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BackTable / ENT / Article
Facial Reanimation: Nerve Transfer vs Free Muscle Transfer
Iman Iqbal • Updated May 26, 2025 • 36 hits
In facial reanimation one of the most important early decisions is whether a patient should undergo nerve transfer or proceed directly to free muscle transfer. This decision depends on several factors, including patient age, time since paralysis onset, and the underlying cause of facial nerve dysfunction. This article explores insights from facial plastic surgeon Dr. Myriam Loyo, highlighting key considerations in timing, surgical planning, and evolving innovations. These include dual innervation techniques, multivector muscle constructs for natural smile restoration, and the use of alternative donor muscles like the strap muscles.
This article features excerpts from the BackTable ENT Podcast. We’ve provided the highlight reel in this article, and you can listen to the full podcast below.
The BackTable ENT Brief
• The choice between nerve transfer and free muscle transfer is influenced by patient age, paralysis duration, and etiology. Pediatric patients have a longer reinnervation window than adults.
• In adults nerve transfers after one year may offer minor improvements but rarely yield meaningful smile restoration due to neuromuscular junction degeneration. Around the one-year mark, combining masseteric and hypoglossal nerve transfers may improve outcomes, though complete restoration is limited.
• For patients beyond one year of paralysis, gracilis muscle transfer is the gold standard. Dual innervation using masseteric and cross-facial nerve grafts (CFNG) improves movement reliability. Coaptation of CFNG and masseteric nerves to the gracilis allows strong muscle contraction.
• New efforts include using cross-facial nerve grafts to reanimate the orbicularis oculi, routed through the nasal bridge, and small muscle grafts like platysma for periorbital reanimation.
• Multi-vector gracilis constructs enhance smile naturalness by targeting the oral commissure, upper lip, and lower eyelid, using careful anchoring and muscle sizing to avoid bulk.
• Composite flaps using the sternohyoid and omohyoid muscles offer thinner, localized alternatives to gracilis, with early OHSU outcomes showing promising function and less facial bulk.
Table of Contents
(1) Nerve Transfer vs Free Muscle Transfer
(2) Free Muscle Transfer Techniques: Gracilis Transfer & Cross-Facial Grafting
(3) Advances in Vector Design for Free Muscle Transfers
(4) Composite Strap Muscle Free Flaps in Facial Reanimation
Nerve Transfer vs Free Muscle Transfer
When planning facial reanimation a key consideration is determining whether a patient is better suited for nerve transfer or if they should proceed directly to free muscle transfer. The timing of facial nerve transfer surgery is highly individualized, influenced by patient age, etiology of paralysis, and the duration since their nerve injury. In pediatric patients nerve transfers may still be considered up to 18 months post-onset due to better neuroplasticity and a longer window of neuromuscular junction viability. In contrast, adults have a much more limited window for effective reanimation – typically closer to 12 months.
Nerve transfers at or just beyond the one-year threshold may offer slight improvements in tone or minimal facial movement, but these are often insufficient to achieve a meaningful smile. The rationale for this timeline focuses on the viability of the neuromuscular junction. As time progresses, the ability of the muscle to respond to reinnervation diminishes, leading to less effective or incomplete functional recovery. Further, around the one-year mark, additional nerve transfer techniques, such as combining masseteric (5-7) with hypoglossal transfers, may be considered to improve outcomes.
[Dr. Shiayin Yang]
In terms of timing, do you have a time point when nerve transfer is not an option? What is your cutoff for patients, or does it vary? Does it vary by their age, their presentation and their etiology? How do you determine when you will do a nerve transfer versus when you're going to take the next step to a free muscle transfer?
[Dr. Myriam Loyo Li]
Yes, great question. I think we don't fully know the answer and the answer is probably a little different for every person. I definitely take age into consideration. For children are much more likely to do nerve transfers even up to a year and a half. For adults, when I'm way past that one year, I will not do it. Then when I'm approaching one year, I'll start having a conversation about either using more nerve transfers, like not just 5-7, but really also using hypoglossal.
There's some data from Dr. Lozeta in Spain that makes me think that hypoglossal might do better after one year than masseter. I talk about expectations and pros and cons and what do they want to do. If they're at that one-year mark or a little bit further out, then I start telling them that we might get some tone, we might get some few millimeters of movement. Do they want to try that or do they want to move towards a free muscle transfer?
I guess if I summarize it, it's really hard. There is no cutoff and that will be different for everybody. I think for me, in children, I will be able to give them a year and a half before I am not going to try a nerve transfer for them. Within a year and a half, I will do a nerve transfer for a child. I think for older adults, it's different. When we are past one year, I'm not excited to try nerve transfers. If we are going to do it around the one-year mark, I will advocate that we use not just 5-7 but also hypoglossal, because I think they will have a better result at that time if we use both.
[Dr. Shiayin Yang]
Then just for our listeners, why is this time important? Explain why we picked that time point.
[Dr. Myriam Loyo Li]
Yes. We think that there's a time when the neuromuscular junction is still viable to reinnervation and that reinnervation is still going to translate into meaningful movement that we see in the faces. The further out we go, the more likely we are to be unsuccessful to do a nerve transfer and get either no reinnervation or no improvement in tone or movement, or get small few millimeters of movement with some improved tone without actually having a meaningful smile. We probably want to try to get people smiling like one centimeter, and half a centimeter is better than nothing, but less than four millimeters is really not ideal.
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Free Muscle Transfer Techniques: Gracilis Transfer & Cross-Facial Grafting
In patients with facial paralysis beyond one year, free muscle transfer – most commonly using the gracilis muscle – is the standard approach for dynamic facial reanimation. Dual innervation is often employed using a two-stage cross-facial nerve graft (CFNG) combined with masseteric nerve input to ensure strong, reliable movement. The sural nerve is typically used for the CFNG, though alternatives like the medial antebrachial cutaneous nerve are considered in cases of prior harvest or neuropathy. When selecting the donor facial nerve branch on the unaffected side, the midface is often targeted due to the redundancy in innervation, minimizing concerns about inducing weakness.
Surgical strategy for dual innervation often involves end-to-end coaptations of both the cross-facial nerve graft and the masseteric nerve to the obturator nerve of the gracilis. While masseteric input provides reliable contraction and rapid reinnervation, there is ongoing debate about whether it may dominate over the cross-facial input, potentially compromising spontaneity.
Recent innovations also include efforts to restore eyelid closure by directing cross-facial nerve grafts to the orbicularis oculi. These nerves are routed through the nasal bridge, either coapted to a recipient nerve or directly neurotized into the target muscle. In parallel, there is emerging exploration of using small muscle grafts like platysma for eyelid reanimation, leveraging the rich vascularity and inherent protective reflexes of the periorbital region. While these approaches are still under investigation, they highlight the trend toward using multiple cross-facial nerve grafts in a single patient to address both smile and eye closure without compromising function on the unaffected side.
[Dr. Shiayin Yang]
Now let's go into the free muscle transfer. I think this is an exciting area, a lot of areas for development. We'll talk about your most recent study, but in terms of the different types that are available, the most commonly known is the gracilis, which is probably the gold standard just in terms of free tissue transfer for facial reanimation, but there's been other types as well. We'll start with gracilis. It sounds like you're usually reserving this for your patients who are more than a year out for your adults with flaccid facial paralysis who've had no return of movement. Tell me just your overall, what are you using in terms of your neural input to this muscle?
[Dr. Myriam Loyo Li]
Yes. The most common innervation that I will use for a gracilis is dual innervation. I prefer doing a two-stage cross-facial nerve graft and then using the masseter. That is my most common choice.
[Dr. Shiayin Yang]
For our listeners, I assume you're using the sural nerve for your cross-facial nerve graft.
[Dr. Myriam Loyo Li]
I am. At the same time, one difference that I've noticed is that I won't harvest again for a sural nerve that has already been harvested. I know other surgeons do. I will go to medial antebrachial cutaneous if somebody has peripheral neuropathy. That's another place where I use nerve conduction. If somebody has diabetes and peripheral neuropathy, I will test their sural nerve. If it is impaired, I will use medial antebrachial cutaneous nerve. I guess I should have said that before also.
[Dr. Shiayin Yang]
I guess the question always is, how proximal do you inset your cross-facial nerve graft on the affected side? It was always like take a good branch that gives you upward excursion. You're going to down-regulate the unaffected side to give them more symmetry, but you're always in your mind like, oh, am I going to make their face-- am I going to ruin their smile on the unaffected side?
[Dr. Myriam Loyo Li]
Yes. Somehow I don't worry about that anymore. I take a good-sized branch that's in the mid-face, and there's just so much redundancy in that area. It's really a mesh more than a single nerve that's going out there. I really think of the nerves more as a mesh than like a pipe. I don't know. I'm much less concerned about giving somebody weakness on their unaffected side. I've never seen it.
I suppose if you don't have a lot of experience with cross-facial nerve graft, you want to be cautious and make sure you have a branch that is robust enough that you will have enough access to grow through this long cable graft and confirm that you have other branches around the area that are producing the same redundant movement. I think it would be hard. You really would have to take a lot to be causing weakness from a cross-facial nerve graft.
There's some exciting research that I've been following out of Brazil about cross-facial nerve grafts for direct innervation of the orbicularis oculi. In my practice, I've been moving towards a cross-facial for the free muscle and then a cross-facial towards orbicularis oculi, towards the eyelids, and I don't have enough follow-up to tell you how well it works, but I'm hoping to replicate some of the results I'm seeing coming out of Brazil where they're getting some direct reinnervation.
[Dr. Shiayin Yang]
How are you bringing that nerve? Where are you reinnervating it?
[Dr. Myriam Loyo Li]
I'm prioritizing the upper eyelid and I'm coming through the bridge of the nose.
[Dr. Shiayin Yang]
Then are you actually finding a branch to co-opt the nerve to, or are you dunking it into the muscle?
[Dr. Myriam Loyo Li]
We're doing a variation of things, which is also why it's hard to know how it works and when it works. For people who are not in the free muscle category but are still on the nerve transfer, we'll try to find a nerve branch and do the co-optation there. For people who are undergoing a free muscle, we'll try to put a branch going into the free muscle, like direct into the free muscle.
Then there is another group that has published on free platysma muscle grafts for the eyelids, which I was very hesitant to believe in. I'm just going to take a strip of muscle and I'm going to put it there and it's all of a sudden going to become alive and reinnervated? I think there is something special about the eyelids that they just have this amazing vascular supply and somehow they do better and our body biologically wants to protect the eye. That's why we get so much blepharospasm and reinnervation there. I think there's something special there. I think we need to study it a lot more before we start doing things like this that I'm talking about.
I guess my point in bringing up this several cross-facial nerve grafts in a single patient is that it is hard to give somebody weakness and the non-paralyzed side, and I'm moving towards more cross-facial nerve grafts rather than less. Dr. Raquel Baptista has been using cross-facial nerve grafts for eyelid reanimation with direct neurotization with some exciting results. We've been trying to replicate some of those findings here at OHSU.
[Dr. Shiayin Yang]
That's really cool. Definitely keep me updated on what you find. All right. You do your cross-face nerve graft, you do your first stage, and then how long are you typically waiting between your first stage and your second stage, so actually doing the free muscle transfer?
[Dr. Myriam Loyo Li]
I think it ends up being longer than six months and then closer to one year. Especially in the children, I think it ends up being closer to one year. I think we would be able to do it sooner. I think it's more coordinating and scheduling in my practice. I think six months at the earliest, I would want to check for strong Tinel's. If it's going to be only innervated through the cross-facial nerve graft, like in pediatric and children, I tend to wait closer to one year.
[Dr. Shiayin Yang]
Then you said that predominantly, most of your patients, you're doing dual innervation with a cross-facial nerve graft with nerve to the masseter. How are you then connecting those? How are you doing those co-optations?
[Dr. Myriam Loyo Li]
Great question. It's always an end-to-end for me. I try to prioritize the trigeminal and the masseter to innervate the free muscle and then find a way to incorporate the cross-facial nerve grafts. Often this will mean that the masseter--
[Dr. Shiayin Yang]
It's end-to-end masseter to obturator and then end-to-side cross-face?
[Dr. Myriam Loyo Li]
It's end-to-end for both.
…
Even though it's usually like the obturator would be a one-to-one match with the cross-facial nerve graft, I think what I'll end up doing often is I'll put the masseter there and then either I'll make it slit further down more proximally where I will then connect the cross-facial nerve graft end-to-end there, or it'll be the opposite where the masseter is closer and I'll end up connecting the masseter here and then end-to-end on the other accents to the cross-facial nerve graft.
[Dr. Shiayin Yang]
Do you ever worry about masseter overpowering your cross-facial nerve graft?
[Dr. Myriam Loyo Li]
Yes. I think for me, the priority has been getting them a smile and getting the muscle moving. I know I'm biased towards having it be successful, and so I'm biased towards prioritizing masseter. Does that come at a cost of spontaneity and cross-facial nerve graft? Probably. I don't think we truly know what is the best way to put those nerves together.
Advances in Vector Design for Free Muscle Transfers
Multivector free muscle transfer is becoming an increasingly common technique in facial reanimation, especially for optimizing natural smile dynamics. While traditional single-vector approaches prioritize lifting the oral commissure, a shift toward dual or even triple vector configurations allows for a more anatomically complete smile, addressing not just lip elevation but also upper lip movement and subtle eye squint. These additional vectors are carefully designed and anchored to recreate the midface and periorbital components of a natural smile.
For instance, the primary vector often suspends the oral commissure to the temporal fascia, while the secondary and tertiary vectors target the upper lip and lower eyelid, respectively, enhancing dental show and recreating eye narrowing. Concerns about excess facial bulk from larger multivector flaps have been alleviated by careful muscle sizing, typically around 35 grams for multivector gracilis transfers, as well as by the natural atrophy-reinnervation cycle of the muscle.
[Dr. Shiayin Yang]
What are you doing in terms of vectors? There's been talk of dual vector, multivector. Many people are still just getting great results with single vector. What have you tried? What are your thoughts?
[Dr. Myriam Loyo Li]
One vector that I don't have a lot of experience with free muscle would be the lower lip. I do think that there's some really cool innovations coming up with how do we recreate that depression of the lower lip or the DLI action when we're smiling. Massanier has shown some beautiful results doing a free graciles that have both vector going to the upper lip and then a vector going to the lower lip. I've been using some static suspension, but I think we will see more and improved outcomes for the smile with lower lip considerations.
[Dr. Shiayin Yang]
Yes, there's so many nuances on what constitutes a spontaneous smile. How can you make that smile natural than what people are looking for? I think all of these different avenues are really exciting to see, what is the best way that we can restore people as best as possible.
….
In terms of the design of the muscle and the transfer of the gracilis, there have been different ways described traditionally, a single vector, but there's also been dual vector as well as multivector. What do you routinely use in your practice and what are your thoughts on these different variations?
[Dr. Myriam Loyo Li]
I definitely started as a single vector person that prioritized the oral commissure and lifting the oral commissure to create the smile. I really have transitioned to doing at least two vectors and to inset not just to the oral commissure, but also to the middle of the upper lip to help that upper lip displace superiorly, move superiorly with the smile and increase the dental show. I think it makes the results just that much better.
I really credit Patrick Byrne and Kofi Boahene, big mentors for making that innovation and that change in the design. I'm definitely a multivector proponent. If I'm doing those two vectors, I might even add a third vector to the lower eyelid. In the lower eyelid, I was a little bit skeptical about how much contraction we would get there and how much vascular perfusion we might still have on that small little tiny third vector. The more we do them, the more we find little tiny perforators where I can even Doppler the third vector. I've been really happy with those. It gets tricky to design the length.
[Dr. Shiayin Yang]
How are you designing that?
[Dr. Myriam Loyo Li]
Yes, I'm still tweaking it and trying to make it better. I put the most important vector as the one that goes to the oral commissure, and it'll inset a little bit more laterally. Then I'll have smaller vectors that are coming closer to the anterior face of the maxilla for the second vector. Then the third vector trying to come all the way across the eyelid. I just finished writing a review that has some diagrams and intraoperative pictures, and it's going to be in press soon. I know it's Elsevier, so it must be Facial Plastics Clinics of North America. I think it'll be in press soon with some photos and diagrams.
[Dr. Shiayin Yang]
Essentially, you're trying to create that narrowing of the eye that you naturally get when you smile?
[Dr. Myriam Loyo Li]
For the third vector, I'm trying to recreate that squinting that we have with the smile so that you don't have like a wide open eye looking out.
[Dr. Shiayin Yang]
Does it help just in general with the lower ectropion?
[Dr. Myriam Loyo Li]
Yes. I find that I'm still having to do the ectropion repair. It's just that I'm using the muscle as part of the repair. Similarly to nerve transfers where I expect somebody that has a successful 5-7 to get lower eyelid contraction, they will get tone, they will get contraction. I don't expect that to correct the ectropion or lower lid malposition, similar for the free muscles. If the muscle gets reinnervation and is successful, I think we will see contraction there. I don't think this by itself will fix the position of the lower eyelid.
[Dr. Shiayin Yang]
What are you routinely doing for your lower eyelids?
[Dr. Myriam Loyo Li]
I'm very lucky that my co-director for the Facial Nerve Center is John Ng, who is the Director of Oculoplastics at the KCI Institute here at OHSU. It can be hard to get oculoplastic surgeons with their busy schedule where they do multiple small little cases to come to an all-day free muscle reinnervation, but he makes it work. He's with us to help us inset with the medial canthus, and he does most of them.
I think it's what we all do for lower eyelid, release the lateral canthus, reposition it where it needs to go, realize that it's not just pulling from the lateral canthus, but also the actual eyelid with the orbic, even if it's denervated. I used two or three vectors when I'm using the gracilis. I really think it's made my results better. One of the things I want to look at is, am I making the faces too bulky as I'm creating--
[Dr. Shiayin Yang]
That was in the next question. With three vectors, how much bulk are you getting with that in their face?
[Dr. Myriam Loyo Li]
I think one of the things that Dr. H did beautifully, and that I feel like she taught all of us, was how to make a gracilis small enough that it could fit in the face, yet strong enough that it could smile. The multivector is certainly a bigger flap. I was putting in single vector graciles that were around 16, 18 grams, and my multivector graciles at the time of inset are more like 35 grams. One concern has been, am I now going to make their faces really bulky? Their smile is going to be really wide, but is their cheek going to look really bulky? I haven't found that, but I am in the process of looking more critically, really measuring the photos and looking at that.
[Dr. Shiayin Yang]
Where are you anchoring your vectors to the oral commissure in the upper lip? Laterally, where are you anchoring them?
[Dr. Myriam Loyo Li]
Oh, the first vector or the vector that suspends the oral commissure goes to the temporal fascia, and then the second vector ends up going a little bit to the most prominent part of the zygoma. It's a little more anterior, and that becomes the pivot point for your third vector. I'm trying to end up around the maximal projection of the maxilla a little bit superiorly, a little bit anteriorly, if that makes sense.
[Dr. Shiayin Yang]
Where are you noticing most of your bulk? Is it where your second and third vector are, or is it still not traditional, above the zygoma?
[Dr. Myriam Loyo Li]
I think one of the things that I have noticed, and somehow I think this last patients that have been doing the multivector have had fuller faces, and I have not noticed excessive bulk. I think because this muscle is going to become denervated and atrophy and then get reinnervated, it's not quite as bulky as I thought it would be.
Composite Strap Muscle Free Flaps in Facial Reanimation
Recent efforts in facial reanimation at OHSU have explored the use of composite strap muscles, specifically the sternohyoid and omohyoid, as an alternative to traditional donor muscles like the gracilis. These muscles offer several advantages: they are thinner, more similar in type and size to facial muscles, and are located closer to the surgical field. When harvested together the sternohyoid and omohyoid can be configured into dual or even triple vector constructs, offering precise control over smile dynamics.
Dr. Myriam Loyo Li notes that the surgical technique involves harvesting these muscles as compact flaps (approximately 20 grams) while preserving their native fascia. The sternohyoid typically serves as the primary vector to the oral commissure, while the longer omohyoid is directed toward the upper lip or lower eyelid with plication as needed. The strap muscles naturally support dual innervation from the ansa cervicalis and ansa hypoglossi, enabling robust reinnervation options.
Although procedures are currently being performed in two stages, single-stage operations may be possible, particularly with cross-facial nerve grafts or masseteric nerve transfers. Early outcomes from a small cohort at OHSU show promising motion and smile excursion within expected timelines. While not suitable for all patients, particularly those with prior neck surgeries or compromised vasculature, Dr. Myriam Loyo Li explains that this approach presents a compelling and less invasive alternative, especially for those seeking to avoid bulkier muscle flaps.
[Dr. Shiayin Yang]
I want to segue into-- we talked about different types of muscles that can be used. Previously, latissimus has been used, serratus, gracilis, but also, Dan Allen published on using the sternohyoid. Now recently you've published on using composite sternohyoid and omohyoid. The advantage of using your strap muscles is that as we were talking, the gracilis is big. It's bulky. It's also a different type of muscle compared to your facial muscles. The strap muscles are very similar in size. They're close to the operating field and then they're of similar muscle type to the facial muscles. Tell me about this. What made you venture into trying this flap? How was it? What did you think? Do you think you're going to try and incorporate it more into your practice?
[Dr. Myriam Loyo Li]
Yes. We have been doing free strap muscles for dual vector reinnervation at OHSU, and we're playing with making the omohyoid also be a third vector. It's something new that we're doing and exciting. We've been doing it for four patients that have had good movement, but that is the total number of times that we've been doing it. I should mention that I don't do this free muscles by myself. I am always doing them with a team. Lori Howell, Mark Wax, and Ryan Li helped me harvest. Really, Ryan, who is my husband, is the lead on harvesting the free strap muscles. It's sternohyoid and omohyoid.
I really learned this technique from Marc Hohman. Talking to Marc Hohman at Madigan Army Center, they were already doing it, and they had at least 10 cases under their belt, and he really encouraged me to do it. It was something that we've been thinking about for a long time. We've been really impressed and really happy with them. The sternohyoid and the omohyoid will already be covered in their fascia, so there will be no need to do dissection within the bulk of the muscle. Then once they're harvested, they're really small flaps, so they tend to be around 20 grams.
Just as we were talking about the adhesions between the muscle and the skin, these are already covered in their fascia, which should allow them to move and not adhere as much as a free raw muscle edge might. The sternohyoid has been our vector one from the oral commissure to the lateral area, and omohyoid, which is long, has been our vector two. We're mostly discarding the posterior valley, and then we're plicating it. Where we're plicating is just where we're seeing that opportunity to work on the lower eyelid.
There's no leg wound, so it doesn't affect their ambulation. I had a patient that ended up on a trip to Europe a month after having their free strap muscle, and they're strong. They're moving well and smiling. I think they need more experience. Not every patient will be a candidate. Definitely, our head and neck cancer survivals won't have the strap muscles and the vascularity.
[Dr. Shiayin Yang]
Can you explain what nerves are you using? What nerve is based off of what artery?
[Dr. Myriam Loyo Li]
Yes. I think the challenge in this harvest is that it's a very meticulous dissection with small perforators. The challenge really is the arteries and veins. We've been using superior thyroid artery, common facial vein. We've mostly been able to identify two veins, so thyroid vein was also used. The innervation, which was really your question, has been the free strap muscles have the advantage that they are already made to have dual innervation. You have ansa cervicalis and you have ansa hypoglossi, and they both innervate both muscles.
[Dr. Shiayin Yang]
Also, are you doing this as one stage? Because technically, it should be long enough.
[Dr. Myriam Loyo Li]
Oh, I haven't brought one over to the-- I haven't brought it over to the contralateral, the nerve long enough to the contralateral. I haven't done that. I've been doing them as two stages. I've done them as a single stage for a rescue for somebody who we're doing a cross-masseter. I see a lot of potential and advantages on using the free strap muscles. They're compact and small and they're already covered in the fascia.
When we're fully harvested, it's around 20 grams. We'll use the sternohyoid, which is the stronger muscle for the oral commissure, and then the omohyoid for the upper lip. You can plicate it and start using it for the lower eyelid. The challenge is in the arteries and the veins.
[Dr. Shiayin Yang]
Yes, because they're considerably smaller, I would assume. What is the team insetting them into?
[Dr. Myriam Loyo Li]
We've done both where we've gone to STA, in superior temporal artery and vein, and we've also gone to facial. We make those work. It's more the veins coming from the harvest and not injuring them during the harvest. Then the free strap muscles will come with ansa hypoglossi and ansa cervicalis. You are able to do dual innervation if you want. We have only done it in two stages. I put a cross and then we connected.
Theoretically, you probably have enough length to do it as a single stage and put a smaller cross over. We've done it at a single stage when we're doing single innervation. Because you have two nerves, it's really an ideal setting for dual innervation, and both nerves will innervate both muscles.
[Dr. Shiayin Yang]
Have any of those patients been out long enough for you to see outcomes? I realize in terms of comparing, it's too limited, but any thoughts?
[Dr. Myriam Loyo Li]
Yes. All of the four that I talked about are all moving. They're all out long enough that we know that they're having movement and excursion. I'm on the process of comparing my multivectors to the straps. Hopefully, I'll have more information for you guys.
[Dr. Shiayin Yang]
Was there any difference in terms of time to movement between just your regular practice that you saw?
[Dr. Myriam Loyo Li]
No, there really wasn't. I haven't done that many cross-masseters, and one of my straps is a cross-masseter. I was impressed that even the cross-masseters were starting to get movement within that three, four-month mark that you would expect for somebody that has masseter as part of their innervation.
[Dr. Shiayin Yang]
I think that's really cool. I think it was something that I first learned about it. I do mission trips with Dan Allen. He was talking about how he used that a lot in his practice, or he still does it in Hawaii. Just intuitively, it makes a lot of sense because they're a lot similar in size. He had done some histologic work in terms of the type of the muscle. It could be something really awesome to see if that's an evolution to something different.
[Dr. Myriam Loyo Li]
I've been really impressed and really happy with them. I know that Dr. Hohman continues to do them. It's his preference. He will always choose a strap if it's an option over a gracilis. I haven't had to abort anyone yet, but I do talk to people about that. If we don't have the proper vessels, we will have the option of going to the leg. It takes a certain type of patient to want to do something that is relatively new and innovative versus something that's tried and true.
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Cite This Podcast
BackTable, LLC (Producer). (2024, November 5). Ep. 198 – Advanced Techniques in Facial Reanimation [Audio podcast]. Retrieved from https://www.backtable.com
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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