Post SMAS I Developed a Deep Dimple Upon Smiling - What Could Cause This?

Post SMAS I developed a deep C shaped dimple upon animation It begins with a dimple punctuating highest part of the central crest of my cheekbone with a substantial depression angling toward my ear. After 5 years later the depression became very wide deeper & more painful. The ENTIRE area was undermined & untethered, layered w/ fat & dermis. It has remained! I continue to feel the stitch-like pull! What's the cause & cure, can anyone help!

Doctor Answers 7

Point of anchor can cause a new dimple after a facelift.

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A dimple is caused by an anchored point that does not move as the other tissues around it do during expression.  This could be due to a suture or a scar.  In either case, it will require surgical removal and possibly the placement of some tissue between the skin and the anchoring point to keep the issue from reoccuring.

Cheek Dimple after SMAS Facelift

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The most likely cause of the dimple is that when the SMAS was resuspended the suture also included a portion of the zygomaticus major muscle.  This would explain why you develop the dimple with animation.  In order to fix the problem the area of the dimple would need to be undermined and the SMAS freed up from the underlaying muscle.  It may also require a graft some sort (dermal-fat graft, temporoparietal fascia, or a graft of the SMAS).  

Michael Sundine, MD
Orange County Plastic Surgeon

Dimple after a facelift

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A dimple after a facelift can occur when the tissue underneath the skin are tightened, like with a SMAS lift. In most cases, with time, the stitches holding it in place dissolve and the dimple goes away. A little massage will at times speed it up.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.8 out of 5 stars 27 reviews

Dimpling after a facelift

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Tethering of the skin to the facial muscles may be the cause of this.  To lift up the skin, you'll probably need a revision facelift to remove the scar tissue and get rid of the dimpling.

Dimpling in face

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This dimpling that you are complaining about may be from adherence to the underlying soft tissue. It is best to be evaluated in person. This may be corrected with surgery or possibly with non-surgical methods like fillers.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Not the "Dimple" you wanted/Scar after Facelift

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It sound like you have a focal area of scar and loss of fat.  The placement of a fat-dermal graft is an appropriate treatment solution.  Since this is persistent I would recommend fat transfer to this area.  The skin is not completely undermined which will help retain it's circulation and enhance survival of the fat.  Good Luck.

Dr. ES

Deep cheek depression after SMAS lift.

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If this is still present you need to see an experienced facelift surgeon to evaluate this and repair it. I have seen patients who have had their surgeon remove to much tissue and it required  a large full piece of tissue to be sutured in to fill this.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.