What happened to Justin Bieber’s face?

In a June 2022 social media post, the singer shared that he had developed Ramsay Hunt syndrome, a rare neurological disorder that stems from the virus that causes chickenpox.

Ramsay Hunt syndrome’s most distinctive characteristic is infection of a facial nerve near the inner ear that causes facial paralysis. It can also cause a painful rash on the ear or mouth, ringing in the ear, ear and neck pain, nausea, vomiting and vertigo. Most of the time, people experience varying degrees of paralysis on one side of their face.

Bieber shared a video of himself talking, showing the distinctive one-sided facial paralysis.

The varicella-zoster virus initially causes chickenpox, a disease that was common before the vaccine was available in 1995. Once the chickenpox clears, the virus can remain dormant in your nerves.

Sometimes, the dormant virus causes complication years later, such as shingles and Ramsay Hunt syndrome.

The syndrome, which stems from a shingles outbreak, occurs in only about 5 out of 100,000 people in the United States per year. It’s typically treated with antiviral medication for up to 21 days, steroids and pain relievers. Antivirals started early improve the chance of faster recovery.  Evidence suggests better outcomes in Ramsey-Hunt with the combination of antivirals and steroids.  In other forms of Zoster, steroids are not beneficial.

While most people who develop Ramsay Hunt syndrome with facial paralysis fully recover muscular control, not all do. Early diagnosis and treatment provide a better chance at full recovery.

Ramsay Hunt syndrome isn’t contagious, though contact with rash blisters could cause chickenpox in someone who has never been infected or vaccinated for chickenpox. The syndrome mainly affects adults age 60 and older but can develop in anyone who has had chickenpox.

Shingrix, the shingles vaccine, can provide protection against both shingles and Ramsay Hunt syndrome. It’s available for adults age 50 and older, given in two doses 2-6 months apart, and is more than 90 percent effective in preventing shingles. You can get the shingles vaccine whether or not you recall having had chickenpox in the past.

If you haven’t had chickenpox and have not been vaccinated against the virus, it’s a good idea to get that shot, too. Anyone age 12 months or older can receive the varicella vaccine, also called the chickenpox vaccine, which is 92 percent effective in preventing infection with the virus that causes chickenpox and its future complications.

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