Facial palsy is a syndrome characterized by loss of voluntary facial movement, loss of expressive function, and trophic disorders of the facial nerve and facial muscle tissues. Facial paralysis patients, due to the loss of the innervation of facial expression muscles, the patient not only can not show emotion, but also cause facial deformity and dysfunction. The consequences of facial paralysis are undoubtedly catastrophic. Because of the separation of the display of facial expressions from real feelings, their strange expressions often lead to misunderstanding of the other party, resulting in psychological distortion of the patient, withdrawn personality, and seriously affecting the patient’s social activities. The severity of the impact on the patient’s daily life is second only to schizophrenia. As a result of facial nerve injury, the innervated facial muscle also undergoes denervation and degeneration, and eventually becomes fibrous tissue without contraction function due to fibrosis. Facial paralysis with a duration of more than two years becomes advanced facial paralysis, and its treatment has always been a major problem in plastic and reconstructive surgery, and it can be said that there is still no ideal method. In order to restore facial activity in patients with advanced facial paralysis, it is necessary to transplant muscles to the affected side to rebuild the function of the expression muscles on the affected side. Due to the complexity and delicacy of facial expression activities, the expression muscles are composed of multiple muscle groups, and the facial nerve has multiple innervations on each muscle group, which can be extremely complex and different from person to person, as manifested by the strength of the contraction force of the expression muscles, the direction of the contraction of the muscles, the strength of the antagonism and synergy between each muscle group, and the coordination of the expression movements. Therefore, it is practically impossible to rebuild the complex and delicate expression function of multiple muscle groups on the affected side by transplanting only 1 or 2 muscles. However, this does not mean that plastic surgeons will not be able to repair facial paralysis. It is still possible to improve the symmetry of both sides of the face and to restore specific facial expressions (e.g., smiling) on the affected side. This allows the patient to return to the community. Facial palsy has been repaired for almost 190 years. Summarizing the work of our predecessors, we can categorize the methods of facial palsy repair into static and dynamic repair. Static restorations are rarely used alone because they can only improve the patient’s static deformity, obtaining the so-called dull facial symmetry and not restoring facial expression. Dynamic repair is further divided into two categories: non-microsurgical repair and microsurgical repair (requiring microsurgical anastomosis of vascular nerves). Non-microsurgical repair of facial paralysis has been used in clinical practice since the beginning of the last century. Due to the avoidance of microsurgical operations, surgical trauma is less, the indications for surgery are wider, the age of surgical patients is not restricted, the success rate of surgery is high, and the efficacy of the treatment is stable. After surgery, patients with facial paralysis can obtain a more symmetrical and natural smile, which can also be promoted in primary hospitals. Due to the continuous improvement and development of the procedure, it is still the most widely used facial paralysis repair procedure today. In the 1970s, microsurgical techniques were applied to facial paralysis, and a new method of vascularized neuromuscular grafting for facial paralysis was developed. With the application of vascularized neuromuscular grafting in the treatment of advanced facial paralysis, a more symmetrical and natural smile expression can appear after the operation, which is considered by most scholars to be the most effective treatment for advanced facial paralysis so far, and it has the superiority not found in other surgical procedures, and it is the direction of the development of the treatment of advanced facial paralysis. However, this method requires simultaneous surgery on both the donor and recipient areas of the patient, which is quite extensive and traumatic, and the indications for surgery are strict, posing a greater surgical risk to the elderly, the infirm, those who cannot withstand the surgery, and children. The biggest problem is that the surgery is difficult, the results are not constant, the regeneration of the grafted nerves and the reinnervation of the grafted muscles cannot be regulated, and even the most skilled surgeons with a high level of seniority cannot accurately predict the final results of the surgery, so both the surgeon and the patient have to bear the great risk of surgical failure. Even if the surgery is successful, the patchy contraction of the face brought about by the block movement of the grafted muscle may not result in a favorable restorative outcome. The surgeon must be skilled in microsurgical techniques and have the appropriate basic skills in facial plastic surgery. All these requirements make the procedure more difficult to promote in primary hospitals. As the muscle fibers of the expression muscle are slender, its innervation is much richer than skeletal muscle, the facial muscle fiber action is very fine, the direction of the expression muscle fibers of each part is different, and the expression movement is different from person to person, colorful, so it is not possible to replace all the expression muscles by relying on one or two donor muscles alone. Moreover, when the nerve regenerates, there is a possibility that the regenerated axon may be lost or misplaced, which may cause the facial muscle movements it innervates to be inaccurate or linkage, making the facial, coordinated and symmetrical movements affected, which directly affects the display and expression of the facial expression. So far, there is no ideal donor muscle for transplantation, although there are various donor muscles reported to be used in the literature, all of them are more or less deficient and do not fully meet the requirements of an ideal donor muscle. There are also many donor muscles that have gone unused for many years and have been eliminated due to difficult surgical anatomy, complex surgical procedures, and excessive trauma. Therefore, obtaining good donor muscles and effective regulation of facial nerve regeneration will definitely be one of the future research directions. In addition, non-microsurgical research on the application of localized muscle repair for facial paralysis must be further deepened, so that this type of surgery can be popularized to the primary hospitals, so that the majority of patients with facial paralysis can be provided with effective basic medical treatment and return to the society. In the past, there have been many studies on the repair of facial muscle paralysis, but there have been few studies on the residual effects of advanced facial paralysis, such as facial muscle contraction weakness, facial muscle mis-movement, facial muscle linkage, and synergistic disorders of facial muscle expression movements. How to classify the sequelae of facial palsy finely and accurately, and then carry out personalized repair, these will be the direction of research on the repair of sequelae of facial palsy. Facial palsy repair has been intensively studied since the 1980s. Over the years, we have obtained a lot of clinical results in our research, and we have successfully investigated a variety of surgical procedures for the repair of advanced facial palsy, including free muscle grafting with microsurgical techniques and localized muscle grafting with non-microsurgical techniques, and so on. In recent years, we have refined the classification of facial palsy sequelae according to the anatomical and functional conditions of nerves and facial expression muscles, and have developed the repair of facial palsy from the simple reconstruction of orofacial movements to the individualized, combined application of multiple surgical procedures, and series of facial deformity repair of facial palsy, which will provide us with experience for the standardization of clinical facial palsy repair in the future.