We would like to present a gracilis case for your consideration.
This patient is a 40-year old lady who developed facial palsy after acoustic neuroma extirpation in 2007. She had facial reanimation with gracilis by 5 in 2010. The size of her muscle was sized 4cm in width and 14cm in length. She was able to have a full dental smile 5 months after the procedure but complained about the bulkiness. She had a second stage thinning and half of the thickness of the muscle was removed. The bulkiness was improved but not optimal.
The patient was able to have a full dental smile because she had a wide muscle, which we were able to inset to the full length of her nasolabial fold. This, however, is also the major reason why she had this bulkiness as this wide muscle will pass over the zygoma, the most prominent site in the face, especially in Asian population. And the bulkiness will be more manifested as she smiles on clenching.
The dilemma here is that the patient needs a wide muscle to generate a natural full dental smile. But in the meanwhile, this wide muscle will inevitably pass the most prominent part of the face, generating obvious bulkiness later. We would like to learn from your valuable experience as to how to balance these two factors.