American Family Children's Hospital

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Facial Retraining

Contact Information

UW Health at The American Center: (608) 440-6440

Facial Nerve Clinic at University Hospital: (608) 263-6190



Retraining the Muscles of the Face

Facial retraining is a non-surgical approach to rehabilitation of facial paralysis. Patients with facial paralysis learn to re-establish and/or re-coordinate the muscles of the face through a series of individually-tailored movement patterns. Facial retraining patients work with an occupational therapist specifically trained in facial retraining techniques, to identify the facial muscles that are functioning incorrectly and teach strategies that will normalize function as much as possible.


Who will benefit from facial retraining?


Patients who will benefit from this therapy may have facial paralysis from the following causes:

  • Bell's Palsy, a disorder caused by viral damage to the seventh (facial) cranial nerve
  • Acoustic Neuroma, a benign tumor that disturbs the auditory or eighth cranial nerve
  • Traumatic injuries to the facial nerve
  • Ramsay Hunt Syndrome
  • Some forms of congenital facial paralysis

Initially, with facial paralysis, the muscles on the affected side of the face become paralyzed and are unable to move. As paralysis subsides, the facial muscles often behave incorrectly, resulting in facial tightness, spasm or unwanted muscle movement, called synkinesis. The goal of facial retraining sessions is to train the facial muscles to once again work in the coordinated manner to which the patient is accustomed.


Training Sessions


Facial retraining sessions consist of the following elements:

  • A comprehensive evaluation, which includes photographs, videotape and a review of the facial muscles. Patients are taught about the function of each individual muscle group and a set of individually-tailored massages and exercises are developed to practice on their own.
  • A review of the aforementioned lessons and work with the therapist to determine which exercises are most effective.
  • A final, extensive review of the activities is accompanied by the formulation of a plan for future, at-home work with which the patient is comfortable. Follow-up is determined on an individual basis.

Before and After Photos


The images below show the effect facial retraining can have on patients with facial paralysis.


Before Facial Retraining After Facial Retraining

UW Health Facial Retraining images: Before and after shots

UW Health Facial Retraining images: Before and after shots

UW Health Facial Retraining images: Before and after shots

UW Health Facial Retraining images: Before and after shots



Examples of Facial Paralysis



Flaccid Facial Paralysis

UW Health Facial Nerve Paralysis: Flaccid facial paralysis

Facial paralysis causes weakness to many muscles of the face. In flaccid paralysis, all muscle tone is lost and no movement exists, resulting in eyebrow and lower eyelid droop, inability to close eye, midface sagging, nasal twisting and obstruction, lower face droop with sagging at the corner of the mouth, difficulty eating, and inability to smile.


Synkesis After Facial Paralysis

UW Health Facial Paralysis: Synkinesis

Although many patients with flaccid facial paralysis will see improvement, sometimes the facial muscles can "over-correct" causing the face to become tight, stiff or "heavy". The eye may appear small. The crease between the side of the nose and corner of mouth (nasolabial fold) may seem deeper than the unaffected side.  In some cases, the facial nerve can heal improperly causing muscles to contract out of sequence at the same time. For example, the eye may close during a smile or pucker, or the cheek may pull up when the eye closes. This improper movement, called synkinesis, can result in uncoordinated or distorted facial expression.