Top Articles


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

Top Articles