well.
What About Acupuncture?
Acupuncture is one of the most commonly asked-about complementary therapies for Bell’s palsy. A systematic review of randomized controlled trials found a statistically higher response rate in patients who received acupuncture, but the included studies had high risk of bias and significant inconsistency in their results. The reviewers concluded there was insufficient evidence to confirm that acupuncture is effective or to draw conclusions about its safety. It’s not harmful for most people, but it should not replace steroids and antivirals, especially in that critical first 72-hour window.
Surgery Is Rarely Recommended
Surgical decompression of the facial nerve, where bone is removed to give the swollen nerve more room, is not part of standard treatment. The American Academy of Otolaryngology found that the data supporting surgery are not strong enough to make a recommendation for or against it. There may be a benefit for a very small subset of patients with complete paralysis who meet specific eligibility criteria based on nerve testing results, but this remains controversial and is not widely performed. For the vast majority of people with Bell’s palsy, medication, eye care, and facial rehabilitation are the appropriate treatment path.