Q: Dr. Eppley, I am seeking an ‘enhanced’ cheek dimple surgery. I already have one existing dimple on my right cheek. Can cheek dimple surgery enhance it and make it more prominent?
A: An existing cheek dimple already has the anatomic features that make it visible, an underlying defect in the buccinator muscle and a tethering of the skin down towards it. To enhance an existing cheek dimple (make it deeper and more pronounced) it is just a matter of removing some tissue between the dimple skin and the underlying muscle and placing a percutaneous suture to bring the skin further in to make it more deeper or more indented. This is a procedure that can be done in the office under local anesthesia.
Dr. Barry Eppley
Q: Dr. Eppley, I have a cheek dimple on one side that I would like deepened. I don’t know if this is possible. I have attached a few pictures of where it is located.
A: Thank you for sending your pictures. You have a very lowly positioned cheek dimple which is below the horizontal level of the corner of the mouth. As you may know, many cheek dimples are posiitoned higher on the face than yours. While such cheek dimples represent a split or bifurcation of the zygomaticus muscle, yours involves some defect in the buccinator muscle. The good news is that it is located in a very favorable position as it lies below the level of where the buccal branches of the facial nerve run through the face. (below a line drawn from the tragus of the ear to the corner of the mouth) Efforts at deepening your cheek dimple involves an incision inside the mouth right opposite where your cheek dimple is. Fat is removed from beneath the cheek dimple and a resorbable suture is placed through the skin and sewn down to the buccinator muscle to pull it inward further. This is done under local anesthesia and does involve some cheek swelling afterward. It would take up to 4 to 6 weeks to see how much dimple deepening may be obtained.
Dr. Barry Eppley
Q: Can you undo cheek dimple surgery I had done about 10 years ago? If so, how is it done?
A: The surgical making of cheek dimples is different from what causes natural cheek dimples. Anatomically, natural cheek dimples have been shown to be present from a split in the zygomaticus nuscle which runs from the upper lip to the cheek above. Because of this natural split in the muscle, the overlying soft tissues are pulled down or tethered into the split muscle, creating an overlying indentation in the cheek. Depending upon the size of the muscle split and the amount of tethering, this is why some dimples don’t appear until one is smiling or those that have them at facial rest get much deeper with smiling. The surgical creation of cheek dimples is done by going from inside the mouth, splitting between the zygomaticus muscle, and sewing the underside of the desired spot on the cheek down to the muscle.
Reversing cheek dimples is a matter of releasing the tethered skin and placing something between the skin and the muscle as a soft tissue filler or spacer. The best filler for that, in my opinion, is fat. The easiest and most convenient place to harvest fat is the buccal fat pad which is anatomically close to where one would be working for the cheek dimple release.
In natural cheek dimples, or in surgically created ones of long-standing, the result will be a softening or less prominent depth of the dimple. This is because some of the dimple presence is due to inverted or indented skin, which an intraoral approach alone will not solve. The skin also could be completely leveled but this would require a skin incision to do so. This creates a small scar in the skin as a replacement for the dimple which may or may not be a good trade-off.
Dr. Barry Eppley