Facial palsy affected side has unique soft tissue characteristic, seems like aging appearance. A mid face soft tissue decent, absent of nasolabial fold, and deep jowl formation require to be active manipulation of soft tissue in facial reanimation. The combination of an extensive SMAS face lift with functional free muscle transfer enable anatomically stable gracilis flap inset and aesthetically rejuvenation effect. An incisional nasolabial fold can be made from mirroring of healthy side to affected side. An under SMAS tunnel has passed through from a semicircular shape of nasolabial fold to face lift incision, then gracilis can be inset under SMAS. In aspects of flap fixation, SMAS fixed superolaterally this enable decent soft tissue lifting effect. Concurrently, symmetrically reset nasolabial fold should be closured with an upper laterally oblique direction that can make midface lifting as well. A gracilis insetting under SMAS technique is effective way for dynamic rejuvenation of face reanimation in paralyzed patient.
