Cheek dimples are natural indentations some people have when they smile. Although some people have them naturally when they are not smiling and they merely become deeper when they do. The aesthetics of cheek dimples are personal, some like them and want them placed and a few others have them wand want them reduced/removed.
The anatomic basis of cheek dimples has been shown to be a defect or diastasis in the muscle layer between the skin and the buccal mucosal lining of the mouth. This is demonstrated by how a dimple deepens when one smiles. Depending upon the location on the cheek, this could involve the zygomaticus or buccinator facial muscles. Although this does not fully explain why one can have a cheek dimple without any facial animation, indicating that there must be a fat defect as well in some patients.
The surgical creation of a cheek dimple, often called a cheek dimpleplasty, does not have a standard technique. It is still a relatively uncommon procedure done by just a few plastic surgeons. How to effectively create a cheek dimple, and then have it maintained, varies amongst different surgeons.
In the March 2014 issue of the Annals of Plastic Surgery, an article entitled ‘Transoral Buccinator-Pexy (TBP)’ was published that details out a method of creating cheek dimples. In this method, the cheek dimple point is marked out about 2 cms above the corner of the mouth on its course to the lateral canthus. Under local anesthesia, a needle is passed through the skin and into the mouth through the buccal mucosa. The key manuever is to avoid the location and course of the parotid duct. Using the needle as a guide, a tissue punch is used to remove a piece of buccal mucosa down to the muscle. The needle is then used to thread a suture back out to the skin, the needle is removed, a bite of the dermis is taken and the suture passed back into the mouth where it is tied down to create the desired depth of the dimple. Their series of patients had successful results with no complications. As is common the cheek dimples because less pronounced as the swelling subsided and only appeared with smiling.
The authors chose to call their cheek dimple procedure a transoral buccinator-pexy, which is an anatomic description of what is actually done. This technique is remarkably similar to the cheek dimple creation technique that I have evolved to over the years. I still refrain from using a permanent suture having had a few infections and extrusions from a permanent suture. This is a risk when a permanent suture is placed into the dermis of the skin. I have found good success even using a 4-0 plain suture on a straight needle.
Regardless of these suture nuances, this technique of cheek dimpleplasty is a very safe and effective one that can be done successfully under local anesthesia.
Dr. Barry Eppley