Perfect rejuvenation of face by dimples creation surgery: A case report on novel technique.
Authors : Dr. Arsalan S. Ansari , Dr. Sanjay Joshi .
Structurally, cheek dimples occur because of a defect created by muscles on the face, whereas the chin dimple is a result of an underlying bony defect. Cheek dimples occur lateral to the angle of the mouth, and in a study published in 1998 by Pessa et al2. Cheek dimples are caused 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 cheek2.
Procedure: Patient prepared, painted and draped. Two lines drawn on face bilaterally, one drawn perpendicular downward from lateral canthus and other drawn from corner of the mouth to tragus. A point where these two line meet is marked and shown to the patient, which is mostly the location for cheek dimples. Local infiltration (2% lignocaine hydrochloride with 1:80,000 adrenaline) to the marked points intraorally and buccal nerve block given bilaterally.
After achieving proper anesthesia circular incision placed intraorally at the desired dimple location. Buccinators muscle identified and part of it is excised. Again desired dimple site rechecked on cheek by pulling from intraoral site. 2 - 0 prolene suture used for suturing the buccinators muscle to the epidermis layer of skin. Make sure there is no perforation on the overlying skin. Then sutured the intraoral mucosa with 3 – 0 black silk. Post operative instruction explained to the patient and recalled for suture removal. Preoperative and postoperative quarter picture(figure 1) and front profile(figure 2) shows the created dimple on face.
Bao and his colleagues (2007) described an elegant technique where they used a syringe needle to guide a monofilament nylon suture through the dermis and the active facial muscles (usually the buccinator), a sling was formed between the skin and the buccinator muscle, the knot was tied, and the dimple was created3.
Keyhan and his colleagues (2012) said that for better suturing technique, the enhanced exposure is useful particularly in subjects with ‘chubby’ cheeks, where the depth of the field and fat tissue can make precise suturing difficult. The blind core procedure using a trephine bur was described. This approach provides a predictable outcome with persistence of dimple more than one year4.
Thomas et al. (2010) claimed that the anomalous anatomy responsible for dimples is surgically mimicked without requiring any soft tissue removal but by allowing adequate exposure5. Contrary to what was proposed, an incision in mucosa was done. Also, dissection of muscle with cutting part of buccinator muscle was made.
Also N. J. Mokal and M. F. Desai did their study in chin dimples, they explained that the bony contouring improves the chances of creating a permanent chin cleft or dimple. Their technique for creation of chin dimples aims to give an aesthetic and permanent result by altering the underlying contour of mandibular symphysis and achieving accurate skin coaptation with non-absorbable sutures6.
Indeed, open technique and blind core method have the same permanent results (up to 1 year). Suturing alone without excision of tissue has no lasting results and the dimple will fade with time. Here we did open technique and excised the tissue which gives dimples for long period. It is slightly traumatic then the blind coring method.
You also get the cutest smile by dimple surgery in a single operation. The best makeup is smile; there is no beauty like the one that comes from inside you.
More references are availabe on request.
Abstract
Dimple creation now desired by many females. It is one of the cosmetic procedure patient are willing to undergo. It is often said that “Many a man in love with a dimple makes a mistake of marrying the whole girl”. Many techniques have been introduced to create dimples. They can be categorized into 2 major categories, namely blind coring and open approaches. We have used open approach through intraoral incision. The important step includes tying the buccinators muscle to the epidermis layer of the skin present on skin, creating a concave indentation on the cheeks.Introduction
As said by Anamika mishra “Love is not about the dimples on the cheeks but it is about the heart that beats.” Having a dimple accentuates your smile and beauty. One of the incredible thing mostly dreamed by many of the girls are dimples on face. It is an important outlet for expressing thoughts and emotions beyond words. It is an autosomal dominant fashion; the cleft chin dimple is on chromosome 5 and cheek dimples are on chromosome 16, with variable penetrance1.Structurally, cheek dimples occur because of a defect created by muscles on the face, whereas the chin dimple is a result of an underlying bony defect. Cheek dimples occur lateral to the angle of the mouth, and in a study published in 1998 by Pessa et al2. Cheek dimples are caused 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 cheek2.
Case report
A 28 year old female patient came to us for dimple creation surgery.After obtaining complete medical history and informed consent; patient was prepared for dimple surgery. Complications like anaphylactic reaction due to lignocaine hydrochloride, intaoperative and post operative bleeding, hematoma, parasthesia, injury to vital structures, delayed healing and complete physiological elimination of dimple were explained to the patient in the language best understood by her. Patient posted for dimple creation under local anaesthesia.Procedure: Patient prepared, painted and draped. Two lines drawn on face bilaterally, one drawn perpendicular downward from lateral canthus and other drawn from corner of the mouth to tragus. A point where these two line meet is marked and shown to the patient, which is mostly the location for cheek dimples. Local infiltration (2% lignocaine hydrochloride with 1:80,000 adrenaline) to the marked points intraorally and buccal nerve block given bilaterally.
After achieving proper anesthesia circular incision placed intraorally at the desired dimple location. Buccinators muscle identified and part of it is excised. Again desired dimple site rechecked on cheek by pulling from intraoral site. 2 - 0 prolene suture used for suturing the buccinators muscle to the epidermis layer of skin. Make sure there is no perforation on the overlying skin. Then sutured the intraoral mucosa with 3 – 0 black silk. Post operative instruction explained to the patient and recalled for suture removal. Preoperative and postoperative quarter picture(figure 1) and front profile(figure 2) shows the created dimple on face.
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| Figure: 1 |
Discussion
“People with dimple have a divine role in this universe: smile!” Beauty of the face is intimately related to expressions. A portrait of a beautiful face is never as beautiful as a face that is alive and expressive. The ultimate beauty of the face is augmented with the presence of dimples. Many techniques have been introduced to create cheek dimples. They can be categorized into two major categories: Suturing with or without blind coring technique and open approaches.
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| Figure: 2 |
Bao and his colleagues (2007) described an elegant technique where they used a syringe needle to guide a monofilament nylon suture through the dermis and the active facial muscles (usually the buccinator), a sling was formed between the skin and the buccinator muscle, the knot was tied, and the dimple was created3.
Keyhan and his colleagues (2012) said that for better suturing technique, the enhanced exposure is useful particularly in subjects with ‘chubby’ cheeks, where the depth of the field and fat tissue can make precise suturing difficult. The blind core procedure using a trephine bur was described. This approach provides a predictable outcome with persistence of dimple more than one year4.
Thomas et al. (2010) claimed that the anomalous anatomy responsible for dimples is surgically mimicked without requiring any soft tissue removal but by allowing adequate exposure5. Contrary to what was proposed, an incision in mucosa was done. Also, dissection of muscle with cutting part of buccinator muscle was made.
Also N. J. Mokal and M. F. Desai did their study in chin dimples, they explained that the bony contouring improves the chances of creating a permanent chin cleft or dimple. Their technique for creation of chin dimples aims to give an aesthetic and permanent result by altering the underlying contour of mandibular symphysis and achieving accurate skin coaptation with non-absorbable sutures6.
Indeed, open technique and blind core method have the same permanent results (up to 1 year). Suturing alone without excision of tissue has no lasting results and the dimple will fade with time. Here we did open technique and excised the tissue which gives dimples for long period. It is slightly traumatic then the blind coring method.
Conclusion
From the perfect nose, to the perfect ears, and that cute face, absolutely devoid of any scars, lines and wrinkles; dimple creation surgery can endow anyone with almost any beautiful feature that is desired. Yes, it is true and in fact a huge phenomenon that people can actually get flawless beauty and perfection manually. What more, all this can be achieved with only a little time, some efforts and desire and of course, money. Therefore if every feature on the face is perfect and the most suited to your profile, then is it possible to tweak one's smile also? Yes it is.You also get the cutest smile by dimple surgery in a single operation. The best makeup is smile; there is no beauty like the one that comes from inside you.
References
- Omotoso GO, Adeniyi PA, Medubi LJ: Prevalence of facial dimples amongst South-western Nigerians: A case study of Ilorin, Kwara State of Nigeria. Int J Biomed Health Sci 6:241, 2010.
- Pessa JE, Zadoo VP, Garza PA, et al: Double or bifid zygomaticus major muscle: Anatomy, incidence, and clinical correlation. Clin Anat 11:310, 1998.
- Bao S, Zhou C, Li S, Zhao M. A new simple technique for making facial dimples. Aesthetic Plast Surg.2007;31:380–3
- Keyhan SO, Khiabani K, Hemmat S. Dimple creation surgery technique: A review of the literature and technique note. J Oral Maxillofac Surg. 2012;70:e403–7
- Thomas M, Menon H, D’silva J. Improved surgical access for facial dimple creation. Aesthet Surg J. 2010;30:798–801
- N. J. Mokal and M. F. Desai “Dimple”-matically correct – Revisiting the technique for the creation of a chin dimple Indian J Plast Surg. 2012 Jan-Apr; 45(1): 144–147.
More references are availabe on request.