Most of the patients with advanced facial paralysis have advanced facial paralysis due to the lack of timely diagnosis and treatment in the early stage of facial paralysis. This causes great difficulties in repairing facial paralysis. In order to enable the majority of patients to not only understand their own condition timely medical treatment, but also to find the right way to get the correct and effective treatment when seeking medical treatment. Based on my experience and that of my predecessors in the industry, the following is summarized in the hope that it will be helpful to the readers. Facial paralysis occurs when: (1) Facial paralysis is found at birth or since childhood; (2) Facial paralysis occurs suddenly; (3) Facial paralysis occurs after trauma to the head and face; (4) Facial paralysis occurs after surgery of the skull, face, cheeks, neck, and back of the ears; (5) Gradual onset of facial paralysis that is worsening; and (6) Facial paralysis of unknown origin, and so on. Since the causes of facial paralysis are many and complex, I cannot discuss them all in detail, but I can only explain the diagnosis and treatment process of common and frequent facial paralysis as follows. (1) Facial paralysis is found at birth or since childhood: Since the children themselves cannot describe the symptoms of the disease, most of them are firstly found by their parents. In most cases, the parents first notice that the child’s expression is usually dull and the corners of the mouth are crooked when he/she cries. When the child is a little older, it is found that he/she cannot smile or the corners of his/her mouth are crooked when he/she smiles. Some children also have eyes that do not close tightly, or eyes that are crooked, or lips that do not close, and they drool a lot, and leak soup when they eat thin food. Some children are found to be weak in chewing when eating hard food, and some are accompanied by malformations of the lips, cheeks or ears. These symptoms may suggest that the child has congenital facial paralysis. In addition, it may be due to forceps injuries to the baby during delivery, accidental injury to the fetus during drug injection, and so on. The authors have encountered a case in which a medication was injected into the uterus of a pregnant woman, but the needle went too deep and was injected into the cheek of the fetus, causing facial injuries to the fetus. Since surgical repair of congenital facial paralysis is quite complicated and delicate, and the repair plan should be designed according to the specific condition of the child, it is necessary to wait until the child is a little bit older, can cooperate with the doctor’s examination, and can cooperate with the doctor’s postoperative facial muscle rehabilitation training before surgical repair. However, it is still important to bring the child to a specialized hospital as soon as possible to receive consultation and rehabilitation training. For adult patients, due to the long-term effects of facial paralysis, the facial bones and soft tissues have obvious changes, in the repair of facial paralysis at the same time, also need to carry out symmetrical plastic surgery repair on both sides of the face in many parts of the face. (2) Sudden onset of facial paralysis: Most patients think that their mouths were blown crooked by the “strange wind”. In fact, except for some special diseases that cause sudden facial paralysis, the vast majority are due to viral infection of the facial nerve and the onset of the disease. A few days before the occurrence of facial paralysis, patients may have the affected side of the top of the head, behind the ears, cheek swelling and pain or numbness, or have a similar cold, herpes on the face and other symptoms. Due to the failure to pay attention to timely treatment, when you wake up in the morning, you suddenly find symptoms of facial paralysis such as crooked corners of the mouth or leakage when brushing teeth and gargling, or leakage of air when puffing. At this time, you should immediately go to the neurology department. The first choice is high-dose hormone and antiviral treatment to reduce the inflammatory reaction of the facial nerve and decrease the swelling of the nerve, and after the swelling of the facial nerve subsides, the function of the facial nerve can be expected to be completely restored. The authors have several colleagues who have recovered from early facial paralysis with hormonal therapy. If the effect of hormone treatment is not good, we should go to the Pentacenter or neurosurgery, the first choice of treatment is decompression of the facial nerve tube, after decompression of the facial nerve, it can reduce the ischemic damage to the facial nerve caused by swelling, and restore the blood supply as soon as possible, after the surgery, most of the nerve function may be restored, if there is still no restoration or the appearance of the facial muscle linkage, false movement, spasm, convulsions, then we can only go to the orthopedic department for repair. Advanced facial paralysis or repair of facial muscle linkage. There is no shortage of patients with advanced facial palsy encountered in the clinic who were not treated in time 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 hopes for a miracle by chance and continues to wait patiently, it is inevitable that early facial paralysis will be delayed into advanced facial paralysis. (3) Facial paralysis that occurs after head and face trauma: Such cases have a history of obvious head and face trauma. The facial paralysis can be caused by head injury, skull base fracture, fracture behind the ear, etc., which directly cause facial nerve severity. Due to the seriousness of head injury, it is often impossible to take into account the damage of the facial nerve in the early stage of the injury. There are also many cases where the facial nerve trunk or branches are poked, cut or slashed by hard objects. Clinically, as long as there is a wound along the anatomical projection of the facial nerve, or the loss of facial expression is found after examination, the damage of facial nerve should be excluded firstly, if the damage of facial nerve is found, as long as the patient’s general condition permits, the nerve should be repaired immediately by surgery, so as to avoid delaying the condition and affecting the effect of recovery of facial nerve. The authors have encountered several cases: due to craniocerebral injury, the patient was unconscious in the early stage, and then after the craniotomy, the patient was fully awakened a few months later, and at this time, he was found to have facial paralysis, and after facial nerve exploration and repair and suturing, the facial paralysis was completely restored. In some patients, there is no obvious facial nerve injury at the early stage of injury, but after surgical debridement, facial paralysis occurs, the biggest possibility is that the facial nerve injury occurs during emergency surgical debridement, hemostasis, and once it occurs, it should be repaired by surgical exploration as soon as possible after the patient’s condition is stabilized. Generally speaking, early surgical repair of facial nerve injury is much easier than late repair, and the result of surgery is much better. If the patient’s condition is very poor, in order to preserve the patient’s life, the repair should be delayed, but the latest should not be more than 6 months, the delay time is too long may cause irreversible denervation of the facial muscle, that is to say, even if the facial muscle is restored to the innervation, it may be difficult to get a full recovery. (4) Facial paralysis occurring after surgery of the skull, face, cheek, neck, and back of the ear: the most common cases are facial paralysis after auditory neuroma surgery as well as facial paralysis after resection of parotid tumors, hemangiomas, and 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 as well. Or the facial nerve was barely peeled off from the tumor during the surgery. Although the facial nerve appeared to be intact at the time of surgery, in fact, the nerve bundles within the nerve had been completely damaged, and the doctor and the patient waited for the recovery of the facial nerve on their own with great patience after the surgery, which often lasted for half a year, and then the facial muscle had already undergone irreversible nerve loss, and the optimal period of facial nerve restoration had been missed. Early facial paralysis becomes advanced facial paralysis. However, if facial nerve graft anastomosis is performed at the early stage of facial nerve injury, it is likely that another result will be achieved. The authors have encountered a patient who developed facial paralysis after parotid tumor resection in an outside hospital, and then the authors found the damage to the common trunk of the facial nerve on exploration, and repaired the facial nerve defect by grafting the nerve, which was very lucky! In the end, the patient had a satisfactory recovery. The outcome of nerve graft anastomosis is determined by the patient’s own nerve regeneration, and at the current level of medical science, doctors are unable to regulate the regeneration of nerves, nor can they accurately predict the final outcome of nerve regeneration or make any promises about the outcome of the surgery to the patient. I have always believed that the best doctor is only human! You can’t go beyond your abilities when repairing the facial nerve, even if you can do everything, you have to do nothing. When it’s time to say no, you have to say no. Overconfidence often gets sad results. But if you have the ability and the means to give your patients a good chance to recover their facial palsy, I believe both doctors and facial palsy patients are willing to try. (5) Gradual onset and worsening of facial paralysis: This is a rather complex situation. In my clinical experience, the most commonly encountered cases are gradual compression of the facial nerve by tumors or space-occupying lesions in the brain, compression of the facial nerve by benign or malignant tumors in or near the facial nerve, and destruction of the facial nerve by infected lesions. Examples include: acoustic neuroma, facial nerve syringomyelia, ear cholesteatoma, parotid tumor, otitis media, and so on. If facial paralysis occurs gradually, or if it is mild or severe, or if it gets better or worse, considerable attention must be paid to it. The necessary investigations must be carried out in the relevant specialties (neurology, otolaryngology, stomatology, etc.), and the diagnosis must be clarified to remove the primary lesion before coming to the plastic surgery department for repair of the facial paralysis. Among the worsening facial paralysis patients encountered by the author, a considerable number of patients had facial paralysis caused by tumor compression of the facial nerve, and after diagnosis, the tumor was firstly removed and then facial paralysis was repaired, and finally satisfactory results were obtained. To put it plainly, 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 in case of house fire. Of course, there may be an exception for cases of facial paralysis of unknown cause. (6) Facial paralysis of unknown cause: limited to the author’s own experience and knowledge, there are still many patients with facial paralysis, although after repeated searches are still unable to diagnose the cause of the disease. In general, the causes of facial paralysis are congenital, traumatic, neuronal, infectious, metabolic, neoplastic, toxic, medical and spontaneous. However, the causes of facial palsy involve a wide range of medical disciplines such as internal medicine, surgery, neurology, ophthalmology, dentistry, obstetrics and gynecology, pediatrics, oncology, endocrinology, and so on. Regardless of the cause of facial paralysis, since the plastic surgeon’s area of responsibility is only to repair facial paralysis. He cannot and will not go beyond the scope of his duties to treat interdisciplinary primary diseases, but can only repair facial paralysis that has been clearly diagnosed, or just the dysfunction of the facial nerve and facial muscle that has been diagnosed. The plastic surgeon is only doing his job, as long as the patient has no contraindications to surgery, and cannot make the patient suffer from facial paralysis with a crooked nose and mouth and inability to smile for life because the cause of the disease cannot be confirmed for a long period of time. No matter how many undiagnosed causes and unanswered questions a patient with facial paralysis may have, it is up to the relevant specialist to reveal them. Finally, it is important to treat facial paralysis as early as possible after discovery, as the richness of human expression is based on the richness and fineness of the facial muscles, and the effect of early treatment may be a complete restoration of the facial muscles before they become denervated. For the repair of advanced facial paralysis, as the facial muscle has been completely lost, doctors can only repair it through local muscle transfer or distant muscle transplantation, however, the available muscle for transplantation is very limited, so the expression recovery of patients with advanced facial paralysis is also very limited, the current level of repair can only be the basic symmetry of the corners of the mouth when the face is in static state, and when the face is in dynamic state, it can be obtained a more natural smile, and it is possible to rebuild it to reflect the complexity of the patient’s inner self, In order to reconstruct a complex, delicate and coordinated facial expression that reflects the patient’s heart, it requires the continuous efforts of both the plastic surgeon and the patient with facial palsy. Human life is limited, the doctor’s medical career is even shorter, we can only lament the shortness of life, a lifetime of energy may only be in a certain nook and cranny of medical science know, to fully grasp the various fields of medicine, but also need several generations of people’s continuous efforts.