Smiling is essential to life... To communicate happiness, demonstrate agreement, satisfaction and that what we are hearing or seeing is funny or pleasant.
Could you imagine a world where no one can or is able to smile?
Smiling is essential...
This can become more of a reality when once is affected by Bell's Palsy and most would do anything to see their lips pull up and out.
Working directly with Bell's palsy sufferers for many years, I know firsthand that regaining the ability to smile is for most a priority. There is a connection between our emotional well beings, our social lives and the ability to smile. For many, not being able to smile is downright depressing and affects them psychologically, bringing on more stress.
So, how does one retrain their face to smile again? What exercises or hands-on technique one can use, at home, to improve and regain their smile, and what should you pay attention to and not overlook?
Smiling, and full smile, are often the last movement to return after a bout of Bell's Palsy. For many, their full smile is never regain as the excursion of the lips does not return... Sometimes because the retraining was abandoned too early in the recovery process or not performed appropriately.
I conduct surveys and ask the question on my Facebook Group, The Bell's Palsy Solution, about what people want to learn or are most interested in learning... and Smiling always come to the top of the list.
This will help with loosening tight (fibrotic) tissue that can be found on the paralyzed side due to lack of contraction and movement of the muscles. But also stretching your non involved side is also good practice as that side is doing all the work, most likely and often for weeks and months at a time, creating a big imbalance in the tension of the musculature in your face.
The extra and abnormal tension of the non-involved side is often responsible for the asymmetry of the mile , or any facial motion, and with which you see a significant pull of the involved side to the non involve side.
I will now go over some techniques to address this... (along with things discussed in this post)
Once you start to seeing a little bit of movement with your smile, then you can really get involved with retraining your smile to address the strength and endurance of the zygomaticus major, and all the other muscles that will help you get smiling again.
What do I need to know to retrain my smile correctly? What should I consider?
1. Smiling with your mouth closed, is much easier than with it opened. Don't start training a full / open mouth smile. Instead, just start with a small, excursion, non forced, smirk. This will start engaging and isolating your smiling muscles without forcing other part of your face to contract ( which is what you want in order to avoid retraining your face into synkinesis).
It will also be less frustrating to practice this smile as you will see more progress at first than with mouth opened. Once you start having more excursion of the lips outward with symmetry and no pulling from the strong side, you can start working on mouth opened smile.
2. One thing that is paramount when you are retraining a facial motion, is that you should be retraining each muscles individually. That is, do not combine practicing smiling while trying to close your eyes, frown or raise your eyebrow at the same time. Many have tendencies to trying to contract their facial muscles as hard as they can and all together ( mass contraction), and this only encourages more recruitment from the other facial muscles, and so this practice should be avoided at all cost.
3. To be more specific with the intensity of practicing your smile, I would recommend keeping that contraction to mild. On a scale of 0-100%, 100 being the hardest you can contract your muscles ( again, do not that!), I would shoot for a 25% intensity. And again, the reason behind that is to prevent mass contraction of your face.
4. If you feel tightness, twitching, contracting or stretching activity anywhere in your face, either on involved or uninvolved side, when you (attempot to) smile besides on the zygomaticus major, I would suggest your massage/rub/stretch that very area for a few minutes and then re-attempt smiling. If you still feel that area after that, massage it as you re-attempt smiling and perform your whole two sets of
How should I massage my face to improve my smile?
Your smile, even though directly control led by the zygomaticus major, will be affected by other muscles and area of the face. For example, various tight areas around the lips/ mouth and between the eye and upper lips will prevent a smile if they are tight. Addressing multiple areas provides you with the best chance to improve your smile as rarely is there only one tight spots in your face when you have been dealing with facial paralysis.
One such area is the chin, which many people overlook and can really be tight and prevent symmetry of the mouth/lips with your smile. The mentalis muscles attach there and is your "pouting" muscles. This is one way to massage it:
Addressing the zygomaticus major directly is also not a bad idea sinc eit is the prime one controlling smiling. Massaging the zygomaticus major( from cheekbone to corner of the mouth ) from top to bottom, and also bottom to top to improve its mobility works out well. ( seen in the first video on this post.)
Not to be forgotten and slightly more aggressive: massage and stretch from inside the mouth!
These can be highly effective. Wash your hand first or wear gloves though!
1. Thumbs on the inside of your upper lip on the involved side, stretching downward, hold for 30 seconds. Repeat 3-5 times.
2. In the same manner, stretch your upper lip toward your non involved side, hold for 30 seconds. Repeat 3-5 times.
3.Massaging your cheek from the inside is highly beneficial. Just slightly pinch cheek between thumb and index and knead down toward your mouth.
Now, to work on the actual motion of smiling, after having stretch and massage as previously described, remember of the point brought up earlier. Easy does it. No need to force a smile. Just think about smirking.
Even if you feel contraction/movement but are not seeing any movement1
1.Initiate a smile, mouth closed. But again think smirk so you don't over do it.
2.Hold smile, and place a finger at corner of your mouth, pulling gently in the direction of a smile
3. Hold for at least 10 seconds, Repeat ten times. Take a break. Repeat for another set of 10.
For more specifics, please watch the first video in this post.
Being struck with Bell's palsy is a challenge most would never choose.
But regaining your smile is possible... It just takes time, dedication and work.
I hopefully gave you some idea of what to address and work on.
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Pierre-Yves Butheau, MPT, CMP has been a physiotherapist for 19 years and has a passion for helping people move better, return from and prevent injuries, as well as improve their function and quality of life. He has a strong interest in addressing the root cause of and treating neuro-musculoskeletal conditions while educating his patients with the knowledge to manage their conditions and prevent recurrence. Pierre also has a niche in treating Bell's palsy and temporomandibular joint dysfunctions.