Is the effect of dimple creation permanent?

Thank you for your question. You submitted a question without a photo asking about the permanence of dimpleplasty, specifically related to the suture you describe as a blue suture, and if its permanent placement can cause a problem later on.
I can give you some guidance about this question. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years, and dimpleplasty is a procedure I’ve become well known for and recognized in the media. Patients have come from around the world for dimples, so I’ll give you some guidance about permanence.
First of all, there is the short-term consistent result with dimpleplasty, and what happens as time goes on. The concept of creating a dimple is trying to mimic what nature creates for a person who has a natural dimple which has to do is an anatomic aspect of the muscle inside the mouth called the buccinator muscle. This muscle has a little opening with a connection, so when someone smiles, they get a dimple - a little indentation. Several well known celebrities have these dimples, so people come in and show pictures of what the types of dimples they like,  the types they don’t like, and what kind they want.
The technical aspect of creating a dimple for a surgeon is to create a little opening in the mouth, then connect the muscle that’s inside the mouth with the skin, then having that connection hold. What I tell my patients is when you have a dimpleplasty procedure, expect the dimple will be there even if when you’re not smiling, and in different degrees of depth for the first several months. That is very important to understand because we want that connection to be tight. I tell my patients that if you are not prepared for that, and you want something that’s subtle, the dimple will not last for the long-term. I end up doing something aggressive to connect the skin with the muscle so the dimple lasts.
To answer the question about the blue suture, what you are describing is basically a non-dissolvable suture, most likely a suture called Prolene. In the deeper tissues of the body where there is no connection between the outside and the inside, permanent sutures are routinely placed. In that space, that suture is not likely to cause any issue. The reason to use a permanent suture for a surgeon is to have the strength of that suture maintaining the connection for the critical amount of time for the body to prevent healing tissue, which allows permanence. When you use a dissolving suture, sometimes because the body breaks down it down with some degree of inflammation, it can be challenging to get the desired outcome, especially when the body forms a capsule or some type of inflammatory response. I think you don’t have to worry if the suture would be a problem in the long-term. It’s just a matter of getting past the initial period where the possibility of infection is a risk because you are working from the inside of the mouth which has lots of bacteria.
In our practice, we have our patients placed on antibiotics and have them use antibacterial mouthwashes. We give them specific restrictions about different types of food and temperature of food to allow the opening of the mouth to heal adequately so the risk of infection is minimized.
With that said, meet with a doctor who is highly experienced with dimple procedures. I always say that this procedure is deceptively complicated. It is working in a very small area to create a very specific result, and a lot of doctors just don’t do it enough to become good at this procedure. I actually have very well known surgeons refer their patients to me for dimples because we do a good number of them. It’s just a niche procedure, so it has nothing to do with being a better surgeon or not. It‘s just a matter of experience and consistency of doing a particular operation. Meet with a doctor who is experienced with doing dimples, and learn from their experience what they feel the longevity of the procedure would be. It’s very important to understand with permanence with any operations in the face, you are also dealing with nature’s process, facial aging, environmental factors, weight gain, weight loss, and stressors. In the context of all that, you have to understand the likelihood of the dimple being something that will last for you, and whether or not enhancement or revision procedure will be necessary. I think when people look for permanence, I always remind everyone that we are not permanent - we are continuously changing, and the aging processes affect everyone differently, considering the factors of genetics and environment. I hope that was helpful, I wish you the best of luck, and thank you for your question.