A dimple is a tether, not a hollow

The cheek dimple people are born with is an anatomical variation. In most descriptions it comes from the zygomaticus major, the muscle that pulls the corner of the mouth up and outward when you smile. In some people that muscle is split into two bellies, or a slip of it attaches into the deep surface of the skin instead of running cleanly to the corner of the mouth. Wherever the skin is bound down like that, contraction pulls it inward and a dimple appears.

Two consequences follow from that, and nearly everything else on this page comes back to them.

The first is that a natural dimple is a moving feature. It shows when the muscle contracts and disappears when the face is at rest, because the tether only pulls when something is pulling on it. The second is that a dimple is made of an attachment rather than of missing tissue. It is not a divot scooped out of the cheek, which is why removing fat from the cheek does not create one and never has.

Dimples are also common, inherited in an irregular pattern, and frequently asymmetric. Plenty of people have one clear dimple and a faint one, or one side only. That is worth knowing before surgery, because a perfectly matched pair is not what most faces with dimples actually look like.

What the operation does

Dimpleplasty reproduces the anatomy above deliberately. The whole procedure happens through the inside of the cheek, so nothing is cut on the outside of the face and there is no external scar.

After the position is marked on the outside and the area is numbed, a small incision is made in the lining of the cheek at the corresponding point inside the mouth. A small core of tissue is removed through it to reduce the bulk sitting between the skin and the muscle. A suture is then passed from the deep surface of the skin at the marked point through to the muscle or the fascia over it, and tied so that the skin is drawn inward. That fixation is the operation. The stitch itself may dissolve, but by the time it does, scar tissue has formed along the same line and takes over the job of holding the skin down.

It is usually done under local anesthesia, takes well under an hour for both sides, and people go home the same day. The size of the operation is genuinely small. The permanence of it is not, which is the mismatch worth sitting with.

The part people are least prepared for

A new dimple is normally visible at rest for the first weeks, with the face completely relaxed. It looks deeper and more fixed than a natural dimple, because the tissue is swollen and the fixation is tight and fresh.

That is expected, and it is supposed to soften. As swelling resolves and the internal scar matures and relaxes, the indentation should retreat until it appears mainly when you smile. For most people that transition happens over several weeks to a few months.

In some people it does not complete. A shallow dimple remains faintly visible with the face at rest, and the result reads as slightly permanent rather than as an expression. Nobody can tell you in advance which group you will fall into, because it depends on how you scar rather than on how the operation was done.

This is the honest center of the decision. Someone who wants a dimple when they smile and could not tolerate a small indentation the rest of the time is taking a risk they should name out loud at the consultation. Someone who would be relaxed about either outcome is a much better candidate.

Reversal is harder than creation

Because the result is scar, undoing it is not a matter of removing a stitch. By the time anyone is unhappy enough to ask, the suture has usually done its work or dissolved, and the tether is fibrous tissue between skin and muscle.

Releasing it means going back into tissue that has already been operated on, dividing the scar, and hoping the skin lies flat again. Sometimes it does. Sometimes the release leaves a different irregularity, or the dimple partially returns as the released area scars again. Fat grafting is occasionally used to fill the defect, which adds another variable in a small and mobile area.

Revision is a real option and surgeons do it. It is simply not symmetric with the original operation, and it should not be presented as though it is. Decide as if this is permanent, because functionally it is.

Placement is the part that decides whether it looks right

Where the dimple goes matters more than any technical detail of the fixation, and it is settled before anything is numbed.

Marking is done with the patient sitting upright and smiling, since the entire point of the feature is how it behaves on a moving face. A frequently cited starting reference is the intersection of a vertical line dropped from the outer corner of the eye with a horizontal line drawn outward from the corner of the mouth. That is a starting point rather than a rule, and it is adjusted to the individual face, to the fullness of the cheek and to where the smile actually creases.

A dimple placed too close to the mouth looks like a crease. Too high and it reads as a dent on the cheekbone rather than as a smile. The depth chosen also matters: deeper does not mean better, and a shallow dimple that behaves naturally beats a deep one that announces itself.

Anyone marking both sides is working with a face that is already asymmetric, as all faces are. Matching the two sides to the millimeter is not the target. Making each side suit the half of the face it sits on is.

Recovery

Most people are back to normal activity within a day or two, and the obvious swelling settles over roughly a week. Because the wound is inside the mouth, recovery is mostly oral care rather than wound care in the usual sense: a soft diet for the first days, antiseptic or salt water rinses as directed, and care when brushing near the site. Chewing and talking can be tender for a few days.

The dimple looking deep, fixed and slightly startling in the first weeks is the normal course and not a complication. Judging the outcome during that window is the most common reason people worry about a result that has not finished arriving. The appearance that will last takes a few months to declare itself.

The risks worth knowing

Infection deserves first mention because the incision is in the mouth, which is not a sterile field. It is uncommon and is treated, but it is the reason the aftercare instructions about rinsing are given weight rather than mentioned in passing.

Bleeding, bruising and swelling that lasts longer than expected all occur. Asymmetry between the two sides is the most frequent aesthetic complaint, followed by a dimple that is too deep, too shallow, or positioned in a way that does not suit the face. A dimple that never softens into a smile-only dimple belongs on this list too.

Two nearby structures explain why placement is an anatomical decision and not a cosmetic one. The parotid duct drains saliva into the mouth near the upper molars, and it crosses the region where this dissection happens. The buccal branch of the facial nerve supplies muscles of facial expression in the same area. Injury to either is uncommon and largely avoidable, and avoiding it is a matter of knowing precisely where you are, which is the argument for having this done by someone who operates on faces routinely rather than by whoever offers it cheapest.

What dimpleplasty is not

This procedure is regularly confused with other cheek and lower face operations that do entirely different things.

It is not buccal fat removal. That operation removes a discrete pad of fat to slim the mid cheek and create hollowing below the cheekbone. It changes the overall contour of the face and it is not reversible either, but it does not create a dimple and cannot. The two are sometimes discussed together because both are done through the mouth, which is a similarity of access and nothing more.

It is not a chin dimple. A cleft or dimpled chin is a feature of the bone and the mentalis muscle in the midline, and altering the chin belongs with chin augmentation. Cheek dimple surgery does nothing to the chin.

It is not a filler treatment. Dermal fillers add volume, and adding volume is the opposite of tethering skin inward. There is no injectable that creates a durable dimple, and volume loss in the cheeks is a different complaint answered by fillers or by fat transfer.

It does not change your smile. If the concern is how much gum shows when you smile, that is a separate problem with its own set of answers, covered in the piece on the gummy smile. If it is the proportion of the upper lip at rest, that belongs with a lip lift.

What a consultation should settle

Three things decide whether this is worth doing. Where the dimple should sit on your particular face, agreed while you are upright and smiling rather than lying down. Whether you would accept a dimple that stays faintly visible at rest, since that is a real possible outcome and not a rare complication. And whether you understand that reversal is a second operation with an uncertain result.

Dimpleplasty is one of the few facial procedures where the operation is minor and the commitment is not. A surgeon who spends most of the appointment on placement and on what happens if the dimple does not soften is giving you the two pieces of information that actually determine whether you will be happy.

Decide on placement before you decide on the procedure

Where a dimple sits, and how it behaves when you are not smiling, are settled in an examination with your face upright and moving.

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Dimpleplasty is a short operation that creates a cheek dimple by binding the underside of the skin to the muscle beneath it. It is done from inside the mouth, so there is no incision on the face. A small amount of tissue is removed through that opening and a suture is passed from the deep surface of the skin to the muscle and tied, which tucks the skin inward at that one point. It is usually performed under local anesthesia and takes well under an hour. It creates a dimple where there was not one before, and it does nothing else to the shape of the cheek.
At first, yes, and that is the part people are least prepared for. A new dimple is usually visible at rest for the first several weeks while the tissue is swollen and the suture is holding tightly. As healing settles and the internal scar matures, it should soften so that it appears mainly when you smile. In some people it does not soften completely and a shallow indentation remains visible with the face relaxed. There is no way to guarantee which way an individual will heal, so anyone considering this should decide whether they could live with a dimple that is faintly present all the time.
Not reliably. The dimple is held by scar tissue that forms where the skin was fixed to the muscle, and that scar is the result rather than the stitch. Releasing it means operating on scarred tissue and hoping the skin redrapes smoothly, which it may not, and the correction can leave its own irregularity. Revision is possible and is done, but it should be understood as a second operation with an uncertain outcome rather than an undo button. Treat the decision as permanent.
Placement is planned with the patient sitting upright and smiling, because a dimple only makes sense in relation to a moving face. A common reference is the point where a line dropped from the outer corner of the eye meets a line drawn outward from the corner of the mouth, adjusted for each face rather than applied as a formula. Position is discussed and marked before anything is done, since a dimple set too high, too low or too close to the mouth reads as odd even when the surgery itself went perfectly. Natural dimples are frequently asymmetric, so matching a pair exactly is not always the goal.
Most people go back to work within a day or two and the visible swelling settles over about a week. Because the wound is inside the mouth, recovery centers on oral care: a soft diet at first, antiseptic or salt water rinses, and care with brushing near the site. Some tenderness with chewing and talking is normal for a few days. The dimple looking deep and permanent early on is expected and is not a sign that something has gone wrong. The final appearance takes a few months to declare itself.
Infection is the one to respect, because the incision sits in the mouth. Bleeding, prolonged swelling and asymmetry between the two sides are the other common problems. A dimple can end up too deep, too shallow, or in a position that does not suit the face, and it can fail to soften into a smile-only dimple. Less commonly, structures nearby are at risk: the parotid duct, which drains saliva into the mouth near the upper molars, and the buccal branch of the facial nerve, which supplies muscles of expression. Both are avoidable with accurate placement, which is the reason anatomical knowledge matters more here than the small size of the operation suggests.

Related reading: buccal fat removal for slimming the mid cheek rather than creating a dimple, chin augmentation for the lower face and jawline, the gummy smile for how much gum shows when you smile, the lip lift for upper lip proportion, and fat transfer for volume loss in the cheeks.