Surgical attempts to reanimate the paralyzed face have been more notable for their failures than for their successes. The use of fascial slings (9), hypoglossal nerve transposition (10), masseter and temporalis muscle (11), primary nerve repair (12), cross-face grafting (13), and the free vascularized transfer of extensor digitorum brevis (4), latissimus dorsi, gracilis (6, 14), and pectoralis minor muscles (8) testifies to the challenge of facial reanimation.

Any attempt at microneurovascular transfer of muscles for facial reanimation should be postponed until attempts to repair the facial nerve, either with direct approximation or interpositional nerve grafts, have failed or have been rejected as inappropriate. Facial paralysis that has persisted for longer than 6 months is best treated with microneurovascular transfer of muscles; this technique does not result in the mass movements associated with some reinnervation techniques, and it prevents the distorted facial movements that follow local muscle rotation.

Contraindications for microneurovascular muscle transfer in patients with facial paralysis include (a) excessive operative risks, (b) peripheral neuropathy, and (c) peripheral vascular disease.