Children who undergo facial reanimation will live with their reconstruction for decades, and they may return for more than one operation.
Dr. Karen Wong Riff is an associate professor in the Division of Plastic and Reconstructive Surgery at the Hospital for Sick Children and the Department of Surgery at the University of Toronto. She presented ‘Pediatric facial reanimation’ at Plastic Surgery The Meeting 2026, organized and hosted by the American Society of Plastic Surgeons (ASPS). The meeting was held October 15 to 18, 2026, in Houston, Texas. Her talk was part of the panel ‘advancements in facial reanimation: microsurgical approaches to treating congenital and acquired facial palsy.’ She described what sets pediatric microsurgery apart and how surgeons can define success for these patients.
‘Kids are kids, and most of the time they don't listen,’ she said. ‘So we need to provide some extra support going through complex procedures, and when we know that there will be multiple procedures, we really want to make sure that we don't traumatize them the first time around because they need to come back again.’
Children also differ on the operating table. Everything is smaller, though not always in proportion, and compared with adults, their vessels have a relatively large surface area. Keeping temperature under control during surgery helps prevent spasm. And because a child will live with the reconstruction for a long time, the donor site and future growth matter in every plan.
Facial Growth Complicates the Timing of Pediatric Facial Reanimation
Dr. Wong Riff presented cases of congenital unilateral facial paralysis and situations unique to children. One is facial reanimation in craniofacial microsomia, where the facial skeleton forms the foundation for the soft tissue. The ideal would be to wait until the jaw has finished growing, but her team generally does not wait until age 18 or 19. Instead, they weigh the benefits of earlier reanimation against anticipated jaw growth and possible future surgery, both of which could affect the reconstruction and place traction on a cross-face nerve graft. She also considers where the muscle will sit, any future ear reconstruction, and the blood supply to the temporalis fascia.
Patient-Reported Outcomes Capture What Facial Reanimation Changes for Patients
Dr. Wong Riff then asked what facial reanimation is meant to accomplish, and answered with the words of individuals with facial palsy. One described covering the affected side of the mouth with a hand when meeting new people. Another said, ‘I would avoid interacting with people because then they didn't have to look at me.’
That raises the question of how to define success. ‘Success is defined by clinically meaningful and scientifically sound outcome measures, which are really the building blocks of evidence-based medicine,’ she said.
She pointed to the World Health Organization's definition of health as complete physical, mental, and social well-being, not merely the absence of disease, and said each of those domains should be measured. The US Food and Drug Administration recognizes 4 types of clinical outcome assessment, and only one of them asks the patient directly. Measuring feelings can raise eyebrows, she acknowledged, but a large body of science supports measuring concepts that cannot be seen or measured in a standard way.
To show this in practice, she presented the FACE-Q™ scales, which measure function, appearance, and health-related quality of life, and walked through the questionnaire and her own patients' responses.
‘Clinical outcome assessments should not just be a single realm,’ she said. Standardized, objective measurements remain important for evaluating surgical outcomes, while patient-reported outcomes show the impact of treatment. By looking at the interplay between the two, she said, ‘we'll really be able to get a better understanding of where patients sit.’