Dimpleplasty: for a dent which dazzles

Dimples are minuscule indentations that can be found on the skin surface. Cheeks, chin, and lower back can be dimpled, and interestingly, cheek dimples may occur on either or both sides of the face.

There is a strong predisposition that genetic factors govern the presence of dimples but it is still scientifically debatable.

Population genetic studies have shown that Caucasians are more observed with dimples and at an average, about 40% of any population is endowed with dimples.

How are dimples on cheeks formed?

Dimples have always been recognized as an enticing addition to the face and definitely a beauty enhancer in both genders.

However, anatomically a defect in the muscle of the cheek namely the buccinator muscle and an inherited split in the zygomaticus major facial muscle that normally raises the upper lip are the cause of the dimple.

It follows that extent of the defect spells out how deep the dimple is and whether it appears only when the person smiles or is present even when the face is in repose. 

This split in the muscle can be referred to as a double or bifid zygomaticus major muscle. Movement of the skin over the double zygomaticus major muscle when one smiles cause the formation of a dimple.

Incidentally, cheek dimples can result from a muscular variation that occurs during fetal development, and hence, they are sometimes mistakenly referred to as a birth defect. It’s important to remember that not only cheek dimples are rather common, but they also don’t have any negative health effects.

This article aims at the enlightening journey into the forays of a kind of cosmetic surgery where value addition to the face is the be-all and end-all objective….like the title announces it’s all about the dent which dazzles and of course the cliché “no gain without pain”(i.e. if Mother Nature has not been generous!!!!). 

Dimpleplasty: a preamble…

Dimpleplasty is a kind of plastic surgical procedure used to create dimples on the cheeks. It is a very universal belief that the presence of dimples on a face substantially adds to the perceived beauty quotient.

In fact in Asian and Indo-ethnic societies, the presence of a dimple is seen as a precursor of wealth, fertility and good fortune.

In the west, however, cuteness is synonymous with having dimples. In the glamour world also, a dimpled face is a crowd puller than otherwise. It follows that individuals are willing to endure the entire plethora of onslaughts on body, mind and even pocket to gain dimples and small wonder that in recent times, the number of dimple surgeries has increased significantly 

Dimple Creation on a Surgeon’s table

Ideally, the title of this aspect should read “at the Surgeon’s table” rather than “on the Surgeon’s table” as the procedure is timed at around half an hour and is executed under local anesthesia.

The invasive procedure requires the formation of an adhesion between the muscle of the skin and the cheek. The resulting dimple occurs when the muscle contracts during smiling, an indentation occurs in the overlying facial region.

After healing, the scar tissue permanently connects the skin and underlying muscle and creates an indentation when the muscle moves, a process that mimics natural dimple formation.

Steps to Dimple creation

A dimpleplasty is interestingly performed in an OPD or on an outpatient basis. This implies that the patient does not require a hospital stay and only local anesthesia is administered.

It is important to note that perioperative procedures like patient profile tests especially if the patient is diabetic, allergic or has some other chronic biochemical complication and a very detailed patient briefing and counseling do form a part of the regimen. A local anesthetic like lidocaine is generally applied to the area and it takes about ten minutes to start the effect.

The cosmetic surgeon then uses a small biopsy instrument to make a hole in the skin area in order to manually create a dimple. The area usually measures two to three centimeters in length and during the surgical procedure, a small amount of the fat and muscle of the patient has to be sacrificed. The dimple is permanently created by the use of a suture from one side of the cheek to the other.

 Methods of Dimpleplasty 

Apparently, the oriental imagination as far as dimples are concerned seems more vivid than classical English language. The Chinese depicted the dimple in a calligraphic presentation in a very graphic manner using a whirlpool and its quintessential ripples.

The Oxford dictionary has been relatively dull in its depiction of meaning calling the dimple a small hollow especially in the cheek or chin, hardly anything to generate romance or poetry. The reality, however, is that not all pretty girls have dimples hence, why not resort to simple techniques to create dimples???

A review of related medical literature specifies that all the techniques for dimple creation surgery project a very safe procedure with excellent results and a very negligible complication rate.

Today’s most prevalent dimpleplasty technique serves to give due credit to surgeon pioneers like Khoo Boo Chai, Shiwei Bao, et al, Thomas and his co-researchers and Saraf and his research group.

The aftermath and the timeline of recovery

Patient recovery from dimpleplasty is usually uncomplicated and straightforward. Since the procedure does not require a hospital stay, the individual can return home. Usually, a mild analgesic is prescribed and a light diet is recommended for about a week or so. Cold packs are also part of the post-procedure management and help to provide relief to the swelling and redness of the affected area.

The downside….Complications

There is a very remote chance of complications arising from a dimpleplasty . However, the possible risks may be serious if they do occur, and hence no discussion is complete without the flip side of the procedure. Some of the possible complications include:

• Uncontrolled bleeding and hematoma at the site of surgery
• Facial nerve damage which may be either temporary or permanent
• Redness and swelling and water retention in the facial tissues
• A post-procedure infection which may be either primary or secondary
• Short term or long term scarring

Since the whole concept is argumentatively vanity based, the patient may not like the result of the dimpleplasty. But lo behold! It is possible to undo what is done. Yes….Dimple surgery can be reversed although the results may.

Reversal of Dimpleplasty….return to nature

Dimple creation is a long term procedure but it does imply that all cosmetic dimples are completely irreversible. Dimple creation may be partially reversible.

In the reversal procedure, the tissue in the cheek may be released and the skin separated from the underlying muscle. It is, of course, a generalization and differs from case to case. As with all cosmetic surgeries, there are exceptions.

As a postscript of this reversal surgery, in certain rare cases, there may be a short term weakness of the cheek muscle after the surgery which may last for a few weeks.

Well, well to sign off, the most important question….What is the Dent on the Wallet for this Dent creation? Cost : The average cost of Dimpleplasty globally is estimated at USD 1,125. In India, it could cost around INR 50,000 and may vary.

Wonder if it is worth it….someone would compliment you in this manner of course:

                       “YOUR SMILE MADE MY DAY IT’S SIMPLE, YOUR DIMPLE!”

The author acknowledges the use of authentic medical literature to structure this article

Also read: Liposuction: a perspective and insight

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