Q: My daughter fell when she was 18 months old. Since then she has had a dimple in her left cheek. It has seemed to be getting worse as she loses baby fat. Is there anyway we can fix this? I do not want to implant any foreign body into her face.
A: Trauma to a facial region, particularly that of the cheeks, can cause subcutaneous fat atrophy. This is the result of the focused blunt trauma and hematoma formation which causes fat cell death and an overlying skin indentation. The best method of reconstruction would be a fat graft using the patient’s own tissues. It could be done using either an injectable fat technique or the placement of a dermal-fat graft. My feeling is that the dermal-fat graft is the best approach and would be placed from an inside the mouth incisional approach, unless there is an external scar in the indentation. It is important to release the contracted skin and then place the interpositional fat graft between the skin and the deeper tissues. A dermal-fat graft about the size of a quarter is needed could be taken from the either the groin or buttock skin crease. This is a fairly simple one hour procedure performed under general anesthesia as an outpatient.
Such fat would be the best ‘implant’ material as it will grow into and become part of her natural facial tissues and grow evenly with the rest of her face as she matures.
Dr. Barry Eppley