Long-term facial palsy can have a huge impact on patients. Facial palsy, known as facial nerve palsy, refers to damage to the facial nerve caused by various reasons, mainly manifesting as loss of facial expression function and tissue dystrophy. Asymmetrical facial appearance is the main characteristic of facial palsy patients, mainly manifested as crooked corners of the mouth, loss of nasolabial folds, incomplete eyelid closure, drooping eyebrows, and dull facial expressions, which are more obvious when speaking and expressing emotions. At the same time, these deformities also expose patients to a number of functional impairments, such as chronic inflammation of the conjunctiva, accumulation of secretions and corneal exposure due to long-term incomplete eyelid closure, which may result in corneal clouding or even blindness. The cosmetic damage and dysfunction caused by facial palsy can cause great difficulties in life, work and social life, making patients lose their confidence and courage to participate in social life, and even suffer from pain. For this reason, scholars at home and abroad have conducted uncountable researches on the treatment of facial palsy. Although significant achievements have been made, the effect of expression muscle repair in advanced facial palsy is still unsatisfactory and is a recognized medical problem for scholars in China and abroad. Late facial palsy must be rehabilitated by plastic surgery Early facial palsy refers to the early stage of facial nerve damage without obvious atrophy of facial expression muscles, such as Bell’s facial palsy caused by inflammation, which can be treated by applying neurotrophic drugs, hormones, physiotherapy, nerve decompression, acupuncture and other methods through internal medicine or Chinese medicine to obtain obvious results. For trauma-induced facial palsy, early nerve release, nerve anastomosis, nerve grafting, and trans-facial nerve grafting can be performed to restore the reinnervation of facial expression muscles. However, in some patients, there is no obvious recovery of facial expression muscle function through the above treatment, or due to delayed treatment, the disease lasts for more than two years and forms advanced facial palsy, at which time their facial expression muscle function has no possibility of recovery and must be treated by plastic surgery to cure and recover. The aim of treating facial palsy is to achieve a normal appearance at rest, symmetry of autonomous movements at dynamics, and control of the sphincters of the eyes, mouth and nose. The current plastic surgery treatment for facial palsy is generally divided into two types of suspension: static suspension and dynamic suspension. Static suspension is the traditional surgical treatment for facial palsy, which involves tension suspension to correct drooping corners of the mouth, incomplete eyelid closure and lower eyelid ectropion. However, this procedure can only improve the facial deformity of patients with facial palsy at rest, and when patients talk and laugh, they still have a skewed facial appearance of the mouth and nose, so this method is suitable for older patients (>50 years old) or patients who do not have high requirements for treatment. If you want to dynamically restore advanced facial palsy, you must go through muscle transplantation, which is currently roughly divided into muscle transplantation with anastomosis of nerve vessels and free transplantation of small muscles with anastomosis of blood vessels. Anastomotic neurovascular muscle free grafts became popular with the development of microsurgery in the 1970s and 1980s, which led to a revolutionary change in the treatment of advanced facial palsy and achieved good results, and are now widely accepted as a two-step method. The first step is transfacial nerve anastomosis, which is performed by transplanting a segment of a nerve from another part of the body (such as the peroneal nerve), with one end anastomosing with a branch of the healthy lateral nerve and the other end buried under the skin of the contralateral cheek via a subcutaneous tunnel, and checking whether the healthy lateral nerve grows into the transplanted nerve 8-12 months after surgery. The second step is the free muscle graft. The available muscles include human femoralis, pectoralis minor, latissimus dorsi, etc. Then, one end of the muscle is fixed to the soft tissue of the temporal region or the zygomatic arch, and the other end is suspended from the corners of the mouth and the nasolabial folds, and finally, the nerve of the grafted muscle is anastomosed to the nerve of the cross-facial graft (such as the gastrocnemius nerve), and the blood vessel of the grafted muscle is anastomosed to the facial artery of the affected area. Although the repair results are satisfactory, there is the problem of excessive delay during the repair and prolonged recovery time. In conclusion, the application of plastic surgery for the treatment of irreversible advanced facial palsy has been a convincing success, allowing many patients to recover their appearance and regain confidence in their social life. However, smile reconstruction is still a medical challenge for plastic surgery, and there are many meaningful tasks that need to be continued. We have reasons to believe that through the unremitting efforts of plastic surgeons and the cooperation of related departments, more patients with facial palsy will be able to enjoy the “luxury” of a beautiful smile.