smile) is selected. This branch is then sectioned. The sural or saphenous nerve as cross facial nerve graft is coapted to this unaffected branch of the facial nerve and tunnelled across the face to the paralysed side through a subcutaneous tunnel. The end of the graft is positioned in front of the tragus (cartilage in front of the ear) on the paralysed side. Nine to twelve months is needed for axonal regeneration in the cross facial nerve graft, because the result of damaged nerve tissue is loss of structure and axonal function. Degeneration appears distally in the paralysed facial nerve but this takes time, this process is called Wallerian degeneration. During the second stage end-to-side or end-to-end nerve coaptation to the proximal end of the paralysed facial nerve is performed with a microscope. And a free muscle transplant is placed, if indicated. Likewise the "babysitter" procedure uses the CFNG, in combination with the masseteric or hypoglossal nerve. In the "babysitter" procedure, the hypoglossal nerve or masseteric nerve on the affected side is identified. This donor nerve is then attached to the distal end of the paralysed facial nerve. Techniques for donor nerve transfers are transposition of the entire donor nerve, partial transposition by splitting the donor nerve longitudinally or indirect hypoglossal- or masseteric-facial anatomosis using a 'jump' interposition graft. This usually is the great auricular nerve or sural nerve. These hypoglossal- or masseteric-facial nerve anastomosis using a 'jump' interposition graft can be used to directly reinnervate the paralysed facial muscles or as a "babysitter" procedure. The goal of the latter is only to achieve fast reinnervation of the mimetic muscle to prevent irreversible atrophy. Simultaneously one or more CFNGs are performed to eventually reinnervate the mimetic muscles, again as a one- or two-stage procedure, depending on the choice for the free muscle transfer graft. If a two-stage procedure is performed, the CFNGs are connected to the distal branches of the paralysed facial nerve during the second stage 9 to 12 months later. The donor nerve can be left intact. If a free muscle transfer is indicated, this is also performed in the second stage of the procedure to augment the partially reinnervated mimic muscles by the hypoglossal nerve. In case of longstanding facial paralysis with irreversible muscle atrophy and unavailability of a suitable donor facial nerve, a free muscle graft is indicated for smile restoration, which has to be reinnervated