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.
Making 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.
Sharp 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.
Because 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