Q: I broke my cheekbone when I was 16 years old in a car accident. After it healed, I was left with a dimple on the left side of my face that is prominent when I smile. I have been receiving botox injections in the dimple and the results are minimal, although the dimple does appear about 50% less noticeable. I would like the dimple to be completely gone. What can I do? I read about fat transfers?
A: While I don’t know exactly where this facial dimple is, I suspect it is over the mid-portion of your zygomatic arch. This is likely because of your history of a car accident and facial injuries. You likely had a zygomatic arch fracture which, when left untreated, results in a classic facial dimple which appears over the midportion of the cheek. This occurs because the zygomatic arch, which is originally a thin arch of bone between the front of the cheek below the eye which extends back to the temporal bone, is fractured at its weakest point at the height of the arch. This creates a V-shaped bone indentation which is then seen as a facial dimple from the outside.
While fat injections are one treatment option, the survival of fat is not assured. I have found that a better solution is to place a small implant or dermal graft on top of the indented bone. This will push out the dimple and be permanent. This is a simple procedure done from inside the mouth and directly treats the actual problem.
Dr. Barry Eppley