Gracilis Muscle Flap Surgery

Gracilis muscle flap surgery is a facial reanimation procedure used to restore your smile after facial paralysis.

This procedure is often recommended if you’ve had paralysis for longer than two years or you were born with it.

Over time, facial muscles that no longer receive nerve signals can weaken permanently. In these cases, surgeons can transfer a small muscle from another part of the body to help your smile.

How Gracilis Muscle Flap Surgery Works

The gracilis muscle is located in the upper inner thigh. A thin portion of this muscle can be removed without affecting leg function.

During surgery, we transplant the gracilis muscle into your cheek. This allows the muscle to lift the corner of your mouth so you can smile. In some cases, we can also position part of the muscle in your lower eyelid. This helps your eye close better and helps recreate the natural crinkle around your eyes seen with a genuine smile.

We connect tiny blood vessels from the gracilis muscle to blood vessels in the face.

A nerve connection is also created so the muscle can move.

Connecting the Muscle to a Nerve

The nerve that controls the gracilis muscle must be connected to a nerve in the face so the muscle can receive signals to move.

In some cases, the muscle is connected to the masseter nerve in the chewing muscle in front of the ear, which allows you to smile when clenching your jaw. In other cases, we connect the muscle to a cross-facial nerve graft from the opposite side of the face so both muscles move together.

In some cases, we use both procedures together.

Recovery & Results

Gracilis muscle flap surgery is a complex procedure with a hospital stay of two to three days.

The transferred muscle needs time to connect with the new nerve supply. Early movement usually starts four to six months after surgery.

With continued healing and physical therapy, the smile often becomes stronger and more natural over time.