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Dimples are well recognized indentations in the midface which can occur either on just one cheek or both. They are known to have a familial predisposition and are passed along on a dominant genetic basis. It has been isolated to the 16th chromosome although its expression is inconsistent. Anatomically it is caused primarily by a split or bifid zygomaticus major muscle in which the undesired of the dermis is tethered inward.

Cheek dimples are often regarded as a charming facial feature whether it occurs in men or women. Some dimples appear only when smiling (dynamic dimples) while other are present in static facial expression and get deeper with smiling. The perception of their attractiveness probably lies in that they enhance the smile or at the least draw more attention to it.

The surgical creation of cheek dimples is not new. Techniques to do it have been available for decades. Both external and internal dimpleplasty techniques exist but the intraoral approach is preferred. (even if it is less effective)

In the November 2018 issue of the American Journal of Cosmetic Surgery an article was published on this topic entitled ‘The Dimpleplasty: A New Streamlined Approach to Surgical Creation of Dynamic Facial Dimples, Our Experience, and Results’. In a series of twenty (20) consecutive patients, the authors performed a transoral cheek dimpleplasty technique. By coring out a circular segment of cheek mucosa and muscle directly opposite the desired dimple location, sutures are placed between the dermis and the cheek mucosa. This creates a simple in the outer skin as well as closes the intraoral mucosal defect.

With six (6) month followup patient outcomes were assessed which include two complications (10%), loss of dimple in one patient and one postoeperative infection. Otherwise the remaining patient’s achieved good dimple indentation with smiling and high satisfaction levels.

The intraoral approach is effective for creating cheek dimples…but be advised this works more successfully for crating dynamic dimples than it does for static dimples. By removing tissues underneath the skin and then compressing the layers together by sutures (with or without an external bolster) an internal tissue defect is created. This becomes most apparent with smiling (dynamic dimples) as the underlying tissue defect is exposed. Creating static dimples is more challenging as tis requires a large amount of tissue resection and fixation than can be typically obtained through an intraoral approach.

Dr. Barry Eppley

Indianapolis, Indiana

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