Objective To investigate the surgical outcomes in patients treated for recurrent facial nerve palsy (RFP) at a quaternary facial nerve referral center. Methods A retrospective chart review was performed on 132 patients with RFP who presented to our institution's facial nerve clinic from 2001 to 2021. Records were analyzed for etiology of palsy, facial nerve function, and recurrence rates. Pre‐ and post‐operative audiometric outcomes were also assessed in surgically managed patients. Results 6.8% of RFP patients underwent surgical decompression. For patients who did not undergo surgery, the House‐Brackmann (HB) score was 2.9 ± 1.3 (SD) at the initial clinic visit, and 2.4 ± 1.3 (SD) at the last clinic visit. This difference was significantly different (p = 0.01, t‐test). For surgical patients, the pre‐operative HB score was 2.9 ± 0.9 (SD) and post‐operative HB score was 1.8 ± 0.6 (SD), which were significantly different (p = 0.01, t‐test). The number of facial palsy episodes also decreased pre‐ and post‐operatively from 3.5 ± 0.8 (SD) to 0.2 ± 0.4 (SD) episodes, which were significantly different (p < 0,001, t‐test). Audiometric outcomes were not significantly different pre‐ and post‐surgery (p = 0.31, t‐test for PTA; p = 0.34, t‐test for WRS). Conclusion Facial nerve decompression for RFP patients with incomplete functional recovery may be an effective treatment for decreasing the frequency and severity of facial palsy episodes. Level of Evidence 4 Laryngoscope, 133:1222–1227, 2023