During a stroke, the face can droop on one or both sides. The eyelids and corners of the mouth may appear pulled down, and a person may be unable to smile or speak clearly.

A stroke happens when there is a disruption in blood flow to a part of the brain — either due to a clot or bleeding in the brain. The lack of oxygen-rich blood in a part of the brain causes cells in these areas to die, leading to impaired communication between nerve cells.

A stroke may cause facial drooping, paralysis, numbness, and vision difficulties. These symptoms can also affect other parts of the body, such as the arms or legs.

This article provides further information about stroke face symptoms and other potential causes of face drooping.

A diagram of the different symptoms of stroke.Share on Pinterest
Illustrated by Jason Hoffman

Stroke can cause facial drooping and muscle weakness that affects the eyes, lips, and mouth on one or both sides of the face.

Typically, stroke affects the lower part of one side of the face and not the forehead. However, if the stroke is in the brainstem, it may affect the forehead.

Stroke may cause:

  • pulling down of the eyelids, cheeks, or corners of the mouth
  • difficulty smiling voluntarily
  • involuntary appearance of smiling
  • drooling
  • slurred speech

Stroke can also cause other symptoms, such as:

  • numbness or weakness on one side of the body
  • sudden confusion or difficulty understanding speech
  • sudden difficulty seeing in one or both eyes
  • sudden difficulty walking or loss of balance and coordination
  • a sudden, severe headache

Some symptoms are more subtle. These include:

  • confusion, disorientation, or memory problems
  • general weakness
  • nausea or vomiting

The acronym F.A.S.T. is a helpful way to remember stroke symptoms:

  • F = face drooping
  • A = arm weakness
  • S = speech difficulty
  • T = time to call 911

If a person has sudden facial drooping or any other potential stroke symptoms, call 911 immediately.

The sooner a person gets medical attention, the sooner treatment can begin. This may save a person’s life and reduce the long-term impact of the stroke.

While waiting for the emergency services to arrive, a person can administer first aid by:

  • ensuring that the area around the person is safe
  • looking at a clock to see when symptoms began
  • talking to them and asking them to squeeze a hand if they cannot respond
  • loosening tight clothing
  • keeping them warm if they are cold
  • making sure they do not eat or drink anything

If the person is conscious, lay them on their side with their head on a pillow. If they are unconscious, place them in the recovery position.

It is important to monitor their breathing. A person can do this by listening to their breath, observing the rise and fall of the chest, or placing the back of a hand close to their mouth to try to feel their breath.

If the person is unconscious and not breathing, administer cardiopulmonary resuscitation (CPR). A 911 emergency responder can instruct someone with no CPR training on how to do this over the phone.

For people without training in CPR, the American Heart Association (AHA) recommend hands-only CPR, which involves pushing hard and fast in the center of the chest and avoiding mouth-to-mouth resuscitation.

Yes, the facial symptoms of stroke often improve over time, although the recovery process may take months or even years. Some people with these symptoms spontaneously recover from paralysis and other facial symptoms at 6 months post-stroke.

Physical therapy and rehabilitation programs can help people regain strength in the affected muscles and relearn movement patterns.

Facial drooping and paralysis do not always happen during a stroke. So, their absence does not mean a person cannot be having one. If other stroke symptoms are present, they may need emergency care.

However, facial paralysis, or palsy, is a common stroke symptom, which is why it appears in the F.A.S.T acronym.

According to a 2020 review, one study found that facial drooping occurs in 45% of stroke cases, while another found rates of 60% in people with first-time ischemic cortical stroke. This is a stroke that occurs due to a blocked blood vessel in the cortex, or the outer layer of the brain.

Stroke is not the only condition that causes facial drooping. Other potential causes include:

  • Bell’s palsy: This condition causes sudden and usually temporary one-sided facial weakness. It is responsible for 70% of cases of facial paralysis and typically improves over several weeks. Doctors may also call it “acute peripheral facial palsy of unknown cause,” as they are not always sure why it happens. Sometimes, a viral infection triggers the symptoms.
  • Injury: Roughly 10–23% of facial paralysis cases are due to fractures and wounds that damage the facial nerves.
  • Infection: The chickenpox virus, herpes zoster, can live in the nerves for years after the initial infection. It can then reactivate and affect the facial nerves. This is called Ramsay Hunt syndrome. Lyme disease is a bacterial infection that can also cause facial palsy.
  • Neurological conditions: Multiple sclerosis and myasthenia gravis may cause facial drooping.
  • Tumors: Rarely, tumors on the face or in the brain compress or damage facial nerves, leading to paralysis.

Stroke’s facial symptoms include drooping, muscle weakness, and paralysis. A person’s eyelids, cheeks, or mouth may droop on one or both sides, and they may have an involuntary smile or be unable to smile intentionally. The drooping may also cause difficulty speaking.

Facial palsy does not occur in all cases of stroke, so it is important to know all of the potential symptoms. An easy way to remember them is via the F.A.S.T. acronym. If a person could be having a stroke, dial 911 immediately.

Other causes of facial drooping include Bell’s palsy, trauma, infections, neurological conditions, and tumors.