Having a perfect nose, perfect ears, and scar less face is as aesthetic as having a well and perfectly shaped dimple. It can be natural or well‑crafted by an oral and maxillofacial surgeon, cosmetic surgeon. Hence, dimple surgery is very safe procedure and can be completed as an outpatient procedure in less time with minimum discomforts. The various described procedures for placing the dimple in cheeks are very simple and easy to perform by the surgeons and can impart a bold and attractive facial aesthetics.

1. Damn,
That Smile!
By – Dr. Prathamesh Fulsundar

2. CONTENTS
Introduction
Anatomy of dimple
Determination of location
Surgical approach
Complications
Recovery and aftercare after surgery
Conclusion
Reference

3. INTRODUCTION
Dimplesaresmallvisible indentationson theskin
andwhenpresent onthe face,it supposedly
enhancesbeautyandexpression.
Mostly,theyarevisible ondifferentpartsofbody
such asshoulder,abdomen,back,andlimbs.
Dimplesmakethe smile moreprominent.It is
thoughttobe inheritedin anautosomaldominant
fashionandhereditaryfactorsplayarolein its
occurrence;thegenetic backgroundofdimple isthe
cleft chin dimpleisassociated with chromosome5
while thecheek dimplesarewithchromosome16.

4. Anatomy of Dimple
Dimples on the face are commonly situated on the
cheeks andchin.
Anatomically, dimples are thought to be caused by
insertion of fascial bands of zygomaticus major
muscle into dermis or dermal tethering effect of
zygomaticus major muscle which may be bifid.
Studies of human facial anatomy of the dimple
demonstrated that dimple is caused by an abnormal
insertionofthemuscles oftheface.
It is usually formed by a small defect in the
buccinator muscle of cheek, such as dermocutaneous
insertion of the fibers on the inferior bundle of the
bifidzygomaticusmajormuscle.

5. Determination of Location Of Dimple
Shaker et al. proposed a simple technique for
creation of artificialfacialdimple.
According to their technique, they asked the
patients to smile and marked the dimple at a
distance of 2–2.5 cm lateral to the nasolabial
fold at the same level or slightly above the angle
of the mouth.
This dimpleplasty surgery can be done
irrespective of anesthesia, i.e., local or general
anesthesia

6. Boo-Chai reported another landmark described
from the cosmetic viewpoints;
it is the point of intersection of two lines, a
perpendicular drawn from the external canthus
and another drawn horizontally from the angle of
the mouth
However, mostly considered position of the
dimple is
The intersection point of the perpendicular line
dropped from the external canthus on the
horizontal line drawn from the highest point of the
Cupid’s bow laterally.
When a negative pressure is created inside the oral
cavity by asking the patient to suck the cheek
inside, the point of maximum depression should
betaken as the position for dimple creation.

7. Surgical Approach To Dimple
Creation
Many techniques are developed to create dimple artificially; some are discussed below.
Bao et al. reported a technique; in this they guided a monofilament sutre material using a
syringe needle through the dermis and the active facial muscles such as the buccinators and
forming a sling between the skin and it. Dimple is created by tying knot.
The latest method of dimple creation was elicited by Rahpeyma
and Khajehahmadi in 2014; they proposed a conservative
approach for facial dimpling after elimination of the
odontogenic infection in the facial space area andit is a novel
technique that ease the removal of odontogenic infection in the
masseteric space and the buccal space and also gives esthetics
by creation of dimple in the defect area.

8. Surgical Steps

9. Complications Associated
Dimple surgery like any other surgicalprocedure is associated with certain
complications such as:
• Mildpostoperative swelling, postoperative hemorrhage.
• Buccalbranch of facialnerve injury, scar formation at operated area.
• Abscess formation, and foreign body granuloma.
• Dimples weakness of the involved muscles after the surgery.
• Judicious use of antibiotics and proper maintenance oforal hygiene
reduce the riskof complications

10. Recovery And Precautions After Surgery
Dimple creation is a day case procedure that takes 20 – 30 minutes.
Recovery depends on age, physical condition, and quality of post-
operative care. Some minimal swelling can be experienced following the
procedure, however, this subsides in a few days. Patient is prescribed
pain and antibiotic medications, and antiseptic mouth rinses to help
copewith painandpreventinfections.
He/She may start eating soft foods a few hours after the effect of your
local anaesthesia has worn off. It is better to avoid hard and spicy food.
Patient can begin all normal activities the next morning following the
procedure. The surgical wounds will heal in one to two weeks, and will
notice a more naturally appearing dimple. The dimples may appear at its
bestin thenext2 to3 months.

12. Conclusion
Having a perfect nose, perfect ears, and scar less face is asaesthetic as
having a well and perfectly shaped dimple. It can be naturalor well-crafted
by an oral and maxillofacialsurgeon, cosmetic surgeon. Hence, dimple
surgery is very safeprocedure and canbe completed asan outpatient
procedure in less time with minimum discomforts. The various described
procedures for placing the dimple in cheeks are very simple and easy to
perform by the surgeons and canimpart a bold and attractive facial
aesthetics.

13. References
 BaoS,ZhouC,LiS,ZhaoM.Anewsimpletechniqueformakingfacialdimples.Aesthetic PlastSurg
2007;31:380-3
 MokalNJ,DesaiMF.“Dimple”-maticallycorrect-revisitingthetechniqueforthecreationofachin
dimple.IndianJPlastSurg2012;45:144-7.
 ShakerAA,AboelattaYA,AttiaKS.Asimpletechniquetocreatecheekdimples.AnnPlastSurg
2015;75:493-6.
 Boo-ChaiK.Thefacialdimple–Clinicalstudyandoperativetechnique.PlastReconstrSurg
TransplantBull1962;30:281-8.
 RahpeymaA,KhajehahmadiS.Needlesubcision:Aconservativetreatmentforfacialdimplingafter
eliminationofodontogenicinfectionsource:Atechnicalnote.OralMaxillofacSurg2014;18:415-8.
 KeyhanSO,KhiabaniK,HemmatS.Dimplecreationsurgerytechnique:

14. Thank You!