Plastic surgery can approach therapeutically a facial paralysis in different manners. In our Clinic for Plastic Surgery in Berlin we follow the concept of muscle transposition ( Gillies plastic procedure) and microsurgical nerve and muscle transplantation. Especially when not only a static facial symmetry needs to be reached, but also the restoration of the dynamics of the face ( laughing capability) are required , the employment of a microsurgical muscle transfer is considered. In the case of a total facial paralysis, the lid closure is not seldom corrected through a Gillies plastic procedure and as a second step, since the neighboring temporal muscle is already being used for the lid closure, a distally located muscle is transplanted in the nasolabial fold area ( the skin fold that runs from the side of the nose to the corner of the mouth). For this to succeed a motor nerve , meaning a functional thus nerve that will generate time-appropriate impulses to our donor muscle , is needed and is harvested from the lower leg, namely the sural nerve. This nerve serves as a pure sensory nerve of the lower leg and when removed leads to no sensory deficits since its action can covered from collateral nerves. The nerve will be then connected to the facial nerve of the healthy side of the face, like described in the cross-face -transfer, and will be directed towards the damaged facial side under the skin above the lip area. After a period of about 6 to 8 months the nerve will have “grown” in the opposite damaged facial side so that the muscle transplantation can follow. The muscle transplantation is employed when the nerve damage is so remote that the facial mimic musculature is failing and in a great degree wasted ( the so called “point of no return”). In this procedure we harvest our cigarette-sized muscle transplant from the upper leg. The removed muscle is the gracilis muscle. This muscle is thin and slender like its name describes. After the removal there are no functional deficits and only a discrete thin 8 cm long scar is left behind. The muscle is harvested together with one artery and one vein so that a microsurgical connection in the recipient site of the chin to a corresponding efferent (artery) and efferent ( vein ) blood vessel is possible. Simultaneously, the nerve that was transplanted about 8 months ago can be finally sutured to the gracilis muscle. As a result the nerve axons can grow into the muscle and finally activate it. This means that the mouth corner can be synchronously with the opposite side elevated and a symmetric smile generated. Thus a great amount of the problematic can be solved through the field of plastic surgery. For further questions concerning facial paralysis as competent partners in Berlin we are at your disposal.