In my daily outpatient work, most of the patients I see with advanced facial palsy are delayed because they did not receive timely treatment in the early stage of facial palsy and became advanced facial palsy. This makes the repair of facial palsy extremely difficult. In order to enable patients to not only understand their condition and seek medical treatment in a timely manner, but also to find the right way to get the correct and effective treatment when seeking medical treatment. I would like to talk about my own experience in treating facial palsy for many years, and I hope it will be helpful to readers. (1) Facial palsy is found at birth or since childhood: Since the child cannot describe the symptoms of the disease, most of the children are first discovered by their parents. Most parents first notice that the child’s expression is usually dull and the corners of the mouth are crooked when crying. Some children have eyes that do not close tightly, some have crooked eyes, some have lips that do not close, often drool, and leak soup when they eat thin food. Some children are found to be unable to chew when eating hard foods, and some have deformities of the lips, cheeks or ears. These symptoms may suggest that the child has congenital facial palsy. In addition, it may be due to infant forceps injury during delivery, misuse of the fetus during drug injection, etc. The authors have encountered a case in which a fetal cheek was injected too deeply into a pregnant woman’s uterus during an intrauterine injection of a drug, causing facial injury to the fetus. Since surgical repair of congenital facial palsy is quite complicated and delicate, the repair plan should be designed according to the specific condition of the child, so it is important to wait until the child is old enough to cooperate with the doctor for examination and rehabilitation of the postoperative facial muscles. However, it is important to take the child to a specialized hospital as soon as possible for consultation and rehab instruction. For adult patients, due to the long-term effects of facial palsy, the facial bones and soft tissues have been significantly altered. (2) Sudden onset of facial palsy: Most patients think that their mouths were blown out of shape by the “strange wind”. In fact, except for some specific diseases that cause sudden facial paralysis, most of them are caused by viral infection of the facial nerve. Several days before the onset of facial palsy, patients may have symptoms such as swelling and pain or numbness on the top of the affected side of the head, behind the ear, or in the cheek, or symptoms similar to a cold or herpes on the face. Due to failure to pay attention to timely treatment, symptoms of facial palsy such as crookedness of the corners of the mouth or leakage when brushing and rinsing the teeth or when puffing are suddenly noticed when waking up in the morning. At this time, you should immediately go to the neurology department for consultation and treatment. The first choice is high-dose hormone and antiviral treatment to reduce the inflammatory response of the facial nerve and reduce the swelling of the nerve, and when the swelling of the facial nerve is reduced, it is expected that the function of the facial nerve will be completely restored. The authors have had several colleagues who have recovered completely from early facial palsy with timely hormone therapy. If the effect after hormone treatment is not good, you should go to the department of pentatomy or neurosurgery. The preferred treatment is facial nerve canal decompression, after the facial nerve is decompressed, the ischemic damage to the facial nerve from swelling can be reduced and the blood supply can be restored as early as possible, and the nerve function may be mostly restored after the surgery. Late facial palsy or repair of facial muscle linkage. There is no shortage of patients with advanced facial palsy encountered clinically who were not treated promptly in the early stage of facial palsy and later turned into advanced facial palsy. When hormonal treatment is found to be ineffective, one should seek surgical treatment from a specialist as soon as possible. If one gets lucky and hopes for a miracle and continues to wait patiently, early facial palsy will inevitably be delayed into late facial palsy. (3) Facial palsy occurring after head and facial trauma: Such cases all have a clear history of head and facial trauma. It can be a direct result of facial nerve rupture caused by brain injury, skull base fracture, posterior ear fracture, etc. Due to the severity of the head injury, it is often impossible to take into account the damage to the facial nerve in the early stage of the injury. There are also many cases that occur as a result of hard object poking, cutting, or lacerating the common trunk or branches of the facial nerve. Clinically, as long as there is a wound along the anatomical projection of the facial nerve, or if there is a loss of facial expression, the injury of the facial nerve should be ruled out first, and if there is a facial nerve injury, as long as the patient’s general condition permits, the nerve should be repaired by surgery immediately to avoid delaying the recovery of the facial nerve. The authors have encountered several cases: due to cranio-cerebral injury, the patient was unconscious in the early stage, and was later resuscitated through craniotomy, and only fully awakened after several months, when he was found to have facial palsy, and after facial nerve exploration and repair suture, the facial palsy was completely restored. In some patients, there is no obvious facial nerve injury in the early stage of injury, but facial palsy appears after surgical debridement. The most likely cause of facial nerve injury is the emergency surgical debridement and hemostasis, and once it occurs, the patient should be repaired by surgical exploration as soon as possible after the condition is stabilized. Generally speaking, early surgical repair of facial nerve injury is much easier than late repair, and the results of surgery are much better. If the patient’s condition is very poor, in order to preserve the patient’s life, repair should be delayed, but not more than 6 months at the latest, too long a delay may cause irreversible denervation of the facial muscle, that is, even if the facial muscle regains innervation later, it may be difficult to get a complete recovery. (4) Facial palsy occurring after surgery on the skull, face, cheek, neck and posterior part of the ear: the most common cases are facial palsy after auditory neuroma surgery and facial palsy caused by parotid tumors, hemangioma and resection of tumors of the facial nerve itself. The authors have encountered many cases in which the tumor was removed along with the adjacent facial nerve, or the facial nerve was removed along with it. Although the facial nerve appeared to be intact at the time of surgery, the nerve bundle within the nerve had actually been completely damaged. After surgery, the surgeon and the patient were expecting the facial nerve to recover on its own with great patience. The best time for facial nerve repair is missed. The early facial palsy becomes late facial palsy. However, if the facial nerve graft anastomosis is performed at the early stage of facial nerve injury, it will probably be another result. The authors had met a patient who developed facial palsy after parotid tumor resection in an outside hospital, and then the authors explored and found the damage to the common trunk of the facial nerve, and repaired the facial nerve defect by grafting the nerve, fortunately! In the end, the patient had a satisfactory recovery. The outcome of nerve graft anastomosis is determined by the patient’s own nerve regeneration. At the current level of medicine, doctors cannot regulate nerve regeneration, nor can they accurately predict the final outcome of nerve regeneration or make any promises to the patient about the outcome of the surgery. I always believe that even the best doctor is only a mortal! When it comes to repairing the facial nerve, one should not go beyond one’s capabilities, and even if one is omnipotent, one should do nothing. When it’s time to say no, you have to say no. Overconfidence often gets sad results. But if you are capable and in a position to give your patients a good chance to recover from facial palsy, I believe that both doctors and patients with facial palsy are willing to try. (5) Gradual onset and worsening of facial palsy: This is a rather complex situation. In my clinical experience, I most often encounter the gradual compression of the facial nerve by tumors or occupying lesions in the brain, the compression of the facial nerve by its own or nearby benign or malignant tumors, and the destruction of infected lesions. For example: auditory neuroma, facial nerve syringomyelia, ear cholesteatoma, parotid tumor, otitis media, etc. If you experience gradual onset of facial palsy or facial palsy that is sometimes mild, sometimes severe, sometimes good, sometimes bad, you must pay considerable attention to it. It is necessary to go to the relevant specialty (neurology, ophthalmology, stomatology, etc.) for the necessary examinations, and make sure to clear the diagnosis and remove the primary lesion before coming to the plastic surgery department for facial palsy repair. Among the patients with increasing facial palsy that the author has encountered, there are a considerable number of patients whose facial palsy was caused by tumor compression on the facial nerve, and after diagnosis, the tumor was first removed, and then the facial palsy was repaired, and finally satisfactory results were obtained. Commonly speaking, facial palsy caused by tumor is equivalent to house fire, while facial palsy repair is equivalent to house renovation, and no one would like to insist on house renovation even if the house is on fire. Of course, an exception may be made for cases of facial palsy of unknown origin. (6) Facial palsy of unknown cause: limited by the author’s own experience and knowledge, there are many patients with facial palsy whose causes cannot be diagnosed even after repeated searches. In general, the causes of facial palsy are congenital, traumatic, neuronal, infectious, metabolic, neoplastic, toxic, medical, spontaneous, and so on. However, these causes involve various disciplines in the medical field such as internal medicine, surgery, neurology, ophthalmology, stomatology, obstetrics and gynecology, pediatrics, oncology, and endocrinology. Regardless of the cause of facial palsy, since the scope of responsibility of the plastic surgeon is only to repair facial palsy. He cannot and will not go beyond his scope of responsibility to treat interdisciplinary primary diseases, but can only repair facial palsy that has been clearly diagnosed or only the dysfunction of facial nerve and facial muscle that has been diagnosed. As long as the patient has no contraindications to surgery, the plastic surgeon should not make the patient suffer from lifelong distortion of the mouth and nose and the inability to smile after facial palsy because the cause cannot be diagnosed for a long time. No matter how many undiagnosed causes and unanswerable questions facial palsy patients have, it should be revealed by the relevant specialist. Finally, it should be noted that facial palsy should be treated as early as possible after discovery. The richness of human expression is based on rich and fine facial muscles, and the effect of early treatment may be a complete recovery before the facial muscles become denervated. For the repair of advanced facial palsy, since the facial muscle has been completely lost, doctors can only repair it by local muscle transfer or distant muscle transplantation, however, the available muscles for transplantation are very limited, so the expression recovery of patients with advanced facial palsy is also very limited, and the current level of repair can only be the basic symmetry of the corners of the mouth when the face is static, and a more natural smile can be obtained when it is dynamic. If we want to rebuild the complex, delicate and coordinated facial expressions that reflect the patient’s heart, we need the plastic surgeon and the facial palsy patient to work together continuously. The life of a human being is limited, and the medical career of a doctor is even more short. We can only lament that life is short, and the energy of a lifetime may only know a certain nook and cranny of medical science, and it takes the continuous efforts of several generations to master all fields of medicine.