Fascial suspension for lower face paralysis

For the treatment of lower face paralysis, neurovascular free muscle transfer is one of the best methods; however, fascial suspension including the muscle bow traction (MBT) method is still effective for restoring facial deformity due to facial palsy and has a wide surgical indication. We describe the operative techniques of the MBT method in detail in the case of long-standing facial paralysis. Points to obtain good results are as follows: directions to pull up the lower and upper lip and oral commissure, sites to fix the fascial strings, and strengths to pull up the lower face. The goals of this method are to improve oral incompetence and obtain facial symmetry at rest, and in addition, mild smiling can be obtained. However, as an ideal dynamic facial reanimation, the MBT method has some limitations. One is limited excursion of up to 10mm and the other is that clenching is necessary when smiling.