Everything to know about Justin Bieber's facial paralysis

Justin Bieber made a surprise comeback in music with his album, SWAG, in July 2025.

However, before the surprise launch of his album, in June of the same year, the star suffered from facial paralysis because of Ramsay Hunt syndrome, which he revealed via Instagram.

Dr. Matthew Miller, the director of the UNC Facial Nerve Center, spoke about facial paralysis and what it means for Bieber and others who have it.

Ramsay Hunt syndrome is a reactivation of the varicella-zoster virus affecting the facial nerve, which results in facial paralysis. 

Typically Ramsay Hunt syndrome is seen in individuals who have had chickenpox — caused by primary varicella-zoster virus infection.

After a person recovers from chickenpox, the virus can remain dormant in the nerves and reactivate years later, affecting the facial nerve near the ear. This leads to a combination of facial paralysis and a painful rash.

“Think of it as shingles of the facial nerve. One in three people will get shingles, whereas Ramsay Hunt syndrome is much less common — affecting about one in 300 people,” Dr. Miller said.

Why Does It Happen?

The condition occurs when the virus reactivates in the geniculate ganglion, a collection of nerve cells that control facial movements and sensations. Factors such as stress, weakened immunity, or aging can increase the risk of viral reactivation.

Symptoms

Ramsay Hunt syndrome can present with a range of symptoms, often appearing suddenly:

• Painful rash around or inside the ear, sometimes on the mouth or tongue
• Facial paralysis on one side of the face, causing drooping or difficulty closing the eye
• Ear pain, which can be severe
• Hearing loss or ringing in the ears (tinnitus)
• Vertigo (dizziness) and balance issues
• Loss of taste or dry mouth and eyes

Complications

If not treated promptly, Ramsay Hunt syndrome can lead to complications such as permanent facial weakness, persistent pain (postherpetic neuralgia), or long-term hearing loss. Early treatment significantly improves recovery outcomes.

Treatment

Treatment focuses on reducing the severity of symptoms and preventing complications:

• Antiviral medications (such as acyclovir) to fight the virus
• Corticosteroids to reduce inflammation and swelling of the nerve
• Pain management, including analgesics
• Eye care, such as lubricating drops, to prevent dryness if the eye cannot close properly
• Physical therapy, which may help restore facial movement

Treatment is most effective when started within 72 hours of symptom onset.

Ramsay Hunt syndrome is a serious but treatable condition linked to the reactivation of the chickenpox virus.

Just like Justin Bieber, recognizing symptoms early—especially facial paralysis and ear rash—is crucial. With timely medical care, many patients can achieve significant recovery and avoid long-term complications.