Dimpleplasty - how long is indentation visible when not smiling?

Thank you for your question. You didn’t submit a photo but express your concern about having a dimple that’s constant after dimpleplasty, even when you’re not smiling, so you ask how long will it last, and how deep will it be. You’ve also seen people who had their surgically created dimples disappear after a few months. These are very reasonable questions that come up in our practice a lot.
I can certainly help you with this question. 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. Dimpleplasty is an interesting niche  we’ve become well-known for, so patients come in from all over, and we’ve even been featured in media for dimpleplasty. What’s particularly interesting about dimpleplasty is it looks like a straightforward procedure, but there are a lot elements that are deceptively complex, which can make it a little less predictable than a lot of cosmetic procedures, which I’ll explain further.
A natural cheek dimple occurs because of a defect in the buccinator muscle that allows a small connection between the skin and that muscle, so when you smile you get a dimple. What we do with dimpleplasty is from the inside of the mouth, inside the cheek, we create a connection between the buccinator muscle and the skin. There are a few different techniques to get this done, but I‘ve developed a variation of a technique that, in my hands, usually works pretty consistently and predictably. With how long does the indentation appears when you’re not smiling, whether someone with thick skin, thinner skin, or whatever their anatomy is, it will last for several months. One of the first things I warn people about is they’re going to have this indentation present even at rest.
Interestingly, having a temporary indentation even at rest has mostly not been an issue for people motivated to have dimples because they understand it’s part of the process. Interestingly, in social settings, it doesn’t seem to draw as much intention as you would predict. Having a constant dimple, doesn’t seem to draw that much attention, even though I’ve always been concerned about people being conscious about it after it’s done.
That said, the constant indentation does fade over time, so more likely it will appear as a natural dimple when you smile. It’s difficult to make it perfect, exactly symmetric, and with both sides being exactly the same depth, but naturally human faces have some relative asymmetry. People point out certain actors and other celebrities, so they show me pictures of how beautiful their dimples are, and want the same dimples. I would say these people very often were more likely than not to be born with these dimples, and they’ve made a career out of their appearance because they are among the very fortunate with greater symmetry and ideal proportions, and with the added benefit of dimples.
However, you have to consider that dimpleplasty does result in a static constant dimple in the first several months, which fades slowly. The risks are the dimple may disappear, so you may need revision surgery; and may have some degree of asymmetry, but ideally you want to maximize the symmetry. We’ll try to do everything we can preoperatively to place the dimple, mark it appropriately, and try to anticipate the behavior of the skin.
Nature gives us a little room to work, and usually staying within that relatively small space, we’re able to create some consistent results. There are certainly patients who I have to do revision procedures, or I have to do other variations to creates dimples. The surgery depends on the internal anatomy of their cheek, and the positioning of the important structures such as the salivary ducts inside the mouth. Like I said, it’s deceptively complex, but it is a very fulfilling procedure. People who get these dimples are thrilled about the results, and very often they are so excited about having dimples that once they get them, they love the results. Very often, they want them deeper, but that’s a balance, and as long as we create a good, natural-looking dimple, I think we’ve achieved success.
You should meet with doctors who perform dimpleplasty and express your concerns. If you’re not comfortable with the presence of static dimples for the first few months, just don’t do it. I think it’s very important to have that conviction and commitment, and to be able to ride through those first few months, and allow this to evolve. Meet with doctors who perform dimpleplasty and see if this is the right choice for you. I hope that was helpful, I wish you the best of luck, and thank you for your question.

The results should be permanent.  In approximately 10 percent of cases the dimple may settle and require a touch up procedure.  A scar would not be advisable.  

Initially the dimples are prominent and static dimple, which means that it shows even if you are not smiling. But over 6-8 weeks, this dimple becomes dynamic and will only show while smiling.
If the dimples are gone, it means the surgery is not done properly. Dimpleplasty does have high chances of failure.