Byline: Ahmed. El-Sabbagh
Background: Subjects seeking aesthetic surgery for facial dimples are increasing in number. Literature on dimple creation surgery are sparse. Various techniques have been used with their own merits and disadvantages. Materials and Methods: Facial dimples were created in 23 cases. All the subjects were females. Five cases were bilateral and the rest were unilateral. Results: Minor complications such as swelling and hematoma were observed in four cases. Infection occurred in two cases. Most of the subjects were satisfied with the results. Conclusions: Suturing technique is safe, reliable and an easily reproducible way to create facial dimple. Level of Evidence: IV: Case series.
Scars like umbilicus or deformities like chin and cheek dimples (small hollows) are established aesthetic features in plastic surgery. In Arabian society, cheek dimples are considered as a sign of beauty and attractiveness. The same concept is also established in oriental communities. [sup]
Cheek dimples are caused by the presence of dermocutaneous insertion of the fibers of the inferior bundle of the double or bifid zygomaticus major muscle. Either or both of the cheeks can present with one or more dimples. Dimples occurring on both cheeks are more common than only one cheek. [sup]
Several techniques had been described for creation of cheek dimples depending on two main principles either to excise soft tissue [sup] or to use suturing technique. [sup], In this article, suturing technique was used with some modifications.
Materials and Methods
This study included 23 female subjects working at King Salman Hospital, Riyadh, Saudi Arabia, who underwent creation of 28 dimples (five cases were bilateral) during the period from August 2013 to August 2014. Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.
Subjects were informed about the following: Swelling and oedema is likely during the first week. Mouth wash and fomentation (cold in the first 48 h and warm on the following three days) is advised. The dimple will be exaggerated in appearance and with time it will appear only with smiling (after one month) and within six months it will fade.
Operative technique [Video online Movies 1, 2]
The surgery was carried out as described by Bao and his colleagues [sup] but with some modifications. The ideal location for marking of unilateral or bilateral dimples would be the area where a less obvious faint dimple is present with smiling. If a pre-existing dimple is not present, it is marked at the intersection of a perpendicular line dropped from the external canthus and a horizontal line drawn from the angle of the mouth. [sup] Sometimes the marking migrated slightly laterally if pulsation of facial artery is palpable to avoid hematoma. The site of dimple may be at the level of angle of mouth or above it according to vector of smile.
The operation was performed with the subject under local anaesthesia [Figure 1]....