Expressing Facial Emotions with Facial Paralysis

How Can Facial Paralysis Patients Express Facial Emotions?

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People use facial emotions to express how they are feeling without saying a word. A facial expression makes it easy to show happiness, sadness, and other emotions. Yet, for people coping with facial paralysis, it can be virtually impossible to use facial expressions to show how they are feeling.

An inability to express emotions can be problematic, particularly for people who experience Bell’s palsy, synkinesis, or other forms of facial paralysis. In some instances, facial paralysis patients who cannot make facial expressions isolate themselves because they feel embarrassed or ashamed of their condition. But, treatments are available to help reduce or eliminate facial paralysis symptoms ⁠— and ensure people dealing with facial paralysis can get the help they need to produce facial expressions once again naturally.

Now, let’s examine facial emotions and paralysis in detail. That way, people can understand the impact of facial palsy on an individual’s ability to produce facial expressions. They can also gain insights into facial paralysis and how to treat facial palsy symptoms.

What Are Facial Emotions?

Facial emotions play key roles in human communication. They involve muscle movements that people use to express how they feel, along with thoughts and ideas. 

There are seven basic facial expressions of emotion:

• Happiness
• Sadness
• Fear
• Disgust
• Anger
• Contempt 
• Surprise

Biologist Charles Darwin first suggested the basic facial expressions of emotion are the same among all people around the world. Furthermore, research indicates these facial emotions may be biologically hardwired into people. 

Initially, facial emotions helped human beings express imminent behaviors. These emotions helped people to connect with and learn from one another. 

Over the years, the use of facial expressions has evolved. Today, certain cultures leverage various social rules to manage their expressions of emotion. 

Meanwhile, researchers continue to study emotions for facial expression. They also have investigated the relationship between facial and emotional paralysis. 

Emotional Impact of Facial Paralysis

Facial and emotional paralysis can occur in combination with one another. Following the loss of facial expression, people can experience any of the following mental health issues that result in emotional paralysis. 

1. Depression

Depression affects millions of people globally, but the mental health disorder may go undiagnosed and untreated, especially in facial paralysis patients. If a facial paralysis patient can identify the signs of depression, this individual can take steps to quickly and safely address them.

The emotional impact of facial paralysis can trigger sadness, loneliness, and other depression symptoms. It may also cause a facial paralysis patient to experience headaches, weight gain or loss, or other physical symptoms of depression. If the patient tries to ignore their depression symptoms, it may be challenging to work, go to school, and perform other everyday activities.

2. Anxiety

Anxiety is common for people at all stages of life. Similarly, people can experience an anxiety disorder due to facial paralysis. In these instances, people can become overly worried about their facial palsy and its impact on their facial appearance. This can lead to repeated and intense feelings of anxiety. It can even contribute to panic attacks. 

A Myriad of anxiety disorders can occur in accordance with facial palsy as well. For example, social anxiety disorder can arise, which leads people to experience high levels of anxiety in social settings due to facial paralysis or other factors. 

3. Stress 

Stress can cause people to feel overwhelmed and unable to deal with the pressure of everyday life. Facial paralysis can cause an individual’s stress to escalate. At this point, an individual may be more prone to disengaging from social situations due to stress over their facial appearance. He or she may experience difficulty sleeping and various stress-related health issues as well. 

Impacts of Facial Paralysis — Social and Psychological 

Along with its emotional effects, facial paralysis can have social and psychological impacts on patients and those associated with them. The social and psychological impacts of facial paralysis include:

1. Family

There is a range of experiences for all families and in constructive scenarios. Parents, spouses, and siblings will support a loved one dealing with facial paralysis in any way possible. Family members may provide a listening ear to ensure a facial paralysis patient can share their concerns as well as educate themselves on facial paralysis and the existing treatments. In this way, loved ones may not only help a facial paralysis patient with emotional awareness and expression therapy but also assist in the pursuit of treatment options.

Family members may experience adverse social encounters and need to explain the symptoms of facial paralysis and that they are due to a facial paralysis patient’s inability to make facial expressions or recognize different types of facial expressions. In certain instances, family members may receive questions about a loved one coping with facial paralysis; this is where personal education on the topic of facial paralysis can be helpful for the family as a whole. Family members should also be aware and prepared that their relative coping with facial paralysis may be susceptible to name-calling, bullying, and other criticism.

Family members may do their best to teach a loved one dealing with facial paralysis how to express emotions, and their best efforts may be unsuccessful at times. This may be due to the severity of a facial paralysis patient’s conditions and not a failure on anyone’s part. However, in these instances, family members may feel frustrated due to their inability to help a loved one overcome their facial paralysis. And while no two familial experiences are exactly the same, these key points of awareness can be helpful in supporting a patient with facial paralysis.

2. Friendships 

Facial paralysis can be difficult to understand, particularly for children. As such, kids who experience facial paralysis symptoms may have trouble relating to other children. This can lead kids with facial paralysis to isolate and can hinder their ability to make friends.

Moreover, children who experience drooping on one side of the face, an asymmetrical facial appearance, or other facial paralysis symptoms may look different from their peers. This may make children dealing with facial paralysis susceptible to name-calling and bullying.

3. Dating

Dating can be rewarding, but it can be tough for a facial paralysis patient to put their best foot forward. Although two people may establish an emotional connection when they engage in phone conversations or online chats, they eventually will meet face to face. At this point, a facial paralysis patient may be fearful of how a potential partner will perceive him or her. This may lead the patient to avoid dating and other social activities.

Facial paralysis can lead to low self-esteem as well. If facial paralysis patients believe they are “undateable,” they may withdraw from the dating scene.

4. Work

People who experience facial paralysis may be required to give presentations or engage with colleagues at work. If workers feel uncomfortable with a facial paralysis patient’s symptoms, they may try to avoid this individual. These workers may look to others for help to complete various work tasks, which can hamper a facial paralysis patient’s career growth.

A facial paralysis patient may need to give presentations or attend public-facing events as part of their job. If the patient feels insecure or fearful of how others may perceive their facial paralysis symptoms, this individual may do everything possible to avoid these interactions.

Facial paralysis can have long-lasting effects. If people understand the different types of facial paralysis, they can work toward alleviating their facial paralysis symptoms.

Types of Facial Paralysis

Common types of facial paralysis include:

1. Bell’s Palsy

Bell’s palsy causes a sensation that causes facial drooping, jaw pain, and other physical symptoms. The condition results in immediate facial paralysis, with symptoms that generally disappear on their own within approximately three months of onset.

2. Synkinesis

Synkinesis refers to abnormal synchronization of facial movement. It can cause facial muscle tightness, spasms, and related issues. Synkinesis patients may also be prone to drooping at the corner of the mouth, which prevents them from producing a natural-looking smile.

3. Congenital Facial Paralysis

Congenital facial paralysis begins at birth. The condition can occur in combination with a cleft palate, deformed extremities, and other physical problems. It can hamper a newborn’s ability to open and close the eyes and nurse. If congenital facial paralysis remains untreated, it can affect a child’s speech and emotional development.

4. Ramsay Hunt Syndrome

People can experience Ramsay Hunt syndrome due to shingles that compromises the facial nerve. In this instance, Ramsay Hunt syndrome can cause facial paralysis that impacts an individual’s ability to display facial emotions. The syndrome can also cause hearing loss on the paralyzed side of the face and a blister-like rash near the ear.

5. Moebius Syndrome

Moebius syndrome is a congenital condition and occurs due to the underdevelopment or absence of the sixth and seventh cranial nerves. The condition can impact an individual’s ability to produce facial expressions and open and close the eyes. It can also result in skeletal, respiratory, and speech problems.

The aforementioned conditions can cause facial paralysis and hamper an individual’s ability to display as well as recognize facial emotions. With proper diagnosis in their early stages, people can treat these conditions to reduce long-lasting side effects. 

Symptoms of Facial Paralysis

In addition to a loss of facial expression, there are many symptoms of facial paralysis. These include: 

• Facial drooping
• Headache
• Loss of taste
• Drooling
• Jaw pain
• Increased sensitivity to sound
• Changes in tear and/or saliva production

Facial paralysis symptoms can affect individuals of all ages, and they can occur without notice. At the first sign of facial paralysis symptoms, it is vital to explore medical treatment. That way, a facial paralysis patient can receive medical support to correct their symptoms and prevent them from recurring.

What Is the Best Treatment for Facial Paralysis and Loss of Facial Emotions?

People dealing with facial paralysis and an inability to produce facial expressions must receive extensive testing. This ensures facial paralysis patients can receive a personalized treatment plan.

A facial paralysis treatment plan can consist of surgical or non-surgical procedures. Facial paralysis surgeries like selective neurolysis and a nerve transplant can be used to help patients regain the ability to naturally move the facial muscles. Botox and other non-surgical procedures can be used to relax unwanted facial muscle movements that contribute to facial palsy. 

Pursuing physical therapy can be beneficial as part of a facial paralysis treatment program as well. Physical therapy lets a facial paralysis patient learn exercises that he or she can use to improve facial muscle coordination. The therapy is commonly utilized following a facial paralysis procedure. It ensures a patient will have no trouble producing their facial emotions in the months and years after their facial paralysis treatment. 

Facial paralysis patients may qualify for surgical or non-surgical treatment options. Regardless, they may need additional support to deal with the emotional, social, and psychological impacts of treatment. 

Meeting with a mental health counselor can help a patient manage the emotional, social, and psychological side effects of a surgical or non-surgical procedure. A counselor can offer insights to ensure the patient becomes more comfortable and confident in their facial appearance than ever before. If a patient encounters any challenges during their treatment recovery, this counselor can provide support during their journey. 

In certain instances, facial paralysis symptoms can be permanent. For people coping with long-term facial paralysis, they must find healthy ways to manage their condition. With the right approach, these individuals can discover the best ways to compensate for their facial paralysis symptoms. 

How People with Facial Paralysis Adjust

There is no one-size-fits-all coping mechanism for facial paralysis patients. In addition to its physical toll on the muscles of facial expression, facial paralysis can have far-reaching effects on emotional and psychological wellbeing. These effects can be significant, and people may consider other ways to compensate for their facial paralysis symptoms.

An Oregon State University (OSU) study published in Health Psychology highlighted the impact of facial paralysis on patients who acquired facial paralysis as adults. The patients’ average age was 45 years old, and the patients were compared against adults who experienced facial paralysis starting at birth.

The OSU study revealed facial paralysis caused physical discomfort and pain and made it difficult for these patients to speak, eat, drink, and produce facial expressions. It also indicated that these patients were forced to deal with discrimination.

Discrimination is illegal, but the OSU study indicated patients who acquired facial paralysis were turned down for public-facing jobs and leadership roles. These patients were often perceived as unfriendly or uninterested on account of their difficulty expressing emotions. They also experienced depression and anxiety at higher rates than congenital facial paralysis patients.

No specialized therapies are available to help patients who experience psychological distress due to facial paralysis symptoms, OSU College of Liberal Arts researcher Kathleen Bogart noted. However, Bogart recommended support groups and communication training to help these facial paralysis patients struggling with facial expressions and nonverbal communication.

The emotional impact of facial palsy was also evaluated as part of a study published in Laryngo-Rhino-Otologie in 2013. This study showed patients experienced emotional issues during acute and chronic phases of facial paralysis.

In the study, researchers found patients frequently felt “negatively” about themselves, even when they tried to smile. Most of these patients experienced stress, anxiety, and depression related to the challenges of facial expression in communication. They often took steps to avoid social settings as well.

The key takeaways from both of the studies: it can be tough to compensate for facial paralysis. The effects of facial paralysis extend beyond a patient’s inability to make facial expressions. Therefore, those who experience facial paralysis require extra help to cope with the condition’s emotional impact.

Learning to Recognize Facial Emotions in Others

Facial expression recognition can play an essential role in a facial paralysis patient’s ability to cope with the emotional effects of their condition. With the ability to recognize facial expressions in others, this patient can use their tone of voice, hand gestures, and other forms of nonverbal and verbal communication to engage with others.

Reading facial expressions requires hard work and patience, regardless of whether an individual is coping with facial paralysis. The first step to effectively read facial emotions is to understand the seven basic facial expressions of emotion.

The universal expressions are displayed in a person’s words, along with their eyebrows, eyes, and other facial expressions. In order to identify these expressions, it is crucial to listen attentively when others speak. This helps facial paralysis patients show others that they are interested in a conversation. It also allows facial paralysis patients to watch for a wide range of facial expressions.

There are many micro-expressions associated with universal expressions as well. These include:

Fear

• Eyebrows appear raised and close to one another as if they are in a flat line
• Wrinkles are present across the forehead, between the center of the eyebrows
• Upper eyelid is raised
• Mouth is open and lips appear drawn back

Disgust

• Eyes appear narrowed
• Upper lip is raised
• Nose is wrinkled
• Cheeks are elevated

Contempt

• Face appears unilateral
• Corner of the lip raised on one side of the face

Anger

• Vertical lines form between the eyebrows
• Eyebrows are lowered
• Lips appear pressed close together
• Nostrils look dilated

Sadness

• Corners of the lips are angled downward
• Lower lip appears pouty
• Jaw is elevated

Happiness

• Cheeks appear elevated
• Corners of the lips are raised
• Teeth may be exposed

Surprise

• Eyebrows are curved and raised
• Eyelids are wide open
• Horizontal wrinkles appear on the forehead

The ability to identify a facial expression in a family member, friend, or colleague can help patients socialize in spite of their facial paralysis symptoms. Over time, a facial paralysis patient can become well-equipped to recognize the emotions associated with facial expressions as well as learn different ways to convey their own emotions. As the patient implements these learned ways to identify and communicate emotions, it can become possible for them to reduce the impact of facial paralysis on their emotional wellbeing.

Raising Awareness of Facial Paralysis Symptoms 

There are several ways facial paralysis patients and others can promote facial palsy awareness to minimize the emotional, social, and psychological effects of the condition. Some of the ways to raise facial paralysis awareness include:

1. Learn About All Aspects of Facial Paralysis

Facial paralysis is complex, and it can affect people in a variety of ways. But, a stigma persists surrounding facial paralysis that impacts the wellbeing of facial paralysis patients, their families, their friends, and others.

Education offers a great option to combat the stigma surrounding facial paralysis. People who learn about facial paralysis can better understand the condition, its symptoms, and its short- as well as long-term impact on their friends, associates, family members, or themselves. They can also review resources to understand how to cope with facial paralysis.

2. Speak Up About Facial Paralysis 

Providing others with insights into facial paralysis can help put the stigma surrounding the condition to rest. If people understand facial paralysis, they can help those coping with the condition and its side effects.

A facial paralysis patient may benefit from sharing details about their condition with family members, friends, and others. This can help reduce the risk that others may be wary of asking questions about facial paralysis; instead, it encourages them to ask questions and learn as much as possible about the condition.

3. Get Support 

Family members, friends, and other loved ones want to help a loved one coping with facial paralysis. If a facial paralysis patient feels depressed due to their symptoms, they can reach out to these loved ones for emotional support. In doing so, a facial paralysis patient can express their feelings to a loved one and find ways to cope with their condition.

Meeting with a mental health professional may benefit a facial paralysis patient, too. A mental health professional can provide tools and strategies to help manage depression and other emotional side effects of facial paralysis.

4. Explore Medical Treatment Options 

Facial paralysis is treatable, and people dealing with the condition can get medical assistance. Remember, the sooner facial paralysis treatment options are explored, the sooner a patient can correct their symptoms.

Keep in mind that medical treatment varies based on the patient, the severity of their facial paralysis, and other factors. Each treatment is customized to a facial paralysis patient. A patient can receive comprehensive medical assistance to address their symptoms by meeting with an expert facial paralysis surgeon.

5. Become a Role Model for Others

Facial paralysis may impact the ability to make a facial expression, but people should not let it prevent them from living their best life. So, a facial paralysis patient who tries to live life to the fullest extent every day can set a positive example for others coping with the condition.

Finally, facial paralysis is a medical condition that cannot be avoided or prevented. At the same time, facial paralysis does not define a person; people can choose how to define themselves. If facial paralysis occurs, people should do their best to educate themselves, explore their options, and find support in order to better cope with their condition. With this approach, they can show others that facial paralysis may limit their facial muscle movements, but it does not affect their ability to enjoy life.

Conclusion

Smiles, frowns, and other facial expressions tell a story without words. Facial expressions are simple yet meaningful communication tools that allow people share their feelings and can even help transform an ordinary conversation into a memorable one.

Facial paralysis patients may struggle to produce facial expressions. In some cases, Bell’s palsy or other forms of facial paralysis can limit facial muscle movement and possibly reduce the patients’ ability to identify emotive expressions in others. Further, it can produce a simultaneous experience of interpersonal and intrapersonal obstacles that result in emotional, social, and psychological side effects for the patient. 

The Facial Paralysis Institute in Beverly Hills is committed to raising awareness of facial paralysis. Dr. Babak Azizzadeh is a globally recognized facial plastic and reconstructive surgeon, and he can evaluate a facial paralysis patient and determine a safe, effective way to address their symptoms. He can also provide personalized treatment programs to help facial paralysis patients better their ability to make natural facial expressions.

Dr. Azizzadeh is happy to discuss facial paralysis treatment options. To learn more or to schedule an in-person or virtual consultation with Dr. Azizzadeh, please contact us online or call us today at (310) 657-2203. 

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