How often does a cheek dimple happen with a neck/lower facelift?

Question

How frequent does a "dimple" on the cheek happen from a deep internal suture from a neck/lower face lift and how long does the dimple take to release and smooth out? Short term, will a hyaluronic filler work to fill the indent in?

Alejandro J. Quiroz, MD · Answer

Than you for your question; It is not uncommon for patients to have dimple after a SMAS face lift that that effect is due to the attachment of the skin to the SMAS. Normally that dimple goes away after a few weeks.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Richard Balikian, MD · Answer

Little "dimples" can be a temporary occurrence after a facelift and are often due to areas of skin that didn't need to be elevated or from swelling. They usually resolve on their own with just a little patience and massage.  I would not recommend filer in the area as it is healing. If they persist after 6 months, other options exist to get rid of them like subcision, but most likely they will go away on their own. As always, best to consult with your surgeon since they know your face the best.

Stephen Prendiville, MD · Answer

This isn't uncommon after a SMAS based facelift and usually resolves within a few weeks.  This is related to placement of fixation sutures in the SMAS, coupled with expected postoperative lymphatic outflow obstruction. I would not recommend a filler or other interventions to correct this over time and patience.

T. Randall Blanchard, MD · Answer

The dimple that you describe may be due to pulling of the skin by the underlying lifted facial structures. In the operation room. this can be prevented by separating the skin from these deeper layers to prevent pulling. In most cases when this occurs, the skin smooths out in a few weeks as the swelling resolves and the skin relaxes. If it does not smooth out, the irregularity may be due to a soft tissue deficit in the area which may be treated with fillers or fat transfer. I recommend that you bring these issues up to your plastic surgeon so they can determine the cause and treat you appropriately.

Larry Weinstein, MD · Answer

i have seen natural dimples revealed after a face lift. These dimples were present in earlier photos at a younger age. If a simple dimple shows up after surgery that is not wanted a filler can be placed to hide it. Also a simple needleing under the skin could release it. Good luck.

William Portuese, MD · Answer

Small irregularities and dimples can be present for the first couple weeks after facelift procedure, but they generally subside on their own.  This can occur in areas where the SMAS has been tightened.

Francis R. Palmer, III, MD (retired) · Answer

I have performed many SMAS facelifts and neck lifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  Dimples can sometimes occur, with the more invasive type facelifts, from swelling around the retaining ligaments of the cheek.  This causes a temporary dimple but requires no intervention.  As the swelling subsides the dimple will disappear.   However, the reality is that there are many different ways to perform a facelift from incision length, incision placement, level of tissue dissection (skin only, SMAS, Deep Plane, Subperiosteal), different degrees of tissue undermining, how to lift and support (imbrication versus plication of the SMAS layer), how much excess skin to trim, is excess fat going to be reduced and finally will the overall shape of the face be made more feminine or masculine (while avoiding the over pulled, windswept appearance).  You would have to ask your facelift surgeon what caused the dimple.  If a deep suture is the cause, it may need to be released (permanent suture) or allowed to dissolve (dissolvable suture).  
 In my humble opinion however, there are some basic requirements that must be met in order for a facelift to be "effective", yielding "aesthetic pleasing" and "naturally attractive" results.  These include: 
 1. Some type of incision either curved around the front (preferred) or straight in front of the ear.  This is how excess skin is removed which is not possible with an incision behind the ear alone.  If you have so little excess skin on the face that "none" needs to be removed you are not a candidate for a facelift in the first place.
2. The facelift must address correction and softening of the "jowls" using a long lasting and effective technique.  If you have "jowls” these are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
3. Facial shaping must be combined to properly shape the cheeks, chin, jaw line and lips for feminizing or masculinizing the face as the case may be.
 In my experience, this is the "key" factor in making the face soft, feminine and naturally beautiful.  An essential part of any facelift on a woman.  Conversely, men look chiseled and handsome when angularity is created in the cheeks, chin and mandibular angles.  The ability to provide precise, facial shaping separately or in combination with a facelift is in my humble opinion the definition of a "facial shaping expert".
 Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek shaping and/or augmentation with liposuction or precise volume placement using a dermal filler can create full, round cheeks that will soften and feminize the entire face.
 A weak chin creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.  I have found placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.
 "Jowls” are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
 My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)can be performed in 90 minutes or less, with or without general anesthesiaproper SMAS Imbrication techniqueno incisions within the hair = no hair lossexcess fat can be removed from the face and neckexcess skin removed from the face and neckcheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implantsmost patients fly back home to parts all over the world in as little as 3 days post-op I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.
 Along with the minimally, invasive SMAS facelift described above, some of the excess skin below the chin can be removed using a small, curved incision under the chin.  This along with skin removed in front and behind the ear will tend to reduce the skin excess by around 70% or more.
 If anterior platysmal bands are present or the maximal amount of neck skin is to be removed, a "formal" neck lift can be done.  In this procedure, the face and neck tissues are elevated using a curved incision around the front (explained later) of the ear that continues in the crease behind the ear and then 3 inches into the posterior hairline.  The tissue is dissected from that point all the way across the entire neck to the same position on the other side of the head in a dissection that is as long vertically as the entire neck.  The Platysma muscles are tightened using a curved incision under the chin and each side is pulled upward and back again being tightened at a line behind each ear (under the tissues).  Since the skin flap pull is up and back, this will pick up any tissue laxity along the jaw line or "jowls" which must be dissected and flattened out using a lower facelift (incision around the front of the ears).  If this isn't done, pleats of excess skin will appear below each ear.
 This is an extensive surgery taking 4 1/2 to 5 hours with large incisions, requires placement of drains, possible hair loss and months of recovery.Hope this helps.