Plastic Surgery
Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘cheek surgery’

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

Buccal Lipectomies – Beware of the Facial Nerve

Monday, November 5th, 2007


In select patients, removal of the buccal fat pad (which lies immediately under the cheekbone and is about the size of a golfball in most patients) can help contour a fuller face. I have performed this procedure, in conjunction with liposuction of the neck andchin implants, many times in patients whose desire is to thin out their fuller faces.

In numerous anatomic studies, dissectors have detailed the known relationship between the facial nerve, buccal fat pad and the parotid duct. Given the frequent proximity to this area during many types during aesthetic and reconstructive facial surgery, it is useful to have a better appreciation of this midfacial crossroads region.

Like most cadaveric studies, there are no absolutes for each person’s anatomy. However, it is clear that several buccal branches of the facial nerve interlace with the multi-lobed buccal fat pad. Most commonly, this is on the superficial (outer) aspect of the buccal lobe, away from intraoral approaches of manipulation. For this reason,
aggressive buccal lipectomies may inadvertently damage these branches. I have never observed facial nerve injury from a buccal lipectomy procedure but this attests to a more limited resection. Complete removal is usually aesthetically undesireable but also places these nerve branches at risk. Since the parotid duct shares a similar pattern of proximity as that of the nerve, injury to it is also theoretically possible. However, it is a much larger structure that is tethered by its attachment to the oral mucosa and, as such, not as easily avulsed from its anatomic bed.

In performing buccal lipectomies, it is important to bear the anatomy of the facial nerve branches in mind and adjust the amount of buccal fat resection accordingly. This is why it is always better to under remove when taking out the buccal fat pad. This is probably better from a long-term cosmetic standpoint anyway.

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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