Nerve transfer surgery is used to treat flaccid facial paralysis, a type of facial nerve dysfunction in which the muscles on one or both sides of the face lose all tone and movement.
Facial paralysis can be an inborn condition — something people are born with — or can be caused by damage to the facial nerve from injury, infection, inflammation, or neurological conditions like stroke. It can lead to trouble with blinking, eating, expressing emotions, and swallowing.
Nerve transfer surgery aims to help restore facial movement when the facial muscles still work but aren’t expected to recover on their own. It’s best to do this type of surgery within 12 to 18 months after the onset of paralysis. However, good results are still possible up to 24 months afterward.
What Is Nerve Transfer Surgery?
Nerve transfer surgery is a method of restoring movement and function to paralyzed facial muscles by rerouting healthy motor nerves to the affected area.
Nerve transfer surgery can:
- Prevent facial muscle atrophy when done early, preserving long-term outcomes.
- Reactivate facial muscles to improve expressions, symmetry, and tone.
- Replace damaged nerve signals by connecting a working nerve to the paralyzed facial nerve.
- Support emotional and social function by helping people regain the ability to smile, blink, and express themselves with facial movements.
Types of nerve transfer surgeries
The main types of nerve transfer surgeries include:
- 5-7 nerve transfer — This surgery reroutes neurons from the masseteric (or “chewing”) nerve to the paralyzed face, restoring dynamic smile function.
- 12-7 nerve transfer — This surgery reroutes neurons from the hypoglossal (or “tongue”) nerve to the paralyzed face to restore natural, resting facial tone.
- Cross-facial nerve graft (CFNG) — This method routes neurons from the facial nerve on the unaffected side of the face to the paralyzed face to strengthen the smile or prepare for a gracilis free muscle transfer.
- Gracilis free muscle transfer —This surgery is intended to restore dynamic smile function in people who are outside of the ideal treatment window or not ideal candidates for nerve transfers.
People often ask if they will have any adverse side effects from “borrowing” neurons from a different source. Due to the natural redundancy of nerve function, people do not typically experience any difficulty chewing, speaking, moving their tongues, or changes to facial function on the unaffected side.
If a nerve graft is taken from the ankle or neck, you may experience a small amount of permanent numbness in that area. There usually are no lasting functional effects from this.
Conditions we treat with nerve transfer surgery
Many conditions cause facial paralysis, including:
- Viral reactivations:
- Infections:
- Tumors:
- Facial nerve schwannoma.
- Geniculate ganglion hemangioma.
- Parotid malignancy.
- Skin cancer.
- Inflammatory conditions:
- IgG4-related disease.
- Miller Fisher syndrome.
- Multiple sclerosis.
- Sarcoidosis.
- Systemic lupus erythematosus.
- Webner’s granulomatosis.
- Trauma
- Forceps delivery.
- Temporal bone fracture.
- Penetrating facial trauma.
- Complications from other treatments:
- Middle ear surgery.
- Rhytidectomy.
- Skull base tumor removal surgery.
- TMJ surgery.
- Congenital (inborn) conditions:
- CHARGE syndrome.
- Congenital unilateral lip palsy (CULLP).
- Goldenhar syndrome.
- Mobius syndrome.
Why Would I Need Nerve Transfer Surgery?
Your doctor might recommend nerve transfer surgery if you have facial paralysis that limits your ability to use facial expressions to convey your emotions — especially if your condition causes you distress.
Facial paralysis can have a significant emotional and social impact:
- Around 60% of patients meet clinical measures for depression or anxiety.
- Misreading facial expressions during everyday interactions can lead to confusion and discomfort for both the person and those around them.
- Research shows that others often view people with facial paralysis as less happy or less friendly.
Treating facial paralysis can restore facial function, as well as your self-esteem and sense of well-being.
What Are the Risks and Complications of Nerve Transfer Surgery?
Studies of nerve transfer report minimal surgical risks, but here are some key considerations:
- Complications in patients with congenital facial anomalies — People with congenital facial issues may need additional facial surgery, which can injure the nerves of the face. For this reason, it is usually best to wait and perform facial reanimation after other planned facial reconstructive procedures have been completed.
- Graft injury — During follow-up surgeries, previously placed nerve grafts can be damaged or hard to locate due to scar tissue or shifting.
- Involuntary movement during chewing — Some people experience unwanted facial movements while eating, although this is usually mild and not bothersome.
- Lack of spontaneous smile — Depending on the donor nerve used, the smile may not be “spontaneous” and may require the patient to bite down to smile.
- Need for smile retraining — People often need therapy to learn how to activate facial muscles without clenching the jaw.
- Scarring — The procedure may involve incisions in the skin, which may leave visible scars.
- Technical challenges — Precise nerve coaptation is needed to prevent damage to existing weak facial nerve fibers.
- Variable outcomes — Recovery time and symmetry can be affected by technical aspects of the nerve transfer surgery, as well as patient-specific factors, such as age, duration of paralysis, and overall health.
Despite these risks, studies report significant improvements in facial symmetry, smile strength, and eye closure, with an overall low complication rate.
What Should I Expect From Nerve Transfer Surgery?
During surgery
Nerve transfer procedures are performed under general anesthesia in the operating room. On the day of surgery, you will meet with your surgeon to ask any questions and sign the necessary paperwork.
The surgery may last two to eight hours, depending on the number and type of nerve transfers being performed:
- 5-7 nerve transfers and CFNGs are outpatient surgeries. You will be discharged home after the surgery. You will need somebody to drive you to and from the hospital.
- 12-7 nerve transfers are inpatient surgeries. You will typically spend one night in the hospital following a 12-7 nerve transfer. You will need somebody to drive you to and from the hospital.
- Sometimes, a small nerve graft may be borrowed from the region of the ankle or neck.
After surgery
You will be asked to keep your face and leg wrapped for 72 hours. After 72 hours, you can remove these dressings and shower as normal.
You will receive an antibiotic ointment to apply to the sutures.
You may notice some facial swelling or minor bruising for two weeks after surgery.
- Apply ice for 48 hours after the procedure and sleep with your head propped up on several pillows to minimize swelling.
- All sutures will dissolve on their own and may take 10 to 14 days to heal fully. No stitches will need to be removed afterward.
- Avoid any exercise, heavy lifting, or strenuous physical activity for two weeks after surgery, or until your doctor clears you at your post-op visit.
What’s the outcome of nerve transfer surgery?
Results are not seen immediately after nerve transfer surgery, as it takes time for the nerves to regenerate. Final results may be seen between three months and one year following nerve transfer surgery, depending on the type of transfer performed.
By UPMC Editorial Staff. Last reviewed on 2026-03-01.
