ABSTRACT Objective To explore the dynamic evaluation of acupuncture treatment effect and clinical value of peripheral facial paralysis by ultrasonic elastic imaging technology. Methods Fifty patients with peripheral unilateral facial paralysis treated with acupuncture and moxibustion in Chongqing hospital of traditional Chinese medicine from November 2019 to September 2020 were selected as the research object. The elastic modulus of facial expression muscles (frontal muscle, descending angular muscle and descending labial muscle) at 6 time points during acupuncture and moxibustion treatment were evaluated by ultrasonic elastic imaging technology, and the degree of facial paralysis was evaluated by clinical facial nerve function score. Linear correlation analysis was used to analyze the correlation between the elastic modulus of the affected side and the clinical facial nerve function score at different treatment time points. Results The elastic modulus of facial expression muscles (frontal muscle, descending angular muscle and descending labial muscle) in patients with facial paralysis decreased gradually with the increase of acupuncture treatment times. The difference between the six detection time points was statistically significant (P < 0.01), and the rate of decline was the fastest 7 days before treatment, while there was no significant change in the elastic modulus of expression muscle in the control group. Consistent with the change of elastic modulus, the clinical score of affected lateral nerve function gradually increased with the increase of treatment time, and the rate of rise of score increased within 7 days after treatment, the difference was statistically significant (P < 0.01). Correlation analysis showed that the elastic modulus was negatively correlated with the clinical facial nerve function score (r = -0.546, P < 0.001; r = -0.757, P < 0.001; r = -0.683, P < 0.001. Conclusion：Ultrasonic elastography can dynamically evaluate the elastic changes of facial expression muscles before and after acupuncture treatment, which is related to the clinical score of facial nerve function, and can provide an important imaging basis for the evaluation of the treatment effect of facial paralysis.