Dimple Surgery | Dimple Creation | Houston, Texas

Dimples, Dimples, Dimples -- How to Get Dimples?

Several people consider facial dimples an attractive feature.  Dimples are considered a sign of good luck and prosperity in some cultures.  They are also generally associated with cheerfulness.  But everyone would agree that dimples brighten and add character to a beautiful smile.  

Miranda Kerr's Beautiful Dimples (Photograph courtesy of urbanfancies.wordpress.com)

Dimples are genetically inherited, and thus this naturally given gift is not for everyone.  Research has shown that parents with dimples will pass this attractive trait to their children.  Studies of the human facial anatomy revealed that dimples occur secondary to an abnormal insertion of the muscles of the face (zygomaticus major muscle), rather than a soft tissue defect.  With the popularity of cosmetic surgery and celebrities with dimples, such as Cheryl Cole & Miranda Kerr, there has been a recent increased in demand  for dimple surgery or "dimpleplasty".  

Fast Facts about Dimple Surgery (Dimple creation)

• Dimple surgery can be done under local anesthesia by a skilled plastic surgeon.
• Majority of the techniques, if not all, involves adherence of the buccinator muscles of the face to the dermis of the skin.  This can be done by transcutaneous sutures or by an open technique done under local anesthesia.
• Typically, there is no incision done on the skin of the face.  The incision is done through the mouth which would show no scarring.
• Like a natural dimple, dimples created surgically typically appears with smiling.  Although surgically created dimples may appear most of the time depending on the surgical technique used.
• The dimple may be present even without smiling the first several days  or even weeks.   Eventually, the surgically created dimple most likely be present with smiling as scar develops between the inner skin and the buccinator muscle.
• The procedure typically takes less than 30 minutes.

The Ideal Dimple

• When one surgically create a dimple, the ideal location would be the area where a less obvious faint dimple is present with smiling.  This would create a pre-existing dimple more prominent.
• If one cheek has a dimple, the ideal site would be marked at the corresponding site that would create symmetry of the face.
• If preexisting dimple is present, the ideal location would be the intersection between a horizontal line from the corner of the mouth and a vertical line from the lateral canthus of the eye.

Potential Complications of Dimple Surgery (Dimpleplasty)

• Sudden disappearance of the dimple.
• Asymmetry
• Foreign body reaction
• Bleeding
• Injury to a nerve (buccal branch of the facial nerve) or salivary gland duct (Stensen’s duct),  which are rare.

It is possible to create dimples surgically, and this procedure may be simple and straightforward when done properly.  It is essential that one be properly educated before one undergoes any procedure.  I recommend seeing a plastic surgeon if one is interested in dimple surgery.

Emmanuel De La Cruz M.D., PLLC
Houston Plastic Surgeon

References:   

Bao S, Zhou C, Li S, Zhao M. A new simple technique for making facial dimples. Aesthetic Plastic Surgery.  2007;31: 380-383.  

Boo-chai K. The facial dimple: clinical study and operative technique. Plastic Reconstructive Surgery. 1962;30:281-288. 

Pessa JE et al. Double or bifid zygomaticus major muscle: anatomy, incidence, and clinical correlation. Clinical Anatomy. 1998;11:310-313.

Thomas et al.  Improved Surgical Access for Facial Dimple Creation. Aesthetic Surgery Journal. 2010; 30 (6): 798-801.

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The Fine Art behind Facial Fat Transfer| Houston

The Fine Art behind Facial Fat Transfer

Facial lipoaugmentation or fat transfer is the art and science of restoring volume and contour of the human face using autologous fat.  The popularity of facial fat transfer seemed relatively new, but the concept is not.  Free fat graft was pioneered in 1893 by Franz Neuber who transferred a small piece of fat from the upper arm to fill a soft tissue defect of the face.  Its use to correct deficits of the cheek and chin areas was further reported as early as 1909.   

The advent of liposuction in the 1980s spurred the move toward modern fat grafting.  Dr. Ilouz reported the transfer of liposuction aspirate in 1984, and Dr. Ellenbogen, a Beverly Hills plastic surgeon, reported the use of fat autografts in atrophic and posttraumatic facial defects in 1986. 

So Is There an Art Behind Facial Fat Transfer?

The Inverted Triangle of Youth   

The young face typically has an inverted triangular appearance.  Having more volume in the cheeks and a soft angle of the jaw suggests a youthful appearance.  As one ages, this inverted triangle of youth becomes more rectangular as one develops jowls and as the malar fat pad (cheek) descends.  Thus, facelift/neck lift procedures, along with selected fat transfer to the face,  revivify this inverted triangle of youth.

Inverted Triangle of Youth (Photograph courtesy of industrial-sourcing-news.blogspot.com; AP Photo/Damian Dovarganes)

The Ideal Beautiful Cheek

One of the secrets to a beautiful face is a pronounced cheek bone with narrow cheeks.  The ideal beautiful cheek has been found to be oval, not round.  It is also angled which extends from the angle of the mouth to the base of the helix of the ear.  Fat transfer to the aged face into the ideal cheek area may beautify the face in selected patients.  Cheek augmentation that deviates from this "ideal" may result in a less attractive and unnatural facial appearance.

Angelina Jolie's Beautiful Cheeks (Photograph courtesy of 640pixels.com)

The Young Brow Line

Recently, aesthetic plastic surgeons have recognized that young attractive female models have a brow line that is low lying with anterior projection of the brow.   Hollowness around the eyes may suggest advancing age.  Atrophy of the fat underneath the brows may cause a tired aged appearance.  Thus, re-establishing the contour of the brow line, such as a fat transfer (as suggested by Ellenbogen), may restore some youthfulness as well as can visually make the eyes bigger.    This powerful technique, especially in combination with other facial rejuvenation procedures, may only be applied in  very select cases, such as the presence of a hollowed eye appearance.  

What are the Indications for Fat Transfer?

•    Depressed scars of the face & body
•   Aging skin with loss of supportive tissue, such as the dorsal hand, hollow cheeks & eyes, upper lip and nasolabial folds.
•   Facial Reshaping for the gaunt/thin face
•   Cheek augmentation
•   Buttock augmentation, such as the Brazilian Butt Lift
•   Chin augmentation
•   Hemifacial atrophy
•   Flattened upper lip 

Complications of Facial Fat Transfer

• Fat resorption is the most common problem encountered.
• Bruising
• Fat embolism, very rare.
• Blindness, extremely rare.
• Iatrogenic injuries, such as vessels & nerves.  Thus, it is important to select a plastic surgeon to perform this procedure.
• Asymmetry may occur due to multiple factors, such as the variable nature of the viability of the fat grafted/transferred and pre-existing asymmetry of the face.

Stay tuned for more....  Next:  The Art of Facial Fat Transfer.

The Golden Ratio of Angelina Jolie (Photograph Courtesy of Digitallywright.com by Brandon Wright)

Emmanuel De La Cruz M.D., PLLC 

Houston Plastic Surgeon References: Arthur Swift's Beautiphication.  American Society of Aesthetic Plastic Surgery Conference 2010. 

Ellenbogen R. Free autogenous pearl grafts in the face: a preliminary report of a rediscovered technique. Annals of Plastic Surgery. 1986;16:179-19

Illouz YG. L'avenir de la reutilization de la graisse apres liposuccion. Rev Chir Esthet Lang Franc. 1984;9:36

Neuber F. Fat transplantation. Chir Kongr Verhandl Dsch 

Gesellch Chir 1893;20:66   Please click +1 below if you like the article.  Thank you! 

Smile Train May 2011: Sierra Leone

One of my craniofacial plastic surgery mentors, Jack Yu M.D., once told me that "to be able to speak is to be human."  Helping children repair their cleft lip and palate not only improve one's speech, but also enable one to live his/her life with dignity.   More than 200,000 children all over the world are born with a severe cleft deformity each year.   With the non-profit organizations, such as the Smile Train and Operation Smile, thousands of children each year are given the chance to smile, to speak, to eat, and live their lives with dignity.  Let's give our support to these non-profit organizations:  The Smile Train and Operation Smile.

Emmanuel De La Cruz M.D., PLLC