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Posts Tagged ‘cheek dimpleplasty’

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

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


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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