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Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘cheek dimples’

Dimpleplasty – A Cheeky Plastic Surgery Procedure

Friday, June 25th, 2010

The cheek is a facial area where many different procedures are available for enhancement. From cheek implants, to cheek lifts, to buccal fat removal, plastic surgery changes to the cheek are numerous. All of these procedures are about altering its volume or shape. But there is one topographic change to the cheek skin that can be done that is a small and eloquent change…the creation of a dimple.

Dimples are skin indentations that are not really in the classic position of the cheek per se, but are actually in the submalar or below the cheek region. They are located above the nasolabial fold and most frequently just outside the corner of the mouth. They may be present only when smiling or can be present (although less so) when one’s face is not moving.

Whether a dimple is appealing is a matter of personal taste. For many, they are seen as a cute and rare adorable quirk of nature. Perhaps they are envied as they lend a more child-like appearance. They are frequently a feature of many dolls. Their universal description of cute would suggest so. Or it may be their appearance in association with smiling that provides a favorable review. Whether they exist in a child or adult, dimple lovers find them adorable.Dimples are not very common and exist due to a congenital defect. While some describe dimples being formed due to an absence underlying muscle and fat in the cheek, this is not accurate. They have been anatomically shown to be present due to a defect in the zygomaticus muscle. This muscle runs from the corner of the mouth in its soft tissue up obliquely to its attachment to the underside of the cheek bone. A split or bifurcation of the muscle allows the intervening fat between the skin and the muscle to be tethered or pulled down into this muscular defect. Much like the belly button, the skin is pulled down closer to the muscle resulting in an overlying skin indentation or dimple.

For those born without dimples who want them, there is no way to get them other than surgery. Cheek dimple devices have been available in the past but they appear to have gone the way of the Sears Roebuck catalog.

They can, however, be created through a fairly simple plastic surgery procedure known as a dimpleplasty. While this is little procedure has been gaining some recent popularity and press, it is not new and has its history dating back several decades. A dimpleplasty is done through a small incision on the inside of the cheek inside the mouth. The incision is positioned exactly on the inside of the cheek opposite where the indentation needs to appear on the outside. Dissection is carried through the muscle and fat to the underside of the marked skin. A small amount of fat and a window of muscle is removed. The underside of the cheek skin is then sutured down to the cheek mucosa. This initially creates an indentation on both sides of the cheek. Initially the new dimple will be a little deeper than it will eventually end up being and the ‘dent’ on the inside of the cheek will go completely away. The goal in dimpleplasty is to try to create a dimple that largely only appears when you are smiling and is either absent or only slightly there when you are not. This occurs because as you smile, the upper lip lifts due to contraction of the zygomaticus muscle. As the muscle contracts, it pulls inward on the overlying cheek skin where the tether (now scar) has been surgically created.

Dimpleplasty can be done under local or IV sedation and takes about an hour to do if both sides are done. There is no recovery to speak of other than some mild cheek swelling and the rare potential for bruising, all of which goes away in a week or less. There are no restrictions on eating or drinking after the procedure. The only undesired effects of significance is too much or not enough final dimple result and asymmetry in the dimples when done on both sides.

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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