A major problem for the patient with Möbius' syndrome is the inability to smile. With the development of vascularized muscle transplantation, the possibilities for improved facial animation were explored. Muscle transplantation was carried out in 7 patients; innervation was provided by the hypoglossal nerve, the motor nerve to the masseter muscle, or in 1 patient a transfacial nerve graft. In this article the technical aspects of the procedure as well as the results are described in detail.