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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24 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 located at a point of intersection between a perpendicular line dropped from the outer canthi of the eye and a horizontal line drawn out from the angle of the mouth. Over the years, along with the KBC point, surgeons have also used other reference points for creating dimples. For example, Lari, 13 in 2012, suggested two methods for determining the site of dimple creation: 1) using the point of intersection of a perpendicular line dropped from the external canthus and a horizontal line drawn from the highest point of the Cupid's bow and 2) asking patients to suck in their cheeks and then marking the site of maximum depression as the location for the dimple. 13 Shaker 10 created a dimple by asking the patient to smile and then marking the dimple site 2 to 2.5cm lateral to the nasolabial fold at the same level or slightly above the angle of the mouth. El-Sabbagh 11 suggested creating a dimple at a point that is level with or above the angle of mouth, according to the vector of smile. For our study, we sought to determine the most natural location of dimples based on the individual's facial shape to provide guidance to surgeons for achieving optimal outcomes by creating more natural and thus more aesthetically pleasing dimples in their patients seeking dimpleplasty. Eighteen percent of our total study population had naturally occurring dimples, and among those study subjects, 79.2 percent were female. This significant difference in prevalence of dimples according to sex was not observed in previous literature, in which dimple prevalence was reported as equal between the sexes. Among our study population, we observed a greater number of bilateral dimples, which corresponds with other published findings. 11 There was no noted difference in the occurrence of dimples on the right side or left side. However, according to Koo Bhoo-Chai, dimples are predominantly on the left side of the face (60%). 2 Though many reference points for creating dimples have been used in practice, 2,10–13 we were unable to find reports in the existing literature that indicated consideration of an individual's facial shape when choosing the optimal location for dimples. In our study, we found that the morphology of dimples was analogous to the shape of the individual's face. We observed a higher prevalence of FIGURE 3. Distribution of dimples in relation to the Khoo Boo Chai (KBC) point FIGURE 5. Leptoprosopic facial form with bilateral dimple FIGURE 4. Mesoprosopic facial form with unilateral dimple

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