Shared decision making (SDM) is a collaborative process by which a patient and physician elect a mutually agreeable, appropriate treatment plan that aligns with patient values, preferences, and circumstances. 1 Thoroughlydiscussingavailableoptionswhileincorporatingpatients' priorities is challenging. Most health care professionals support the principles of SDM yet fail to incorporate all SDM elements in practice. 1 There are critical gaps in communication and patient engagement. Implementing SDM in heterogeneous populations facing preference-sensitive decisions in reconstructive surgery may improve patient knowledge, manage patient expectations, and improve patient satisfaction and outcomes. In addition, SDM is required by the Centers for Medicare and MedicaidServicesforreimbursementinspecificscenarios. 2 In the context of dynamic smile reconstruction, many surgeons offer only a single neurotization option for given scenarios owing to surgeon preference, ability, or opinion that it is the reference standard. Despite the applicability of SDM, few surgeons incorporate it in their facial (re)animation practice. Here, we describe how SDM may support patient-physician discussions about treatment options for long-standing facial palsy.