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Cultural impression: Fashioning a favored facial feature

Article-Cultural impression: Fashioning a favored facial feature

Quezon City, Philippines Patients born without dimples in their cheeks or whose dimples have faded as they grew older now have a surgical option available to create or restore that special attribute emblematic of a youthful appearance.

Using a straightforward outpatient procedure, physicians can create facial dimples for those patients who desire them. Although not commonly performed in the United States, facial dimple creation has found favor in other parts of the world.

Dimples, those indentations of the skin caused by an attachment of the skin to underlying muscle tissue, are common in babies and young children, but tend to diminish or become less noticeable with age as the underlying muscles stretch through use. This pattern of appearance contributes to the association of facial dimples with youthfulness.

From his offices in the Philippines, Carlos I. Lasa, Jr., M.D., is one of a number of physicians in Asia who surgically create dimples for patients. Dr. Lasa is a plastic and reconstructive surgeon who specializes in aesthetic/cosmetic surgery and liposuction. His training has included a fellowship in aesthetic plastic surgery at the Institute of Aesthetic Plastic Surgery in Atlanta, and a second fellowship in aesthetic plastic surgery and maxillofacial surgery at Mount Sinai Medical Center in Cleveland.

Dr. Lasa has performed the facial dimple creation procedure since 1987 on patients ranging from 18 to 50 years of age — perhaps interestingly, on approximately equal numbers of men and women. Although it can be combined with other cosmetic procedures, Dr. Lasa reports that his patients who desire dimple creation usually request only this one procedure.

"Asians find this an attractive facial feature," he says.

DIMPLE CONNECTION the key to the creation of a facial dimple is to create an attachment between the skin and the cheek muscle underneath. with this attachment successfully in place, contraction of the muscle will result in the presence of a dimple.

"A punch biopsy instrument is placed against the buccal mucosa and circular motions are made to cut through the mucosa, submucosal fat, and cheek muscle," Dr. Lasa says. "A circular core of these tissues is removed, leaving the skin intact, which will create a shallow cylindrical-shaped defect under the skin."

"This 'defect' then is closed by placing an absorbable suture through the cheek muscle on one side of the defect, then through the dermis layer of the skin, and finally through the cheek muscle on the other side of the defect," Dr. Lasa says.

"A surgical knot is tied, which, in turn, will result in dimpling of the skin even without smiling."

As the suture is absorbed the dimple will flatten out, according to Dr. Lasa. This process will usually take a week or so. As the site heals, internal scarring resulting from the presence of the suture will connect the skin and muscle, creating the dimple.

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