Aims The natural history of facial nerve palsy remains poorly defined, with limited longitudinal evidence describing how recovery differs between flaccid and synkinetic disease or how interventions influence functional outcomes. This study aimed to characterise temporal trends in patient-reported outcomes and identify treatment-specific recovery patterns. Methodology We retrospectively reviewed patients managed at the Sydney Facial Nerve Clinic. Patient-reported outcomes included the Facial Disability Index (total, physical, social) and Synkinesis Assessment Questionnaire. Temporal change was modelled using linear regression, expressed as percentage change per month. Results A total of 477 patients (1,149 visits) were included (mean age 39.7 years; 65.6% female). Flaccid palsy accounted for 24.7% of cases and synkinetic palsy 75.3%. Surgery was performed in 28.7%, physiotherapy in 63.5%, botulinum toxin in 51.6%, and speech pathology in 19.3%. In flaccid palsy, FDI-physical improved by 0.3% per month (95% CI 0.12–0.46, p = 0.001). Surgery yielded significant gains in next-visit FDI total (+10.8%, p < 0.001), FDI-social (+13.8%, p < 0.001), and FDI-physical (+6.0%, p = 0.004). Physiotherapy and speech pathology showed no significant effect. In synkinetic palsy, physiotherapy improved FDI total (+8.4%, p < 0.001), FDI-physical (+7.3%, p < 0.001), and FDI-social (+6.7%, p < 0.001). Botulinum toxin produced a modest FDI total change (+2.4%, p = 0.094) but significantly improved synkinesis severity (SAQ +13.2%, p < 0.001). Speech pathology improved FDI-physical (+8.1%, p = 0.016). Conclusion FNP demonstrates distinct, phenotype-dependent recovery trajectories. Flaccid palsy demonstrates progressive functional gains, particularly after surgery, whereas synkinetic palsy responds most strongly to physiotherapy and botulinum toxin for synkinesis-specific morbidity. These findings support targeted, multimodal rehabilitation and sustained longitudinal follow-up to optimise outcomes.