Bell's Palsy Steroids: Why the First 72 Hours Matter Most
Steroids within 72 hours are the one treatment that reliably changes outcomes. What the evidence supports, what it does not, and what to ask for today.
By Bello's founder
July 17, 2026
Most of Bell’s palsy is waiting. But not all of it, and the part that is not waiting happens in the first three days.
If your face has just stopped working, here is the whole of it, briefly: see a doctor today, ask about steroids, and protect your eye tonight. Everything else on this page can wait until tomorrow.
The one thing that reliably helps
A short course of oral corticosteroids, usually prednisolone, started within about 72 hours of your symptoms beginning.
This is the treatment with genuinely strong evidence behind it, and it is worth understanding why it works, because the reasoning makes the urgency obvious.
Bell’s palsy is your facial nerve becoming inflamed and swelling. That nerve runs through a narrow channel of bone, and bone does not give. So the swelling has nowhere to go except inward, compressing the nerve and choking off its signals. Steroids reduce inflammation. Give them while the swelling is still building and you limit how badly the nerve gets squeezed.
Give them a week later, once the peak has passed and the damage is done, and you are treating a fire that has already burned out.
Around 70% of people recover completely with no treatment at all. Around 85% recover completely when steroids are started promptly. Steroids do not decide whether you recover. They improve your odds of recovering fully, and they cost you very little.
Please be the person who asks
I want to be careful here, because this is not about blaming doctors.
Bell’s palsy is genuinely easy to underestimate on a busy day. It is not life-threatening, it usually gets better on its own, and it does not look like an emergency. But it is quietly time-critical in a way that most conditions which “usually get better on their own” are not.
Sometimes people are not offered steroids. It happens. And because the window is so short, “I’ll mention it at my follow-up” is often too late.
So: you are allowed to ask directly. “Should I be on steroids for this?” is a completely reasonable question, it is the standard of care in most guidelines, and no reasonable clinician will mind you asking. If you are unsure, ask again. If you are outside the window and were never offered them, it is still worth raising, because it changes what happens next even if it no longer changes the odds much.
Your eye, tonight
The second half of treatment gets far less attention than it deserves.
If your eye does not close fully, it cannot protect itself. It cannot blink to spread tears, and it cannot seal overnight. An exposed cornea dries, and a dry cornea can scratch, ulcerate and scar. That is the one part of Bell’s palsy that can cost you something permanent, and it is almost entirely preventable with drops, ointment and a proper seal at night.
There is a cruel detail: it may not hurt. Some people have reduced corneal sensation too, so the usual warning system is muted. A comfortable eye is not proof of a healthy eye.
This starts on night one, not when it becomes uncomfortable. The full eye care guide is here, and honestly, if you read one other page on this site, read that one.
Antivirals: the honest position
You may be offered antivirals like aciclovir or valaciclovir, and you may not. Both are defensible, and here is why.
Bell’s palsy is thought to involve reactivation of a dormant virus, most often herpes simplex, which is the reasoning behind trying an antiviral. Sensible in theory. The trouble is that the evidence has not really cooperated.
Broadly, reviews find that antivirals alone offer little clear benefit, and that antivirals combined with steroids may offer a small additional benefit in severe cases, though this remains debated and the effect is nothing like as convincing as steroids on their own.
What this means practically:
- Antivirals are not a substitute for steroids. If you are offered antivirals instead of steroids, that is worth questioning.
- If your doctor adds them for a severe presentation, that is reasonable.
- If your doctor does not, that is also reasonable.
- This is not something to seek out on your own.
One important exception. If you had significant ear pain, or a rash in or around your ear, that may point toward Ramsay Hunt syndrome, which is shingles affecting the facial nerve rather than Bell’s palsy. There, antivirals matter a great deal more, and the outlook is different. Ramsay Hunt is mistaken for Bell’s palsy often enough that it is worth mentioning any rash or pain to your doctor specifically and directly.
What does not work
Some honesty about the rest, because there is a lot of noise and you deserve to save your energy.
Nothing makes the nerve regrow faster. Nerves regenerate at roughly 1mm per day. From the injury to your facial muscles is several centimetres. That is a distance problem and there is no shortcut. No supplement, no device, and no amount of trying changes that rate.
That is not a counsel of despair. It means the things worth doing are: get the steroids early, protect the eye, and then recover well rather than fast.
Facial exercises help you recover well, not quickly, and the timing matters more than the effort. Early on, forcing big movements achieves little, because the nerve is not conducting. Later, aggressive or lopsided effort can encourage synkinesis, the miswiring where your eye closes when you smile. Gentle and staged is the point. More on exercises here.
Electrical stimulation is genuinely contested. Some studies suggest benefit, some clinicians advise against it, and insurers frequently do not cover it on the grounds of insufficient evidence. We do not include it in Bello, and that is a deliberate choice rather than an oversight. If you are considering it, discuss it with a facial therapist rather than buying a device online.
Acupuncture, vitamin B12 and home remedies all have thin or inconclusive evidence. If something is harmless and it helps you feel like you are doing something, that is not nothing during a long recovery. But please do not spend money you cannot spare, and do not let it delay the things that do work.
What to actually do, in order
- Today, if you are inside 72 hours: see a doctor. Ask about steroids explicitly.
- Tonight: protect your eye. Drops through the day, ointment and a proper seal at night. Ask to be shown how to tape rather than improvising.
- This week: rest, and expect to get slightly worse before better. Weakness usually peaks in the first 48 to 72 hours, and that is normal rather than a sign of failure.
- Week 2 to 3: watch for the first flicker of movement. That is the moment that predicts the rest.
- Month 3, if nothing has moved: ask for a referral to a facial nerve specialist or facial therapist. Do not just keep waiting.
The short version
- Steroids within 72 hours. The one time-critical decision. Ask for them.
- Protect your eye from night one. The only part that can cost you permanently, and it may not hurt.
- Antivirals are debated and are never a replacement for steroids.
- Nothing speeds the nerve up. Aim to recover well, not fast.
- Ear pain or a rash? Mention Ramsay Hunt to your doctor by name.
Sources
The clinical statements here, including the 72-hour corticosteroid window, recovery rates with and without treatment, the debated role of antivirals, Ramsay Hunt as a differential, and the roughly 1mm per day rate of nerve regeneration, reflect consensus reported by sources including the NHS, Mayo Clinic, NINDS, and Cochrane’s reviews of corticosteroids and antivirals for Bell’s palsy.
This article is educational and is not medical advice. Decisions about steroids, antivirals and your own prescription belong to you and your doctor. It is scheduled for clinical review.
Common questions
What is the main treatment for Bell's palsy?
A short course of oral corticosteroids, usually prednisolone, started as soon as possible and ideally within 72 hours of your symptoms beginning. This is the one treatment with strong evidence behind it. Steroids reduce the inflammation compressing the facial nerve, and starting them early measurably improves the chance of a complete recovery. Alongside that, protecting an eye that will not close is essential, because it prevents the one complication that can cause permanent damage.
How soon do I need to start steroids for Bell's palsy?
Within 72 hours of onset, and sooner is better. This is the single time-critical decision in the whole condition, and the window closes quickly. If you are inside it, please see a doctor today rather than waiting to see whether things improve on their own. If you are already past 72 hours, it is still worth being seen, but the largest benefit of steroids comes from starting early.
Do antivirals help Bell's palsy?
The evidence is much weaker than for steroids and remains debated. Antivirals such as aciclovir or valaciclovir are sometimes added to steroids, particularly in severe cases, on the reasoning that a dormant virus may be involved. Reviews generally find little clear benefit from antivirals alone, and only a possible small additional benefit when combined with steroids in severe presentations. Antivirals are never a substitute for steroids. This is a decision for your doctor, not a reason to seek them out yourself.
Does Bell's palsy go away without treatment?
Often, yes. Around 70% of people recover completely without any treatment at all, which is genuinely reassuring. With steroids started promptly, that figure rises to roughly 85%. So treatment does not decide whether you recover, it improves your odds of recovering fully, and it costs you very little to take. That is why it is worth having even though most people would be fine anyway.
Can physiotherapy or facial exercises treat Bell's palsy?
Facial retraining does not speed up nerve regrowth, which happens at roughly 1mm per day regardless. What it can influence is how well you recover rather than how fast, particularly in reducing or managing synkinesis, the miswiring where your eye closes as you smile. Timing matters more than effort: forcing strong movements during the early flaccid phase achieves little, and aggressive exercise later can encourage synkinesis. Gentle and staged is the approach facial therapists recommend.
Which steroid is best for Bell's palsy?
Prednisolone is the most commonly used, and it is what most guidelines specify. The specific drug, dose and duration are decisions for your doctor, and they vary between countries and between patients, so it is not something to self-direct. What the evidence is clear about is not which steroid but when: starting within roughly 72 hours of onset is what drives the benefit.
Is 5 days of prednisone enough for Bell's palsy?
Courses are typically around ten days rather than five, though regimens vary and some taper. This is genuinely a question for your prescriber rather than a website, because the answer depends on your dose, your other conditions and local guidance. Please do not stop a course early or extend it on your own. If you are unsure whether your course was the right length, ask your doctor or pharmacist, who can see what you were actually given.
How did Angelina Jolie treat her Bell's palsy?
She has spoken publicly about having had Bell's palsy and about recovering from it, and acupuncture has been mentioned in her account. It is worth being careful here: one person's story, however famous, is not evidence, and the systematic reviews of acupuncture for Bell's palsy find the evidence inconclusive. Most people who recover would have recovered anyway, which is exactly what makes individual anecdotes so misleading in this condition. The treatment with strong evidence remains steroids started early.
What should you avoid if you have Bell's palsy?
Leaving your eye unprotected is the one that can cost you permanently. Waiting past the 72-hour steroid window is the one that costs you outcomes. Forcing strenuous facial exercise early is the one that may cost you later, through synkinesis. Beyond those three, most restrictions you will read about are not well supported, including the common advice to avoid cold air or draughts, which do not cause or worsen Bell's palsy.