Procedure to fix a "dent", not an actual scar? What type of doctor is best to see? Plastic Surgeon or dermatologist? (Photo)

Question

I have a "dent" in my left cheek exactly where a laugh line would be, this is from a car accident years ago wherein my face hit the steering wheel a day the air bag did not deploy. It makes my smile crooked. I would like something more permanent than filler but am also scared of risky procedures. What type of doctor is best to see? Plastic Surgeon or dermatologist?

George Yang, MD · Answer

Hi BarbFly367,Tough question.  Since there is no standard answer, I suspect you may not get a lot of answers to your question.  As soon as I saw your photos, it reminded me of the actress Robin Tunney on the Mentalist, except that hers is on her right side.  I wanted you to know that you were not the only one, and even a well known actress has it and it has not hindered her career or attractiveness. I think a plastic surgeon would be able to offer more options than a dermatologist, but really the surgeon or dermatologist needs to be interested in treating it. The simplest way to approach it is to consider fillers.  It you had the same indentation on both sides, we would just call it nasolabial folds and offer fillers.  If you like how the temporary fillers looked, then you could consider a longer lasting filler or a permanent filler such as Artefill.  Permanent fillers are not without their own risks, so please do your online research before committing to permanent fillers.  Once the permanent filler is under your skin, it is not removable without surgery, and even surgery will not cleanly remove the injected filler like it was a breast or chin implant, some may be left inside.  With temporary fillers, either the improvement will be acceptable for you, or it may not make enough of an improvement, that you would want to get a permanent filler.I have thought about this problem before.  My younger son was about 2 years old when he fell head first into a door jamb.  The 90 degree corner left an imprint on his forehead, but it did not break his skin.  After the bruising and swelling went away, there is clearly a small "dent" in on his forehead.  Even though the skin did not break, I suspect the subcutaneous (sub- means under; cutaneous- means skin) tissue must have been "cut" but the skin did not break.  The reason the indentation formed, is that the "foundation" under the skin is not solid and the skin is falling into the "cut" subcutaneous tissue. After it happened, I was thinking about if I could have done anything to prevent the indentation.  The two options that I thought of, was to actually cut the skin and sew the "subcutaneous" tissue which had split together, then resew the skin, but this would leave a scar on the surface of the skin.  The second "thinking out of the box solution" was to place the dissolvable deep sutures in a way, without making an incision, or place vertical mattress sutures, which can help to pull together the deeper tissues together while it is still healing.  The vertical mattress sutures will leave some track marks on the surface of the skin, but hopefully they would fade and be less noticeable than an actual incision.Since years have passed, it is too late to try to help sew the deeper tissues together, so if it ever bothers him, I would probably just inject some fillers.  As he gets bigger, I think it is less and less noticeable, but I still remember what happened, so I will always see the little dent, and remember him as a toddler.It don't know what the right answer is, but sometimes the simplest answer is best.  As long as your expectations are realistic, and improvement is the goal, then I think you will be pleased.  If you are looking for a complete elimination of the indentation so that it matches the other side perfectly, then it will be hard to find someone who can do that.  But most providers should be able to provide improvement.  For people with deep smile lines, it is difficult for all providers to completely eliminate them, but improvement is clearly achievable.  Good luck on your symmetry improvement journey.Best,Dr. YangP.S. If you find my answers or other doctors answers to questions are helpful, please +1 those answers to push up the better answers to the top, which helps others who read the same post, get to the more helpful answers first.P.P.S. There is a new feature on Realself, which is the "Follow" button. It is similar to the "Like" button on Facebook. If you like my response or any of the doctor responses while you research on Realself, you should "Follow" them. You will get email updates, when the doctors you follow post any new answers to questions, post new photos, or have any new reviews.

John J. Martin, Jr., MD · Answer

The good thing is that if this is a scar, it is in the smile line.  You could have some subcision of the scar, where it is freed up from underneath, and then have a little fat put in.

Darryl J. Blinski, MD · Answer

See as many different type doctors until you find one you feel comfortable with.. Options for correction depend upon the in person examination - excision, fillers, laser, fat grafts....

Tae Ho Kim, MD · Answer

One thing you may consider doing is a small operation to release the tethering of the skin from the underlying tissue, which is probably scar tissue.  This may not be enough, however.  You may need to place additional tissue to fill in the area and also not let it tether back down.  Fat grafting may be the best option.  I would advise you to see a plastic surgeon, board certified by the American Board of Plastic Surgery.  Good luck.

Procedure to fix a "dent", not an actual scar? What type of doctor is best to see? Plastic Surgeon or dermatologist? (Photo)

Answers (4)

Answer: Plastic surgeon would give you better options.

Answer: Plastic surgeon would give you better options.

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Procedure to fix a "dent", not an actual scar? What type of doctor is best to see? Plastic Surgeon or dermatologist? (Photo)

Answers (4)

Answer: Plastic surgeon would give you better options.

Answer: Plastic surgeon would give you better options.

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Recommended reading

Everything you need to know about Facelift

Our mission is to create a world where every investment in modern beauty is Worth It.