Dimpleplasty

A dimple is an attractive feature to have, but since it’s somewhat of a rarity, only the lucky few have it. Nevertheless, for those desiring one, there’s something a surgeon can do to fulfill the wish.

 

What is a dimple?
A small depression on the surface of some part of the human body, which either exists permanently or forms on making some expression, like the one that forms in the cheek when one smiles, is defined as a dimple. There are numerous cultural beliefs that believe that cheek dimples are a good luck charm that entices people, who perceive them as physically attractive. Along with this, in many cultures, it is regarded as a sign of beauty and youth.
A dimple is actually an anomaly of the underlying muscle that causes a dent on a part of the human body. Some people have dimples in both cheeks, others in just one cheek, and a few have it even on the chin. As only 20 – 30% of the world’s population has dimples, it is considered to be rare.

What are the types of cheek dimples?
Cheek dimples can be broadly classified into three types—1. lower para-angle, 2. para-angle, and 3. upper para-angle. Lower para-angle dimples are those that form underneath the mouth and lips. Para-angle dimples are those that form around the angle of the mouth, and upper para-angle dimples are the ones that form above the mouth and lips.

Can a dimple be created?
A dimple can be created under local anesthesia, with or without sedation, in an office set-up, and that too in less than an hour. And, as the surgery is performed on the inside of the cheek, there are no resultant scars on the outside skin. This technique is called dimpleplasty.

What is the anatomical basis of the dimple?
Anatomically, a dimple is caused by a double, or bifid zygomaticus, major muscle, whose facial stands insert into the dermis and cause a dermal tethering effect.

How to decide the position of the dimple?
Generally, the position of the dimple is marked by the patient in front of the mirror. If the patient is undecided, the landmark described from the cosmetic viewpoint is the intersection of a perpendicular line dropped from the external canthus, and a horizontal line drawn from the highest point of the cupid’s bow laterally.
In people with natural dimples, the area of the maximum depression is the area of the dimple when the person sucks his cheeks inside. Thus, the position can be determined by asking the patient to create a negative suction and suck the cheeks inside. The site of the maximum depression is the marked site of the dimple.

What are the benefits of having a dimple?
Many men and women desire for dimples on their faces as they find it attractive. Not just as a sign of beauty, but having a dimple may also help us communicate with others. Studies on human facial features have shown that presence of a dimple makes an expression or smile more noticeable, or conveys more information about the intensity of a person’s expression.

How is a dimple created?
The first step in dimpleplasty is marking the site where the dimple is to be placed. After lying down comfortably in the bed, around 3 to 5 ml of local anesthesia is injected from the skin down to the mucosal side at the marked site. A period of 7 to 10 minutes is allowed to lapse for the adrenaline to act, so that there is less bleeding.
A small stab incision is made on the mucosal side, taking care not to damage the papilla of the stensons duct. The muscle is separated till it reaches under the skin at the marked site of the dimple, and then with the help of the blade, the skin is scraped of all the mucomuscular attachments. A similar procedure is done on the mucosal side. A dent can be felt with bimanual palpation on completion of the scraping, and if the desired depression is not felt, then it denotes that the scraping is inadequate. The area of scrapping is decided depending on the requirement of a smaller or wider dimple.
Now, the last step in the surgical step is to create and maintain adhesion between the two layers, for which different surgeons use different techniques. Some use stitches on the skin with a bolster dressing, which has to be removed in a period of week or 10 days, while others use suturing on the mucosal surface, with the stab incision sutured with absorbable suture.

Steps to be taken care in the post-operative stage?
Oral antibiotics and pain killers are to be taken regularly. The most important part is maintaining meticulous oral hygiene with mouthwash and oral rinse.
Initially, there will a static dimple, which deepens on animation, but with time, there will be only a hint of a dimple when static, which accentuates on animation.