We observe the forehead, we observe the eyelid openings - we call them the palpebral fissure – and make sure they are symmetric. We look at the naso – nose – labial – lips fold. This fold right here, the nasolabial fold, and we look right there and make sure that everything is symmetric. If one eye is more open that the other, that is a sign of facial weakness. If one side of the nasolabial fold is flattened, that is a sign of facial weakness on that side. Let’s just observe. The next thing we do is have the patient raise the eyebrows.
-“Raise your eyebrows.”
And you can see that he wrinkles his forehead equally on both sides, that is normal strength in the forehead.
-“Now, I want you to close your eyes as tight as you can. Tight, tight, tight, don’t let me open them.”
The next thing we do is have the patient smile or grimace to imitate you.
-“Smile for me.”
-“Very good.”
And I am looking to see that the sides both go up equally at the same time. If one side goes up first all the time, this may be slightly weak on the side that went up slowly. So look very carefully.
-“Smile again for me.”
-“Very good.”
You might also want to tell them something funny.
-“What would you do if you won a million dollars?”
Okay, the reason for that is that sometimes facial asymmetry can occur only with spontaneous smile, as opposed to the mimetic, or imitated, smiles, so you can sometimes see asymmetry there and you should probably test for both.