The most famous and captivating dimples in memory were probably those of Shirley Temple, but Kirk Douglas also did pretty well with his. No one can say exactly why dimples are appealing but they probably represent a commonly understood pleasant facial expression, like the smile which usually produces them. Natural dimples are inherited and result from tiny bands of fibrous tissue running from the undersurface of the skin to become attached to a muscle or fascia of the facial structure below. When the muscle contracts (as in smile) the fascia moves with the muscle, the fibrous bands pull on the undersurface of the skin and draw it down to create a depression in the surface. This can occur to any degree producing a shallow dimple all the way to a deep one with the bottom hidden by shadow. Dimples can also be only on one side or unequal in size and position.

A great deal can be done to produce or correct dimples. Oddly, it is easier to produce new dimples where none existed before than to tamper with existing dimples to make them equal or deeper. There are several ways to accomplish this but the usual or most common method is to produce them from inside the mouth by a small punching tool. Local anesthesia is used after the desired location of the dimples has been marked and approved in a mirror by the patient. A straight needle is pushed through the dimple mark from the outside to mark the exact spot on the inside. A circular punch about 3/8 to ½ inch in size is then slipped over the needle point and pushed into the mucous membrane of the cheek. The needle is withdrawn and the punch is twisted and pushed toward the outside.With a finger on the dimple mark the surgeon can feel when the punch is almost to the skin level. The punch is withdrawn and the round plug of tissue which was in it is removed by scissors. Bleeding is stopped by pressure or by electrocoagulation. A permanent non-absorbable stitch such as clear nylon is then used to pull down a dimple. The stitch is placed from the inside of the mouth and starts from one side of the punched hole, then goes into the lower layer of the skin into the other side of the punched hole. It is then tied and pulls the skin down to make a dimple. The hole inside the cheek is then closed with a catgut absorbable stitch.

The dimple is visible immediately after the surgery but as healing takes place over several weeks it may become a little more shallow. If there is scar contracture, as happens in some people’s tissues, the dimple can become even deeper. At any rate it is important to understand in the beginning that while dimples can be created, one cannot predict exactly how deep they will be. No ethical surgeon will promise or guarantee that the dimples will be deep or shallow, equal or even, only that he will use his best skills. Slight differences in the two sides is more natural anyway as almost no one has the two sides of the face exactly same.

One thing you must remember after you get your dimples.

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