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Cheek dimples are well known facial features that are congenital in origin and appear in about 20% of the population. They are inherited and as a result occur in families. Their anatomic origin is a defect in the zygomaticus major muscle. This muscle originates at the zygomatic arch and inserts at the corner of the mouth. Its action is to lift the corners of the mouth superiorly and posteriorly in smiling. A bifid or split zygomaticus major major makes a cheek dimple appear when smiling or male it deeper if one exists at rest.

For those who desire cheek dimples a surgical procedure exists to make them. This entails a small intraoral procedure where a small defect is made through the zygomaticus muscle and the overlying skin is sutured down to it. Most people that seek cheek dimpleplasty surgery do it for the obvious reason…to create this distinct cheek feature.  

But there is another indication for cheek dimples as a technique to help improve the contour of the fuller or rounder midface. When other facial defatting procedures have been done (buccal lipectomies and perioral liposuction) and further efforts are desired to improve the cheek contour cheek dimples can be created to do so. The technique for cheek dimpleplasty contouring is the same as any other cheek dimpleplasty.  The desired location of the cheek dimple is marked and a needle passed to marked its location on the intraoral mucosa. A 6 mm dermal punch is used to remove a section of the mucosa and buccinator muscle.

A clamp is passed through this intraoral punch excision and the zygomatic muscle split until the dermis of the skin is encountered. A resorbable suture is passed intraorallhy out through the skin and then back through the skin to inside the mouth. This suture is tied down to the buccinator muscle edges creating an external cheek indentation. The intraoral punch excision site is then  closed with small resorbable sutures.

In this cheek dimpleplasty technique success is not defined by how persistent the depth of the cheek dimple is but the creation of a more evident cheek inward shape.. This technique can also be combined with a buccinator myectomy procedure to enhance the cheek contouring effect.  To the maximally effective cheek defatting should be maximized either as a staged procedure before or concurrently with the creation of the dimples.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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