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    Do you do dimples?

     

    How to Create a Dimple

    Dr. Sidebottom says he marks the ideal position the patient would like in the mirror, then injects local anesthetic. He removes an intraoral punch of mucosa and places a resorbable suture through and through to tie the skin to the buccinator. He closes the oral wound with Vicryl Rapide sutures (Ethicon).

    “The depth of the dimple can be discussed with the patient in the mirror whilst tightening the through and through suture,” Mr. Sidebottom says. “The ideal approach would be to use a suture tied to the dermis; however, this is very difficult to achieve without a larger access wound. Multiple sutures can create a longer dimple. Don't tie the suture too tight, most patients prefer subtlety.”

    Dr. Lahiri says he asks patients to draw where they’d like the dimples to be on their cheeks before surgery.

    “The procedure is performed under local anesthesia,” he says. “A disc of muscle (buccinator) is removed at the site of election. The edges of the cut muscle are sutured to the dermis….”

    Dr. Lahiri recommends doctors counsel patients realistic expectation and provide detailed post-surgery instructions to avoid loosening of sutures.

    “Thorough dissection of the muscle fibres is necessary to allow good fixation,” he says.

    The approaches for creating cheek dimples fall in two categories: “Suturing with or without blind coring technique and open approaches,” according to a paper in the April-June 2015 Journal of Cutaneous and Aesthetic Surgery, describing a simple technique for creating the facial dimples. The author, Ahmed Hassan El-Sabbagh, M.D., in the department of plastic surgery and member of the medical faculty at Mansoura University, Mansoura, Egypt, writes literature on dimple creation is sparse but demand for cheek dimple creation is on the rise.

    Dr. El-Sabbagh describes a suturing technique he used on 23 female subjects. Bao and colleagues wrote about the technique in 2007, in which they would guide a monofilament nylon suture with a syringe needle, going through the dermis and active facial muscles — most notably the buccinator. As a result, they formed a sling between the skin and muscle, tying a knot to create the dimple. Dr. El-Sabbagh’s version had a few modifications. He uses one suture, rather than multiple sutures. To avoid hematoma formation, Dr. El-Sabbagh marks for dimples according to the location of facial artery pulsation. He creates dimples that are rounded or vertical, depending on facial shape. And vector of smile determines whether the dimple should be level with the mouth’s angle or above it.

    He writes the suturing approach is simple and safe and results last about four months.

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    Lisette Hilton
    Lisette Hilton, president of Words Come Alive, has written about health care, the science and business of medicine, fitness and wellness ...

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