Definition & Overview

Dimple creation surgery is a simple outpatient cosmetic surgical procedure performed by plastic surgeons to create artificial dimples.

Dimples, which are technically a result of a facial muscle deformity, are considered an attractive feature in many countries because they accentuate a person’s smile and improve facial appearance. The procedure is currently one of the most popular cosmetic surgical procedures and is generally safe and straightforward with a high satisfaction rating.

Who Should Undergo and Expected Results

Dimple creation surgery can be taken advantage of those who wish to enhance their facial appearance and emphasise their smiles. This is because most people consider dimples as an attractive facial feature that adds to one’s overall personality.

Some cultures also place a significant emphasis on dimples, with some considering them as a sign of good luck and factor in partner selection.

The anatomical formation of dimples is known to be caused by a muscle defect, in which a double or bifid zygomaticus major muscle’s fascial strands insert into the dermis. This causes a tethering effect in the skin. Dimples are also mostly hereditary.

Patients who are considering having dimples created on their cheeks decide where to have them placed. However, if the patient is having difficulty deciding, surgeons generally suggest the intersection of the horizontal line coming from the angle of the mouth and the perpendicular line dropping from the external canthus as the ideal location. For some people, however, this places the dimples too low in the face. Thus, as a simpler reference, the area of maximum depression when a person sucks his cheeks inwards is generally an ideal location for a dimple.

In the procedure, the dimple is created by making a scar in the dermis and is designed to adhere to the muscles underneath it to create a permanent tethering effect. Studies performed on patients who underwent the procedure report high satisfaction ratings, with most patients reporting good long-term results. However, it is possible that in some patients, the dent made by the surgery may also decrease in depth or may diminish slightly, but studies show that the dimple remains visible after four years of follow-up.

How is the Procedure Performed?

A dimple creation surgery is performed under local anaesthesia. Once all preparations have been made, the patient is asked to lie down, and the surgeon proceeds to draw on the patient’s face bilaterally to mark the site where the dimple will be placed. After this, the surgeon begins the surgery by making a circular intraoral incision at the desired location. The surgeon takes care not to affect the papilla of the stensons duct. The mucomuscular attachments in the skin just below the dimple site are scraped, removing a small piece of muscle and fat tissue. This procedure is also done on the mucosal side, with the surgeon taking extra care to avoid damaging the mucosa. The two raw areas created by the scraping procedure will then adhere to each other, effectively creating the dimple. The size of the dimple is controlled by the size or width of the scraped area. If the patient desires a larger dimple, a larger area will be scraped. Once these two areas adhere to each other, the surgeon performs other steps to maintain the adhesion.

The incisions performed during a dimple creation surgery are closed with dissolvable sutures, which dissolve easily within the next few days. The outer part of the cheek remains completely unaffected by the procedure. The whole surgery typically takes 20 to 30 minutes, and patients are discharged soon after. Due to the intraoral incision, patients are required to stay on a soft diet for a few days.

In patients with thicker fat tissue in the cheeks, resulting in chubby cheeks, a different technique allowing for enhanced exposure of the area may be necessary.

Possible Risks and Complications

Dimple creation surgery, although a fairly simple procedure, is not without potential complications. These include:

  • Anaphylactic reaction due to the anaesthesia
  • Bleeding
  • Hematoma
  • Parasthesia
  • Injury to vital facial structures, such as the buccal branch
  • Delayed healing
  • Dimple asymmetry, or when the dimple positions are not symmetrical


Aside from these potential risks, patients can also expect to experience some swelling and bruising in the cheeks, which usually resolve without treatment. Patients are often able to resume their normal activities the day after the procedure.

Since there is still the common surgical risk of infection, patients are also required to take a course of antibiotics following the surgery. Most patients are also given analgesics to help with post-operative pain, although this is usually mild in dimple creation procedures.

Studies on patient follow-ups after a dimple creation surgery lasting from 3 weeks to 4 years show that only 3 out of 100 patients experienced intraoral infection. The cases are linked to a too tight bolster, causing ischaemia of the mucosa, as well as poor oral hygiene. The infection cleared after antibiotic treatment and by removing the bolster. The dimple, however, remained unaffected; in fact, the additional scarring caused by the infection further accentuated the dimple.

References:

  • Ansari AS., Joshi S. “Perfect rejuvenation of face by dimples creation surgery: A case report on novel technique.” http://www.facethetics.in/articles/facial-plaastic-surgery/80-perfect-rejuvenation-of-face-by-dimples-creation-surgery-a-case-report-on-novel-technique

  • El-Sabbagh AH. “Simple technique for facial dimple.” Department of Plastic Surgery, Mansoura University, Mansoura, Egypt. 2015; 8(2): 102-105. http://www.jcasonline.com/article.asp?issn=0974-2077;year=2015;volume=8;issue=2;spage=102;epage=105;aulast=El-Sabbagh

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