With complete facial palsy for more than 2 years, there is permanent atrophy of the facial expression muscles and sagging of the facial tissues. At this point, even if facial nerve function is restored surgically, free facial movement due to the expression muscles cannot be restored. For complete advanced facial palsy, reestablishing facial dynamics requires the introduction of new motor capable muscles, and vascularized thin femoral muscle is the best choice. The procedure for vascularized thin femoral muscle transplantation is as follows: A long strip of thin femoral muscle tissue (containing the closed nerve vascular bundle), approximately 15-20 cm long and weighing 20-40 g, is excised from the thigh opposite to the facial palsy (in the case of left-sided facial palsy, from the right thigh). The ends of the femoralis muscle were fixed to the affected corners of the mouth and temporal subcutaneous tissue (to replace the orofacial motor function of the atrophied zygomaticus major, zygomaticus minor, and upper lip lift muscles). The foraminal nerve was microscopically anastomosed to the occlusal nerve or trans-facial nerve graft. Anastomosis of the vascular bundle of the thin femoral muscle to the facial artery. After muscle contraction begins to occur 3 months postoperatively, rehabilitation and biofeedback training are performed until facial dynamics are stabilized. undefined The vascularized thin femoral muscle graft is a milestone in the treatment of advanced facial palsy and has been clinically used for more than 30 years now. It has been clinically validated by major medical centers around the world as a safe and reliable procedure. If combined with trans-facial nerve grafting, it can restore voluntary movements on the side of facial palsy; even with anastomosis to the occlusal nerve most patients can develop a satisfactory smile.