Facial Paralysis and Pictures


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Pictures capture the memories of life – both significant and small. For Acoustic Neuroma survivors, it also causes serious stress and angst. We WANT to be in pictures, people in our lives encourage us, we cooperate, and are then frequently horrified by the results.

First, the facts.

Smiling intentionally and smiling spontaneously are two different things. How often do you walk around with a smile like in pictures? Our cheeks would ache and we would appear insincere. We move our mouths normally all day with minimal movement, and then say “CHEESE” with huge movement when a camera appears. So if you think about it, you’ll start to notice the distinct change in others’ faces at that moment that the camera appears.

The mechanics of smiling

Our Eyes – We smile with our eyes as much, or even more than our mouths. Technically, the twinkle in the eyes of someone who is genuinely happy is caused by tear layer being compressed with slightly squinted eyes, which causes more reflection in the thicker layer of fluid.

Our Cheeks – We smile with our cheeks. A spontaneous smile originates when our cheeks lift our lips.

What?  – There’s two ways to smile if you really think about it. Try it in front of a mirror. If we force a smile, it is using the muscles around our mouth. Those muscles are frequently suffering from a combination of paralysis and synkinesis following brain surgery. However, If we try to ignore our mouths and think happy thoughts and let our eyes smile, our cheeks pull up our lips. Subtle, but worth thinking about.

When the pictures come – We are accustomed to seeing ourselves in a mirror. Pictures show us as others see us, which is different. We might think we look okay in a mirror only to be horrified when we see a picture. The more symmetrical one’s face is, the more familiar their face will be in pictures. Since paralysis and synkinesis causes asymmetry, we then look very different to ourselves in a picture. So, when the pictures come, or someone hands you their camera phone, hold it up to a mirror and look at it in the mirror. You might be surprised. It doesn’t change the picture, but it lets you see yourself in the way that you are accustomed to.

Positioning – Huge life moments happen that we want to remember, but we cringe about having our picture taken.  That’s where positioning comes in. In a formal picture setting, quietly mention to the photographer that you have a legitimate issue with your face and could they keep that in mind when positioning. I did that at my daughter’s wedding and was very pleased with the outcome. I’m turned so that the good side of my smile shows, and the “bad” side is turned away from the camera.

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Kendra’s wedding

If you are in a candid setting, don’t lose the moment! Turn your face a bit to the side, or hold something in front of your bad side. I have a picture with my grandson where he is holding a balloon. You can only see the top half of his face and one side of mine. It is very cute with us peeking around the balloon. I’ve held a wine glass up (cheers) to cover half my face or the corner of my mouth.  When my face was fully paralyzed on the right side, I turned totally sideways in front of the ocean. You see my profile with wind blowing my hair over the good side of my face. I love the picture. For me, it captures my pleasure at surviving, walking, and breathing ocean air. Call it art if you don’t consider it to be a portrait. . .


Ocean Air and Wind

Smile small – I hate it when I pose for a picture and someone I don’t know says “smile bigger!” I just say, “This is all you’re going to get.” A small, pleasant smile can minimize the two sides and look quite nice.

Makeup – Here’s a bonus for the ladies: A couple of things that can be done to help symmetry is to part our hair so that it draws the eye to the “normal” side of our face. Contrary to what you would think, you want the part of your hair on the paralysis side. Also, if you put lower eyeliner above the lashes on your larger looking eye, and under the lashes on the smaller looking eye, they will look better. On your lips, put lipstick on, but then add a touch of shiny gloss on the skinnier side of your upper lip. That will cause a slight optical illusion.

SO. . .

Even with these tips, there are times when you need to forget facial issues and “just” smile, let a picture be taken, and embrace that we are unique. It’s okay.  There’s much more to us than our faces.  There are many ways to show love, pleasure, or acceptance beyond a facial expression.


17 thoughts on “Facial Paralysis and Pictures

  1. rocksand5

    This is such a good piece! Your advice is wonderful for anyone but especially those struggling with asymmetric issues caused by strokes or brain surgery. Well done.

  2. Helen McHargue

    Sally…this is so interesting. I think we should have a local support group meeting with “Smiling” as the
    subject matter. I love that photo of you with your hair blowing!

    1. sallystap Post author

      Candy – I understand completely. Nobody really gets it until they live it. With time, I’ve learned to focus on the beauty of life and relationships instead of appearances, but it is a challenge. Thank you for your comment

  3. Suzanne B

    Thanks Sally! This could not have come at a better time. I am scheduled for part 2 of a facial reanimation procedure in two weeks and have my son’s wedding in 10. I have already used some of the tricks and tips you’ve offered here, but now have a few more from which to pick from for the big day. Love the wine glass idea!!

    1. annette

      Sally – Your blog is fantastic, very moving, informative and uplifting:)

      I had facial reanimation surgery at Duke University in 2007 at age 46 by Dr Jeffrey Marcus. The surgery was a success! (At birth, high forceps were used which servered my 7th cranial nerve causing paralysis on my left side of my face, my eye functioned properly.)

      Note: The link below is for a the Yahoo Facial Paralysis Group on Yahoo and I have pictures posted there as well, before and after surgery.

  4. Wanda

    Greetings Sally:

    I was informed of your blog several months ago and Helen reminded me again today, given your post on how to deal with photos. Wonderful ideas for all my facial palsy friends; suggestions best transmitted from someone with first-hand experience. May I share your blog with my clients and place a link to your blog on my website? Thank you for the great support you provide.

    1. sallystap Post author

      Hi Wanda, Thank you for your note. Yes, please feel free to share and put a link to my blog on your website. I hope it helps someone right when they need it! Sally

  5. Tammy

    Thank you so much! It’s so wonderful to read the words from someone who gets it! I had my surgery at 35, and almost 13 years later, it isn’t any easier to see photos of me.Before my surgery, I was frequently complimented on my smile and my eyes. I’ve only had one compliment on my eyes and obviously none on my smile in 13 years, yet, I continue to go into my high school classroom every day and try to give my all for my students. Thank you for writing.

  6. Laurie Martinez

    This is good information. I was born with facial paralysis and am very insecure when I need to have my pictures taken. You have good advice on how to take pictures. It is nice to know others go through the same challenges that I am going through. I am 51 years old and have lived with paralysis, and it is no easy road. I count my blessing because things could be worse. I have two beautiful children and a wonderful husband. I have a career that I absolutely love. I am thankful every day for what I have. The paralysis is part of me, however it does not define me.
    Taking pictures is one thing I hate, because I see all those flaws and I don’t like it. My daughter is getting married in a year and I need some tricks for pictures so my bad side is not as apparent.

  7. Leigh

    My son has 7th cranial nerve paralysis from birth. He doesn’t like taking pictures and we often try to help him find a way to smile that he can be happy with in photos. Breaks my mama heart sometimes.

    1. sallystap Post author

      Yea, it is hard. Hang in there. Remind him that a smile is seen in his eyes. Get creative! I look back and laugh at some of the ways I “hid” my face in pictures.


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