Q: Hi Doctor, I was born with a cyst in my cheek and had it removed when I was a teenager and it left a prominent dimple in the left side of my cheek. I would like it somehow corrected and removed, is this possible? One plastic surgeon said something about an injectable filler. Not sure what that is. Any advice would be greatly appreciated.
A: The removal of cysts on the face, even they are of any size, has the potential to leave a residual dimple or indentation. This is the result of a space where the cyst once was collapsing as it heals, resulting in an overlying surface contour indentation. While this is not apparent at the time of surgery and in the early healing phase (weeks to months), it is fluid (blood) that fills the space and makes it initially look smooth. As the blood resorbs, the underlying tissues collapse. If the cyst is small enough, the blood may be replaced with scar tissue. But in larger cyst removals, there will not be enough scar tissue created to leave the overlying skin smooth.
For this reason, I routinuely place dermal-fat grafts in the residual space left behind by the removal of large facial cysts during the initial surgery. This may make the overlying skin look a little full or a raised bump in some cases, but this will go down as the area heals.
For repair of facial dimples after excision of some mass, a dermal-fat graft still remains the best option in my opinion for this type of scar revision. While one can use an injectable filler for an immediate and non-surgical treatment, the result will only be temporary. By going through the scar, the underlying tissues are opened up and the graft placed where the dimple exists. While this does require a harvest site somewhere on the body, using one’s own tissues will produce a permanent solution in one simple operation.
Dr. Barry Eppley