Synkinesis After Facial Palsy: Causes, Symptoms and Rehabilitation
Why does your eye close when you smile after facial palsy? Learn what synkinesis is, when it appears after Bell’s palsy, and how neuromuscular retraining helps.
Months after facial nerve palsy, some people notice something strange: when they smile, their eye narrows; when they close their eyes, the corner of the mouth lifts. This is called synkinesis — one of the complications that most needs clear understanding and specialist rehabilitation.
What is synkinesis?
Synkinesis is an involuntary movement in one part of the face that happens with a voluntary movement of another part. Common forms:
- The eye closing or narrowing when smiling or eating.
- The mouth corner lifting when closing the eye.
- Tightness in the neck or chin with facial movements.
- Tearing while eating (“crocodile tears”).
- Constant tightness and stiffness on the affected side.
Why does it happen?
When the facial nerve is damaged, its fibers regrow. Sometimes fibers reconnect to the wrong muscles, so a “smile” signal also reaches the eye muscle. Synkinesis is therefore a sign the nerve is recovering — just not in a perfectly organized way.
When does it appear, and who is at risk?
- Usually several months after onset, as movement returns.
- More common after complete or severe palsy, or slow recovery.
- May be encouraged by forceful, exaggerated exercises early on.
How is synkinesis treated?
- Neuromuscular retraining — the cornerstone, led by a facial-palsy physiotherapist. You learn to separate movements with conscious control: slow, small movements in the mirror, one movement at a time while the rest of the face stays relaxed, stopping just before the linked movement starts.
- Massage and stretching of tight muscles, especially around the mouth and cheek.
- Botulinum toxin — small doses given by a specialist to relax overactive muscles, usually combined with rehabilitation.
- Surgery — a rare option for selected cases.
Mistakes that can worsen synkinesis
Forceful exercises and squeezing, chewing gum for hours as “exercise”, and electrical stimulation without specialist supervision. See common facial palsy mistakes.
How Raq helps
Raq is built around calm, precise exercises with video and voice guidance, plus real-time AI guidance through your camera that helps you perform each movement correctly. Practicing this way from the start matters. Begin with our facial palsy exercise guide.
Frequently asked questions
Does synkinesis mean my condition is getting worse?
No. It shows the nerve is regenerating, but some fibers reconnected to the wrong muscles. It can improve a lot with specialist rehabilitation.
Can synkinesis be prevented?
Not always, but avoiding forceful exercises and unsupervised electrical stimulation, and practicing precise, symmetrical movements, may reduce its severity.
When should I see a specialist?
If you notice facial tightness, your eye closing when eating or smiling, or tearing while eating, see a physiotherapist specialized in facial palsy.
Sources & references
- Facial Palsy UK — Information and support
- Physical therapy for Bell's palsy — Cochrane Review (Teixeira et al.)
- NHS — Bell's palsy
Educational content by the Raq team, based on trusted medical sources.
