How Facial Masking Influences Perception and Relationships

Woman holding empty cardboard in front of her face for facial masking

Written by Kelsey Phinney, BS

Earlier this fall, my parents came to visit me in Sun Valley, Idaho. During their visit, we had some of my new friends over for dinner. These friends had never met my parents, and they also had never met a person living with Parkinson’s.

Thanks to my recent work with the Davis Phinney Foundation, I’ve come to understand that it is important to be able to talk about the different sides of Parkinson’s with those close to you. With this in mind, I realized that the main thing I needed to tell my friends before dinner was that one of the more notable symptoms of my dad’s Parkinson’s is facial masking.

My dad has an amazing smile, makes goofy faces and gets that sparkle in his eye when he talks about something he’s passionate about. While those things haven’t disappeared with years of Parkinson’s, they unfortunately can be subdued. Particularly when he is tired, his face can appear to be “masked.”

Facial Masking
click to enlarge

The Effects of Facial Masking

My dad’s face, like many people with Parkinson’s who experience facial masking, is less expressive and more neutral than one would expect, given the content of his conversation.

Facial masking causes a loss of facial expressivity. The muscles of the face lose muscle tone, leading to a seemingly blank expression.

For people who don’t know facial masking, the blank expression can be misconstrued as a lack of interest, displeasure, low sociability or low cognition. We’re accustomed to a person’s face shifting and changing regularly with the conversation. With a masked face, there is often slowness and stillness in the muscles of the face.

The primary thing I notice is less blinking and less reaction, positive or negative. However, when someone with a masked face is passionate about a story or topic, you can often see the most genuine and beautiful smile!

Even though I know what facial masking looks like, having a conversation with a person with facial masking can feel confusing. We expect facial responses in conversation. A simple smile, nod, eyebrow raise or crinkle of the eyes makes the person who is talking feel heard. With facial masking, these small movements are not so simple.

It is easy to take for granted our ability to subtly communicate through our face and movements. It can be challenging to gauge how someone should react to our own facial expressions and stories. We may disregard someone with facial masking because their facial expressions, or lack thereof, go against our social expectations. Also, it can be difficult to trust verbal communication when the facial expression doesn’t match the sentiment.

From my dad’s point of view, I imagine it is incredibly frustrating to not be able to effortlessly express himself.

Listen to Kelsey’s Podcast

I wanted to know more about the implications of facial masking and the importance of facial expressions in social interactions, so that we can all better understand how to respond. I interviewed Professor Linda Tickle-Degnen, Director of the Health Quality of Life Lab at Tufts University. Listen to my podcast to hear about her research on the effects of facial masking, what it is and how it impacts how people are perceived by healthcare professionals as well as their own care partners.

Click to listen to the podcast below

Check out the second podcast

Dr. Tickle-Degnen had a lot of interesting information to share, so part two of my interview focuses on her current research along with ideas and tactics for people who experience facial masking.

Kelsey Phinney’s dad, Davis Phinney, was diagnosed with Parkinson’s when she was five years old and she has been interested in learning more about the brain and ways to help people living with Parkinson’s ever since. Kelsey graduated from Middlebury College in May of 2016 with a degree in neuroscience and is currently cross country skiing professionally in Sun Valley, Idaho. Learn more about Kelsey at

Share this post on social:

To receive our electronic newsletter and other updates, sign up now.

Related Posts

Comments (8)

Thank you so much for this information. Calls me and I hope others to stand up for our loved ones and all people, dealing with PD, LBD, all forms of illnesses where caregivers need to understand more.

Social support more important than physical support?
I’ve been married 35 years to my best friend. Facial masking is becoming a part of his PD, ? LBD, not severe yet. He is only 57. We are already starting to practice using our own sign language to help so that when his ability to communicate becomes harder, we will be able to communicate, with signs language.

Blessings to you for undertaking this study.
Rev. Catherine Oliver

My husband has Parkinson’s, and was diagnosed 4 years ago, about 2 years ago I wrote this poem:
You are the man , who I have always seen as being 10 feet tall.
Always had a playful smile , and an amazing word for me.
Now there is a mask there in it’s place, and the words are short.
Where has that beautiful mind gone?
The one that was always hopeful.
the one who always said we could do anything together?
Hold me for a moment, right now, make me believe, that this is still true!
I need this from you, I love you, always will!
Denise Ortego

Hi Denise – Thank you for such a beautiful poem!

I have had the honor to meet and speak with Davis during a dance class in Boulder.
He is able to override his habitual activities by focusing attention, and consciously controlling them. I watched him raise his arms high after he had shown he “couldn’t” the week before.
It is indeed tiring to focus attention and keep the muscles toned, but it can be done.
Encourage folks with Parkinson’s to work on attentional endurance, conscious control, and constant learning to override increasingly faulty habitual activities.

Richard, great that you met Davis in dance class! A good example as well, as we recommend people with Parkinson’s see if consciously being more expressive helps to improve facial masking. Check out Kelsey’s latest post on facial masking to learn more!

Great treatment way. thanks for sharing.

Linda Prestridge

I have seen this facial mask take over my husbands face. He was diagnosed with PD in 2012, although symptoms began in the early 1990’s. First the tremors in his left hand and thumb began diagnosed as Essential Tremors, Distonia, never PD until the Dapper (sp) brain scan test. He was tremor dominant and in 2014 had DBS surgery which saved his life. His tremors are controlled but his ability to speak so I can understand him, or hear him, ability to walk and now I understand facial masking which made me think he didn’t care or was indifferent. Thank you for one more piece of the puzzle. Paul was a preacher and we traveled to over 14 countries preaching the Gospel. Our last trip was to Honduras in Oct. 2015. Thank you to Davis Phinney and his foundation helping us understand and care for our loved ones suffering from PD.

Hi Linda,
Thank you for reading. Facial masking is one of the most difficult aspects friends and family members of those with Parkinson’s deal with. We rely so much on facial cues when we’re talking to people and when we don’t get feedback, it’s difficult to assess the interaction. I’m glad this article was helpful to you. It’s one we share with care partners a lot.

Comments are closed.

Back to top