Dimple creation; I need to know the pros and cons?

Thank you for your question. You’re interested in having dimples, by undergoing dimpleplasty as you stated you have a fetish for them, but you are also concerned about the pros and cons, so you want to learn more before considering a consultation.
I can share with you how I counsel my patients who are considering dimpleplasty. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. I have become well known for dimpleplasty as I’ve been featured in some media about it. It is a procedure that is growing in popularity. Patients come here from everywhere for dimples. That said, I do spend a lot of time counseling my patients about the pros and cons of dimpleplasty.
I feel a common characteristic of patients who come for dimples is they really love the idea of having dimples. They often have situations where their siblings have dimples, and have always envied them for that. They have seen particular stars and famous people who have dimples, and they think they really are great. They do spend a lot of time showing me pictures on their phones of different people they admire and their dimples they really like, and asking if they can get the same one.
For the right face, dimples have an impact that can be very positive. Often when I do my consultation, I take a neutral position and I’ll say, “Well, do you really want to have dimples, and what is it about dimples that you really think are really good?” What I’ll do for them is show where anatomically nature would have created the dimple.
Often people think dimples are much higher in the cheeks than they really are. There’s a particular area in the cheek that I refer to as the sweet spot where statistically there are no significant nerves, blood vessels, or other things that can potentially be problematic, with the exception of a salivary duct that transports saliva. Essentially, there’s one spot because when you go higher, it’s not exactly safe nor will it hold; and if you go lower, it won’t look very good. When I show them where that sweet spot is and I place marks and have them hold a Q-tip to push in those areas, we take pictures, have them smile, and show them where that would be.
Once the patient says it looks good and it’s what they want, I explain to them it is a procedure creating surgically a connection between a muscle in the inside of the mouth called the buccinator muscle with the skin. The approaches can be in the inside, or a combination approach from the outside and the inside depending, on the anatomic advantages.
People who have thicker skin, and lot of fat in their cheeks tend to have a harder time getting a really good, deep dimple. There are always exceptions to that, but creating that connection, the procedure itself seems to be relatively straightforward, but has many technical challenges that make it not so straightforward. I’ve had referrals by some very well known colleagues in our field who can do so many really good surgeries, but will refer their patients to me for creating dimples.
It’s a procedure that can be very gratifying and satisfying, but we have to consider some risks. When you’re working in the inside of the mouth, you always have to be concerned about potential infection. We routinely place our patients on antibiotics, and I’ll irrigate the area with antibiotic solution so we have to be careful about that. There’s a possibility of an infection, and also a possibility of issues related to taking antibiotics.  Bleeding is also a potential issue like any surgery, so you have to prevent bleeding dealing with the two B’s: blood thinners and blood pressure. You have to maintain certain oral hygiene rituals after the procedure done from the inside of the mouth, such as avoid hot liquids, and avoid potential bacterial sources such as milk products, etc. as precautions.
There’s the chance the dimple will not be as deep as you like, or not the shape that you like. There’s a limit of what can be done. There are times when enhancement is necessary, like any cosmetic surgical procedure.
One important variable I have to always explain to our patients, and usually they’re already aware of this because they do so much research before they come in, is when you do surgical dimple placement, the dimple is always going to be there for the first several months. That means there’s going to be a little indentation that looks like a dimple, even when you’re not smiling. Surprisingly, that’s not a disincentive for our patients who come for dimpleplasty as they understand that, and don't mind. The feedback we get is that socially, there has been no issue, which I find interesting sociologically. Nonetheless, those are the things I think are important to consider.
As time passes, as you get past the third month, the presence of that dimple becomes more prominent only with facial movement, be it smiling or different facial expressions. Once it’s settled in, it can look very good for many years. I do advise my patients that if there are significant shifts in weight, whether gain or loss, that can have an impact on the facial fat volume, therefore it can have an impact on the dimple.
I think it’s important if you are considering dimpleplasty to find a doctor who has extensive experience and expertise in this niche area. Learn about their approach, style, and management, then decide if you’re comfortable enough to move forward. I hope that was helpful, I wish you the best of luck, and thank you for your question.