Cheek dimples have been proven by anatomic studies to be the result of an underlying muscle defect or unique type of muscular anatomy. They occur because of a split or defect in the zygomaticus muscle which runs from the underside of the cheek bone down into the upper lip. While appearing as a slight indentation at rest, the act of smiling contracts the muscle and pulls the overlying skin inward deepening the dimple.
This anatomic knowledge makes it possible to surgically create cheek dimples through an intraoral technique, making a similar defect through the zygomaticus muscle and anchoring the overlying dermis through it.
Dr. Barry Eppley