Facial Exercises After Stroke

First, a new droop is not an exercise problem

Everything on this page is about facial weakness from a stroke that has already been diagnosed and treated. A face that starts drooping today, or a droop that suddenly gets worse, is a medical emergency. Call 112 or 108 for an ambulance straight away, especially if there is also arm or leg weakness, slurred speech, sudden vision loss or a sudden severe headache. Do not wait to see if it improves. The page on what to do when someone is having a stroke explains the first steps.

Why a stroke mainly affects the lower face

The muscles of the forehead get nerve signals from both sides of the brain. The muscles of the lower face, around the mouth and cheek, depend mostly on the opposite side. So when a stroke damages one side of the brain, the forehead usually still wrinkles normally while the mouth droops on the other side. Doctors call this central facial weakness.

This is one way it differs from Bell's palsy, where the facial nerve itself is affected and the whole side of the face, including the forehead and the ability to close the eye, is weak. The two are managed differently, so it matters which one you are dealing with. Families sometimes describe a facial droop due to a previous CVA years ago as "Bell's palsy from the stroke", and the exercises they have been given turn out to suit the wrong condition.

What the weakness changes day to day

The droop itself is the visible part. The everyday problems are usually more practical. Food collects between the cheek and gums on the weak side without the person noticing. Liquid dribbles from the corner of the mouth, particularly from a steel tumbler. Lips don't seal fully around a spoon. Some sounds, like "p", "b" and "m", come out softer. And many people feel self-conscious about their smile, enough to avoid photographs at family events or stop going out.

These problems often sit alongside speech and swallowing difficulties, which are more common when the stroke affects the left side of the brain and causes weakness on the right side of the body, though they can occur with either side.

Mirror work: the core of facial practice

Facial muscles are small, and the person often cannot feel what the weak side is doing. A mirror fills that gap. Sit upright at a table in good light, with a mirror at eye level, ideally a stand mirror so both hands are free. The person watches both sides of the face and tries to make them match.

The common mistake is effort. When the weak side won't move, people squeeze harder, and the strong side takes over and pulls the mouth further sideways. It's more useful to make small, slow, matched movements. Some people lightly hold the strong side still with two fingers so the weak side has to do the work. Short practice spells with rests in between tend to give better quality than a long session.

Facial exercises we commonly start with

These are examples, not a set programme. Which ones you use, how many and how often are decided after your physiotherapist or speech therapist has looked at the face, the lips and the swallow.

• Closed-lip smile: slowly draw both corners of the mouth outwards and slightly up, lips together, hold briefly and relax. Watch that the strong side does not race ahead.
• Lip press: press the lips firmly together as if holding a sheet of paper between them, hold, and relax. This helps lip seal for eating and drinking.
• Pucker: push the lips forward as if to whistle or blow out a diya, then relax.
• Cheek puff: with lips sealed, puff air into both cheeks and hold, then move the air from one cheek to the other. If air escapes on the weak side, help by holding the lip corner.
• Lower lip down: pull the lower lip down to show the bottom teeth, then relax.

Gentle stroking or tapping over the weak cheek and lip before practice can help some people feel the area better. Hard rubbing does not help and can irritate the skin.

Practice around meals and speech

The most useful facial practice often happens during ordinary activities, but eating carries risk. If there is any coughing during meals, a wet or gurgly voice after drinking, or a history of chest infections, the swallow must be assessed by a speech and language therapist before practising with food or drink. Read about swallowing problems and chest infection risk if you're unsure.

Once eating is cleared as safe, small habits help. Sit fully upright. Take small mouthfuls, placed on the stronger side if that's what the therapist advises. Check the weak cheek with the tongue, or a quick look in a hand mirror, after each few mouthfuls. A cup with a cut-out rim or a straw may reduce dribbling. Reading aloud from a newspaper for a few minutes, slowly, with clear lip movements, combines facial and speech practice.

Who covers what: physiotherapy and speech therapy

Facial rehabilitation sits between professions. A speech and language therapist leads on swallowing, tongue movement and speech clarity. Physiotherapists in neuro rehabilitation often work on facial muscle control, sensation, and the head and neck posture that affects the face and swallow. Occupational therapists help with eating aids and daily routines. The page on how occupational therapy and physiotherapy differ after stroke explains the split for other activities. What matters most is that everyone is working from the same plan.

Realistic expectations for stroke face recovery

Many people see the face improve over the first weeks and months, often faster than the arm or hand, but timing and extent vary a lot. Some mild asymmetry may remain, especially when the person is tired; families often notice the droop is more obvious late in the evening. That is normal and does not mean progress has been lost.

Recovery depends on repeated, accurate practice, which is why how the brain relearns movement applies to the face as much as to the leg. Facial exercises also tend to work best when they're part of a wider plan, with physiotherapy after a brain stroke covering the rest of the body and the broader stroke recovery guide for the overall picture. Low mood about appearance is common and real; emotional changes after stroke deserve as much attention as the smile itself.

Frequently asked questions