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Posts Tagged ‘cheek dimple surgery’

Technical Strategies in Plastic Surgery- A Simplified Cheek Dimpleplasty Method

Monday, December 15th, 2014

 

The cheek dimple is an anatomic anomaly that is often inherited. They can occur on just one side of the face but more commonly are bilateral. They can be present only when one smiles or is always present and just gets deeper when one smiles. Cadaveric studies have shown that it is created by a defect in the zygomaticus muscle and represents, in essence, a tissue defect/deficiency between the skin and the underlying muscosa.

This anatomic knowledge is important when trying to create a surgical technique to create  cheek dimples. (cheek dimpleplasty)  Few surgical techniques have been published and one consistent reliable method has not been described to my knowledge. I have tried numerous cheek dimple creation methods and it is not as simple to achieve a more natural  looking dimple as it may seem.

Cheek Dimpleplasty Technique mucosal punch incision Dr Barry Eppley IndianapolisMaking a cheek dimple is really about creating a dermal adhesion to the underlying muscle. The first step is to mark where the patients wants the cheek dimple and numb the area with local anesthesia. A small incision is made inside the mouth using a dermal punch to remove the mucosa passing it over a needle introduced from the outside skin mark.

Cheek Dimpleplasty Technique percutaneous suturing Dr Barry Eppley IndianapolisSharp scissors are then used to make a pathway from the oral mucosa through the muscle and out to the underside of the skin. A plain gut dissolving suture on a straight needle is passed from inside the mouth and out through the skin. The needle is turned around and passed back inside the mouth moving it over from the skin exit hole by about a millimeter.

Cheek Dimp[eplasty Technique suture tying Dr Barry Eppley IndianapolisBecause it is a dissolveable suture, I pass two separate sutures and tie each one down individually with the knots on the inside of the mouth. When tying the sutures the cheek dimple is created and it is always best to tight them fairly tight and ‘overcorrect’ the depth of the dimple. The unpredictable part is how well the dermis will adhere down to the muscle. But with two sutures per dimple, the odds are increased that some adhesion (and dimpling) will occur. After the sutures are tied down, a single resorbable suture is used to close the small circular cheek mucosal incision.

Dr. Barry Eppley

Indianapolis, Indiana

The Anatomy and Surgical Technique For Cheek Dimpleplasty

Sunday, June 3rd, 2012

Cheek dimples are considered by some to be an attractive facial feature. Why there are appealing is not precisely known but, since they appear largely on smiling, one can assume that they cast an impression of happiness. For others they may merely be ‘cute’ or a sign of facial distinction much like a well placed mole. The location of a cheek dimple varies on different faces. It has been described as being located at the intersection of a horizontal line drawn out from the corner of the mouth and a vertical line dropped down from the corner of the eye. (lateral canthus) While that may be true for some people, dimples can also frequently be seen superior to that point.

 

The anatomy of a cheek dimple has been studied and has been found to be an anomaly of the underlying muscles The zygomaticus major muscle originates on the zygomatic (cheek) bone and runs down to insert into the corner of the mouth. It is a major elevator of the lip, particularly the corner of the mouth. Cheek dimples occur because there is a natural split or bifidity of the muscle as it heads downward into the lip. When the muscle contracts and the lip lifts, this split in the muscle pulls the overlying skin downward into the muscle defect much like an inward hernia. This creates the classic indentation on the cheek that either appears or is magnified on smiling.

 

The making of a cheek dimple (dimpleplasty) is a fairly simple procedure and has been traditionally described as a coring or soft tissue excision technique. Done from inside the mouth, a core of tissue is removed from the mucosa outward to the underside of the skin where the dimple is desired. A suture is placed from the dermis of the skin down to the mucosa where it is tied, thus pulling down the skin. While this can look effective when doing the procedure, I find that its results are very inconsistent. Dimples often don’t persist as it heals or asymmetry develops when cheek dimples are created on both sides. Some report problems, such as suture granulomas or even injury to the buccal branch of the facial nerve, neither of which I have seen.

 

 Any cheek dimple technique is intended to partially create what occurs in natural dimples, a defect in the muscle. The adherence or scarring of the underside of the skin down to the muscular defect is not what occurs naturally but is necessary to create the dimple effect. That is why all surgically created dimples will appear at some depth even when not smiling.

 

Creating this muscular adhesion is the key to surgical cheek dimpleplasty. While blind coring or cautery tissue excision creates a soft tissue defect, that does not always ensure that the skin will scar down to the muscle despite a pull down suture. An alternative and superior approach is to sew the muscle proper to the skin without any soft tissue excision. This is done by identifying the intervening muscle between the mucosa and the skin and isolating a strip of it. In theory this should be the zygomaticus muscle but the buccinators muscle will do as well. The muscle is transected and the superior end of it is then directly sewn to the underside of the skin. Thus when the muscle contracts the outer skin is pulled inward. This will also lessen the unnatural inward dimple that can occur when a coring technique is used.

 

While the recovery after cheek dimpleplasty involves no specific accommodations, it does take time to see the final result. It will take four to six weeks for the swelling and complete scarring and muscle adherence  to take place to see the final outcome. The stability of a surgical-created cheek dimple awaits for three months after the procedure.

 

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? The Anatomy of Cheek Dimples

Saturday, April 7th, 2012

Cheek dimples have been proven by anatomic studies to be the result of an underlying muscle defect or unique muscular anatomy. They occur because of a split or defect in the zygomaticus muscle which runs from the underside of the cheek bone down into the upper lips. While appearing as a slight indentation at rest, the act of smiling contracts the muscle and pulls the overlying skin inward deepening the dimple. This anatomic knowledge makes it possible to surgically create cheek dimples or help to make them less noticeable.


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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