Journal of Clinical and Aesthetic Dermatology

MAY 2018

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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22 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY May 2018 • Volume 11 • Number 5 O R I G I N A L R E S E A R C H F Facial dimples, according to the Oxford English Dictionary, are defined as small hollows typically seen on the cheek or chin. The presence of dimples on the cheek is considered to be a symbol of good luck in Chinese culture and is seen as a sign of beauty in Arabian society. 1,2 Dimples can be seen to accentuate the smile, which might in turn increase one's perception of attractiveness, sociability, and facial beauty. Some believe that dimples make a person's smile more memorable and distinct, associating it with cheerfulness. Dimples occur in both sexes, with no predominance in either sex. 3–6 The occurrence of dimples on the face is an autosomal dominant trait. Cheek dimples are believed to occur on chromosome 16, whereas cleft chin dimples occur on chromosome 5. 3 According to a study published by Pessa et al in 1998, 7 cheek dimples are caused by dermocutaneous insertion of the fibers on the inferior bundle of the double or bifid zygomaticus major muscle. Smiling makes the overlying skin draw inward, making the dimples larger and more visible. However, in contrast, chin dimples are formed because of an underlying bone defect. 8 Facial dimples are located on more mobile tissue. 9 They are mainly seen on the cheeks, followed by the regions of the angle of the mouth. They are categorized as those opposite the angle of the mouth (para-angle), those below (lower para-angle) the angle of the mouth, and those above (upper para-angle) the angle of the mouth. Lower para-angle dimple is the most common type of facial dimple. 2 Currently, there has been an increased demand worldwide for the surgical creation of facial dimples. 1,4,10,11 When surgically creating a dimple, the ideal location would usually be at the site of a pre-existing faint dimple, making it more prominent. If a unilateral dimple is present, the ideal position for the other dimple would usually be marked at the corresponding site on the contralateral side. 2 When no pre-existing dimple exists on the patient's face, the most common point for creation is the Khoo Boo-Chai's point (KBC point), which lies at the intersection between a horizontal line drawn from the corner of the mouth and a vertical line dropped from the outer canthi of the eye. 2 For more than 60 years, the KBC point has been the "gold standard" positioning guide for the surgical creation of the dimples; however, differences in facial shape have not traditionally been taken into consideration when determining the optimal size, shape, and location of surgically created dimples. In this study, we assessed the facial shape of a sample of men and women, all of whom had natural dimples, to determine if characteristic patterns in dimple size, location, and shape existed according to each specific facial form. We hypothesized that certain characteristics of dimples are predominant among certain facial shapes. Understanding these differences could help surgeons achieve optimal outcomes A B S T R A C T Dimleplasty is the surgical creation of dimples. The demand for dimpleplasty has increased over the past few years. Despite this increasing demand, the most widely used reference point for determining where to place a surgically created dimple, the Khoo Boo Chai (KBC) point, dates back more than 60 years. The aim of our study was to assess the facial shape of a sample of men and women, all of whom had natural dimples, to determine if characteristic patterns in dimple size, location, and shape existed according to each specific facial shapes. For our study, 1,194 people were examined for dimples and of these, 216 individuals with a group total of 336 naturally occurring dimples were included in the study. Facial form was categorized as mesoprosopic, euryprosopic, or leptoprosopic. We found that 54.8 percent of the total dimples were not positioned on the KBC point. In mesoprosopic group, out of 204 dimples, 117 were not positioned on the KBC point (87 were); in leptoprosopic group, out of 66 dimples, 30 dimples were not positioned on the KBC point (36 were); and in the euryprosopic group, out of 66 dimples, 36 were not positioned on the KBC point (30 were). Most of the dimples in the mesoprosopic group were positioned 4mm anterior to the KBC point, and in the eryprosopic group, most dimples were positioned 3mm above and behind the KBC point. Most of the dimples in the leptoprosopic group were positioned on the KBC point. We also observed differing patterns in size and shape between the groups. Understanding these differences could help surgeons achieve optimal outcomes by creating more natural looking and thus more aesthetically pleasing dimples among their patients seeking dimpleplasty. KEYWORDS: Dimpleplasty, facial form, facial shape, leptoprosopic, mesoprosopic, eryprosopic, Khoo Boo Chai's point, KBC Point, dimple New Landmarks for the Surgical Creation of Dimples Based on Facial Form by HAYAAT F. ALMAARY, BDS; RAMAKRISHNAN KARTHIK, MDS; and C YNTHIA SCOTT, MDS Drs. Almaary, Karthik, and Scott are affiliated with the SRM Kattankulathur Dental College and Hospital in Chennai, India. J Clin Aesthet Dermatol. 2018;11(5):22–26 FUNDING: No funding was provided for this article. DISCLOSURES: The authors have no conflicts of interest relevant to the content of this article. CORRESPONDENCE: Hayaat Farid Almaary, BDS; Email: halmaary@gmail.com

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