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Cheek dimples are a unique human facial feature that is often seen as having a desired appearance. In certain ethnicities and cultures cheek dimples are highly prized and surgical techniques to create them are commonly done. The anatomy of a cheek dimple typically comes from a bifidity or defect in the zygomaticus muscle. But the surgical technique for dimpleplasty is based on creating an adhesion of the underside of the skin down to the deeper tissues. How to create that cheek effect is where different techniques have been described to do so.

In the September 2020 issue of the Archives of Plastic Surgery an article was published on cheek dimpleplasty entitled ‘Analysis of the clinical and aesthetic results of facial dimple creation surgery’. In this paper the authors review their large experience in a specific technique for creating cheek dimples. Over 2,000 patients were treated with their cheek dimple creation technique over a four year period, Using a special cheek dimple clamp an external suture is looped under the skin and then both ends passed down through the skin and out an intraoral cheek mucosal incision where they are tied down.

Their results showed that roughly 8% had reoperation due to either undercorrection, loss of dimple appearance or over correction. A very small percent requested dimple removal by suture removal (3%) because they changed their minds about having it. Infections occurred in 3% of the patients. Collectively 1 out of 10 patients either reversed or had their cheek dimples revised.

Cheek dimpleplasty is a very safe and effective procedure but, like all aesthetic surgeries, has its own unique set of potential complications and need for revisions. Because a suture is used to create the effect and is exposed intraorally, in rare cases an infection can ensue. I am surprised it was as low as just a 3% occurrence. Tying the suture down and creating the desired effect is an art form and not an exact science. Coupled with having to do it on two cheeks in the same patient, getting the exact desired dimple effect in a symmetric fashion is certainly not an assured outcome. Thus a near 15% revision rate occurs in cheek dimple creation surgery for a variety of reasons.

Dr. Barry Eppley

Indianapolis, Indiana

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