Quick answer
When people search for “Lyme disease face,” they usually mean facial palsy: sudden weakness or drooping on one or both sides of the face caused by Lyme bacteria affecting the facial nerve. It looks much like Bell’s palsy. With antibiotic treatment, most people regain full or nearly full facial movement, usually gradually.
- CDC lists facial palsy, a loss of muscle tone or drooping on one or both sides of the face, among the later signs of Lyme disease that can appear days to months after a tick bite.
- About 9 of every 100 Lyme cases reported to CDC include facial palsy.
- CDC lists oral doxycycline for 14 to 21 days as the treatment for Lyme facial palsy in adults and children.
- If the eye on the affected side cannot fully close, eye drops or an eye patch may be needed to keep it from drying out.
What Lyme facial palsy looks like
Facial palsy happens when the facial nerve, which controls the muscles of expression, stops working properly. With Lyme disease, the bacteria can reach this nerve as the infection spreads through the body. This is part of what doctors call neurological Lyme disease.
Changes people may notice include:
- one side of the mouth drooping, or a smile that pulls to one side
- trouble closing one eye fully, or blinking less on one side
- food or drink escaping from one corner of the mouth
- a flatter look to the forehead or the fold beside the nose on one side
- in some people, both sides of the face are affected
It can be distressing to see your face change, and to have others notice it. Facial palsy affects how you look, not who you are, and for most people it is temporary.
Lyme facial palsy vs. Bell’s palsy
Bell’s palsy is the name for facial palsy when no specific cause is found. Lyme disease is one identifiable cause, so the two can look the same in the mirror. The difference matters because Lyme facial palsy is treated with antibiotics.
Clues that point toward Lyme include living in or visiting an area where Lyme is common (check our risk map), a recent tick bite, an expanding rash, or other symptoms such as fever, aches or a severe headache. CDC recommends standard two-step blood testing to diagnose neurologic Lyme disease. See our Lyme test guide for how that works.
On steroids: the 2020 IDSA/AAN/ACR guideline made no recommendation for or against adding corticosteroids for Lyme facial palsy. Separately, Bell’s palsy guidance from ear, nose and throat and neurology groups advises steroids within 72 hours for people 16 and older when Lyme disease is not suspected. This is one reason to get seen quickly.
Before and after: what recovery looks like
Many people searching “before and after Lyme disease face” want to know one thing: will my face go back to normal? The research is encouraging.
- Adults: A 2022 study of US patients with Lyme facial palsy (published in Annals of Clinical and Translational Neurology) followed 38 people treated with antibiotics. Of these, 34 (about 89 percent) recovered completely, 3 recovered nearly completely, and 1 had moderate lasting weakness. Adding steroids did not change how fast or how fully people recovered.
- Children: A 2021 Swedish trial protocol in BMC Pediatrics estimates that about 80 percent of untreated children with sudden facial palsy from any cause recover completely. Some children with Lyme-related palsy have mild lasting differences. A small share develop synkinesis, where muscles move together unexpectedly, such as the eye closing slightly when smiling.
Recovery is usually gradual rather than overnight. Researchers often judge the final result at about 12 months, when facial function has settled. If movement is slow to return, ask your provider about follow-up care, which may include a facial nerve specialist or physical therapy.
Protecting your eye while you heal
When one eye cannot close fully, its surface can dry out. CDC notes that eye drops or a patch may be needed. Your provider may suggest lubricating drops during the day and protecting the eye at night. See our page on Lyme disease and the eyes for more.
Can the Lyme rash appear on the face?
Yes. CDC says the erythema migrans rash can appear anywhere on the body, including the face, scalp and neck. It starts at the bite site, grows over several days and is usually warm but rarely itchy. Our Lyme rash guide explains what to look for.
We are collecting real experiences about living with and recovering from Lyme facial palsy from people who have lived it, shared with their permission. As stories come in, they will appear here, clearly marked as personal experience rather than medical advice.
Call 911 right away if face drooping comes on suddenly with arm or leg weakness, trouble speaking, confusion, vision loss or loss of balance. These can be signs of a stroke, and CDC advises calling an ambulance rather than driving.
For facial drooping on its own, contact a healthcare provider the same day, especially if you have had a tick bite or spend time in Lyme areas.
Frequently asked questions
Does Lyme facial palsy go away?
For most people, yes. In a 2022 US study, about 89 percent of treated patients recovered completely and most of the rest nearly completely. Recovery is usually gradual.
Can Lyme disease affect both sides of the face?
Yes. CDC describes Lyme facial palsy as drooping on one or both sides of the face.
Is Lyme facial palsy the same as Bell’s palsy?
They can look identical. Bell’s palsy is the term used when no cause is found. Lyme is a known cause that is treated with antibiotics, so tell your provider about any tick exposure.
How is Lyme facial palsy treated?
CDC lists oral doxycycline for 14 to 21 days for adults and children, plus eye protection if the eye cannot close. Your provider decides what is right for you.
Should I worry about a stroke?
Sudden face drooping can be a sign of stroke, especially with arm weakness or trouble speaking. Call 911 right away if you notice these signs.