Aims Objective grading systems for facial nerve palsy (FNP) often fail to reflect patient quality of life. This study evaluated how well objective facial function scores correspond to patient-reported physical, social and synkinesis-related disability. Methodology We retrospectively reviewed patients attending the Sydney Facial Nerve Clinic. Patient-reported measures included the Facial Disability Index (FDI), Synkinesis Assessment Questionnaire (SAQ), Oral Competence Questionnaire (OCQ) and Speech Handicap Index (SHI). Objective assessments included House–Brackmann (HB), Sunnybrook and the Sydney Facial Nerve Scale (SFNS). Spearman correlations and regression models quantified associations and translated objective changes into patient-reported differences. Results A total of 477 patients were assessed (mean age 39.7 years; 65.6% female). Bell’s palsy (39.4%) and iatrogenic injury (19.1%) predominated. The FDI showed weak correlations with HB (ρ = –0.29), Sunnybrook (ρ = 0.28) and SFNS-motor (ρ = 0.26) (all p < 0.001). FDI-physical showed stronger associations (ρ = –0.34 to 0.37), while FDI-social showed none. Each 1-point worsening in HB corresponded to a 12% reduction in FDI; each 1-point improvement in Sunnybrook translated to a 0.4% increase. The SAQ correlated strongly with SFNS-synkinesis (ρ = 0.62), whereas the SHI showed only weak motor associations. Conclusion Objective scores capture only part of the patient experience. FDI-physical aligns most closely with objective motor grading, while social and speech-related disability diverge. Synkinesis-specific burden is best measured using the SAQ. Integrating objective and targeted patient-reported measures provides a more accurate appraisal of functional and quality of life impairment and supports individualised management in FNP.