Bell’s Palsy

Bell’s Palsy is the number one cause of facial paralysis in the United Sates. It is a disorder of the nerve that control movement of the muscles in the face, paralyzing facial expression functions. Bell’s palsy includes any type of facial paralysis that does not have any other associated causes such as tumors, trauma and salivary gland inflammation.


Dr. Azizzadeh is a highly sought out facial paralysis and Bell’s palsy surgeon because he is trained in Facial Plastic & Reconstructive Surgery, as well as Head & Neck Surgery, giving him a distinctive insight into facial nerve function and facial aesthetics. Few physicians in the US have the expertise needed to treat facial paralysis disorders. When other doctors tell patients there is no treatment for their Bell’s palsy, Dr. Azizzadeh is usually able to provide them with treatment.

What is Bell’s palsy?

Bell’s palsy is a paralysis or weakness of the muscles on one side of your face. The face becomes paralyzed as a result of damage to the facial nerve that controls movement. Usually, facial paralysis from Bell’s palsy comes on suddenly.

Patients with Bell’s palsy fall into three groups:

  1. 85% of individuals with Bell’s palsy completely recover from the paralysis with no noticeable deformity or issues.
  2. 10% of individuals with Bell’s palsy will have incomplete recovery, resulting in synkinesis and partial facial weakness.
  3. 5% of individuals with Bell’s palsy will have complete facial paralysis and significant synkinesis.

What causes Bell’s Palsy?

Research shows that Bell’s palsy occurs when the facial nerve becomes swollen or inflamed, essentially “shutting down” the nerve’s ability to send signals to the brain. The exact cause of the swelling is often unclear, but is thought to be a result of the herpes simplex virus. Bell’s palsy generally occurs very quickly and most patients who suffer from the condition have acute onset and immediate facial paralysis. It is more commonly seen in patients who are pregnant or have a family history of Bell’s palsy.

What are the symptoms of Bell’s Palsy?

Since the facial nerve is very complex and controls many functions, damage to the nerve can lead to a variety of problems. Bell’s palsy symptoms can vary from patient to patient and range in severity from mild weakness to complete paralysis. Overall, your face will feel stiff or pulled to one side. Other common symptoms include:

  • Twitching
  • Weakness
  • Paralysis on one side of the face
  • Problems smiling or making facial expressions
  • Drooping of the eyelid and/or corner of the mouth
  • Difficulty closing your eye
  • Drooling due to a lack of control over the facial muscles
  • Difficulty eating and drinking
  • Dryness of the eye or mouth
  • Impairment of taste
  • Excessive tearing in one eye

Symptoms usually begin suddenly and reach their peak within 48 hours and often lead to significant facial distortion.

How is Bell’s Palsy diagnosed?

If you experience sudden facial paralysis it is imperative that you are properly evaluated as soon as possible. You should go to the emergency room immediately to be evaluated. The emergency room physicians can run a series of preliminary tests to see if a virus is causing your paralysis. However, many physicians do not have significant knowledge about facial paralysis and Bell’s palsy, so you should seek consultation from an ENT specialist or facial nerve expert. A Bell’s Palsy expert will perform the following exams and tests to determine the cause and severity of your facial paralysis:

  • A complete ear, nose and throat evaluation to make sure there isn’t an inner ear infection or any evidence of any head or neck tumor or malignancy.
  • A complete neurological evaluation.
  • Hearing test to see if there is any damage to your inner ear and hearing ability.
  • Vestibular test to make sure that the nerve balance is in tact.
  • Tearing test to evaluate the level of tearing function, as this can be indicative of a tumor.
  • A CT scan of the neck and temporal bone to rule out any tumors or trauma to the area.
  • An MRI exam of the internal auditory canal and brain to rule out any tumors such as acoustic neuroma.
  • An electrophysiologic test such as ENoG or EMG.

It is crucial that you seek out diagnosis and treatment immediately after the onset of facial palsy so that you do not increase your risk factors.

What is the treatment for Bell’s Palsy?

The treatment of Bell’s palsy varies depending on the patient’s symptoms and duration of the paralysis. If you develop Bell’s palsy you must be diagnosed as soon as possible, and other facial paralysis causes, such as tumors or trauma, must be ruled out before treatment can begin. Bell’s palsy needs to be treated right away with a high dose of steroids (prednisone), as well as antiviral medications (Famvir and Valtrex). Once the initial treatment has been administered, careful follow-up with Dr. Azizzadeh needs to be carried out for a year.

Botox injections are one of the most effective treatments for Bell’s palsy and synkinesis. It relaxes unwanted muscle movements on the normal side of the face, thereby reducing tension in areas of the face that are hyperactive due to the Bell’s palsy. Dr. Azizzadeh uses Botox to address asymmetrical facial movement in an innovative manner to create a more symmetrical facial movement and reduce signs of the facial paralysis.


In addition to treatment of the Bell’s palsy, Dr. Azizzadeh makes sure that the patient’s weakened eye is protected. Bell’s palsy can interrupt the eye’s natural blinking ability, leaving it exposed to irritation and drying. Dr. Azizzadeh instructs patients to keep the eye moist and protected from debris and injury to avoid further complications, such as loss of sight.

*In patients who are pregnant and are suffering from Bell’s palsy, extreme caution should be taken, and treatment decisions should be made in consultation with an OB/GYN.

What is synkinesis?

Patients who have Bell’s palsy typically develop some level of “synkinesis,” which occurs when a damaged nerve grows back into the wrong areas of the face, causing muscle response to be misdirected. For example, when a patient is trying to laugh or chew their eyes will close, or when they close their eyes their mouth may begin to twitch.

Bell’s Palsy vs. Facial Paralysis

It is extremely important to understand the differences between Bell’s palsy and facial paralysis. Facial paralysis is a general term given to all patients who have weakness of their face, including those suffering from Bell’s palsy, where as Bell’s palsy is a specific subset of patients who have facial paralysis that is a result of a virus. Thus, not all patients who are suffering from facial paralysis have Bell’s palsy.

If you or someone you know has experienced sudden facial paralysis, please call Dr. Azizzadeh’s office immediately to schedule an appointment. He is a renowned facial paralysis and Bell’s palsy expert in Los Angeles. His expertise in this disorder makes him sought out by patients from around the country. Dr. Azizzadeh is the author of several books profiling different facial plastic surgery and reconstructive procedures, including facial nerves and facial paralysis.

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