Severe chainsaw injury of an elderly lady who was taken care of in an emergency in an outside clinic. During the sawing injury, facial nerve branches which controlled the lip and chin were severed. In addition, tissue is missing, so that a massive gap in the left half of the mouth appears after initial treatment. We performed a correction operation with microsurgical suture of the facial nerve branches, reorganization of the lip and chin tissue, and reconstruction of the orbicularis oris (mouth ring) muscle. In addition, fat was transferred from the upper abdomen to restore volume. After a few weeks, she has a much more pleasing appearance: the patient can close her mouth completely and press the lips together (the ring muscle is back in continuity and functions). The scarring will continue to improve significantly over the course of 1 to 2 years and become less noticeable.