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Dr. Barry Eppley

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Posts Tagged ‘cheek dimple creation surgery’

Surgical Techniques in Cheek Dimpleplasty

Sunday, May 4th, 2014


Cheek Dimple Surgery Dr Barry Eppley IndianapolisCheek dimples are natural indentations some people have when they smile. Although some people have them naturally when they are not smiling and they merely become deeper when they do. The aesthetics of cheek dimples are personal, some like them and want them placed and a few others have them wand want them reduced/removed.

The anatomic basis of cheek dimples has been shown to be a defect or diastasis in the muscle layer between the skin and the buccal mucosal lining of the mouth. This is demonstrated by how a dimple deepens when one smiles. Depending upon the location on the cheek, this could involve the zygomaticus or buccinator facial muscles. Although this does not fully explain why one can have a cheek dimple without any facial animation, indicating that there must be a fat defect as well in some patients.

The surgical creation of a cheek dimple, often called a cheek dimpleplasty, does not have a standard technique. It is still a relatively uncommon procedure done by just a few plastic surgeons. How to effectively create a cheek dimple, and then have it maintained, varies amongst different surgeons.

Cheek Dimple Muscle Surgery Technique Dr Barry Eppley IndianapolisIn the March 2014 issue of the Annals of Plastic Surgery, an article entitled ‘Transoral Buccinator-Pexy (TBP)’ was published that details out a method of creating cheek dimples. In this method, the cheek dimple point is marked out about 2 cms above the corner of the mouth on its course to the lateral canthus. Under local anesthesia, a needle is passed through the skin and into the mouth through the buccal mucosa. The key manuever is to avoid the location and course of the parotid duct. Using the needle as a guide, a tissue punch is used to remove a piece of buccal mucosa down to the muscle. The needle is then used to thread a suture back out to the skin, the needle is removed, a bite of the dermis is taken and the suture passed back into the mouth where it is tied down to create the desired depth of the dimple. Their series of patients had successful results with no complications. As is common the cheek dimples because less pronounced as the swelling subsided and only appeared with smiling.

The authors chose to call their cheek dimple procedure a transoral buccinator-pexy, which  is an anatomic description of what is actually done. This technique is remarkably similar to the cheek dimple creation technique that I have evolved to over the years. I still refrain from using a permanent suture having had a few infections and extrusions from a permanent suture. This is a risk when a permanent suture is placed into the dermis of the skin. I have found good success even using a 4-0 plain suture on a straight needle.

Regardless of these suture nuances, this technique of cheek dimpleplasty is a very safe and effective one that can be done successfully under local anesthesia.

Dr. Barry Eppley

Indianapolis, Indiana

The Surgical Creation of Cheek Dimples

Monday, May 25th, 2009

Cheek dimples are visible indentations of the skin that usually become apparent when one smile’s. They may be present in some people when their face is expressionless but most occur with facial movement. Cheek dimples are usually inherited and are a dominant genetic trait. What purpose they serve is unknown and the value of their genertically carried is even more obscure. When dimples are present, they are usually on both cheeks.  It is rare that they occur on one side of the face only.

While no one knows what the functional  purpose of cheek dimples is, it is known anatomically why they are present. In a study published in the 1998 journal of Plastic and Reconstructive Surgery, an anatomic study was performed and reported on them. It was discovered that they are caused by variation in the zygomaticus major facial muscle. This muscle is a major contributor to our smile by raising up the upper lip in an upward and outward direction. The muscle runs from its bony origin on the cheek (zygomatic) bone to insert into the upper lip. When a cheek dimple is present, it is caused by a split in the muscle. This makes the muscle be a double-band or is bifid. As one smiles, the muscle contracts or shortens and the split in it opens up drawing the overlying skin in. This explains why a cheek dimple may not be seen when one is not smiling but is when one is.

Very few people actually have dimples on their cheeks and the ones who have them are often viewed as an attractive feature. In my Indianapolis plastic surgery practice, it is possible to make dimples (cheek dimple creation surgery) through a relatively minor procedure. This is done by making a small incision on the inside of the cheek opposite the desired location of the dimple. Dimple locations are anterior to the parotid duct and the main body of the buccal fat pad. Dissection is carried through the zygomaticus muscle and a small permanent suture is placed between the underside of the skin and the muscle. It is important not to overtighten this suture since it isn’t particularly natural to have dimples when one isn’t smiling. The procedure definitely creates some bruising and it’s biggest complication is that the dimple may not be permanent if the suture pulls through in the first few weeks after surgery. Usually small to moderately-sized dimples can be created but large or deep indentations require tissue removal which I don’t advise.

A good question is ask is if this procedure is reversible or correctable if one doesn’t like the results. It is easily reversible in the first month or so after surgery which is in the time frame when one should know if the result is acceptable.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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