Dimple Creation using Ellanse

Dimples are visible indentations of the skin, caused by underlying flesh, that form on some people's cheeks, especially when they smile. They are usually found on both cheeks.

Dimples may appear and disappear over an extended period. Dimples may play a role in sexual selection. Some cultures, for example Asian and Indo-ethnic sub-groups, prefer dimples as a sign of attractiveness and veracity.

Dimples may be genetically inherited and have been called a simple dominant trait, but there is no scientific evidence for this.

Dimples may be caused by variations in the structure of the facial muscle known as zygomaticus major. Specifically, the presence of a double or bifid zygomaticus major muscle may explain the formation of cheek dimples.

This bifid variation of the muscle originates as a single structure from the zygomatic bone. zygomatic bone. As it travels anteriorly, it then divides with a superior bundle that inserts in the typical position above the corner of the mouth. An inferior bundle inserts below the corner of the mouth.

A natural dimple is usually formed when there is a small defect in the cheek musculature (most often the buccinator muscle). The skin overlying this small defect is stuck down to the underlying connective tissue and creates a dimple in the skin with facial animation (smiling).

Why would anyone consider getting Dimples?

In some cultures dimples are considered a sign of good luck and prosperity. Also, dimples help brighten a smile and add character. Many patients state that one of their siblings or close friends have a dimple and they are happy to know that dimple surgery is available to give them that option as well.

Creating Dimples using Ellanse, an invention of Dr Ayham Al-Ayoubi: Until 2010 there was only one method to create or enhance dimples (DIMPLE CREATION SURGERY) which has been performed very safely and successfully all around the world.

In 2010, Mr Ayham Al-Ayoubi has invented and pioneered a new non-surgical, non-invasive dimple creation technique using Ellanse (Poly-caprolactone – PCl) a well-known totally bioresorbable soft medical polymer.

Ellanse is made of Poly-caprolactone (PCl), is a well-known totally bioresorbable soft medical polymer. PCl is used in numerous CE-marked and Food and Drug Administration (FDA) approved commercial bloresorbable product applications for several decades world-wide and has demonstrated an excellent safety profile.

ELLANSE offers the maximum potential for modelling due to the combination of optimum viscosity, unique elasticity and uniform homogeneity. Hence, the ELLANSE Family can be used in a variety of beautifying indications:, Correcting wrinkles and folds, Volumizing, Contouring, Sculpting.

The ELLANSE is an injectable implant, indicated for deep dermal and sub dermal implantation. The nasolabial folds used in the clinical study are representative for deep and sub-dermal soft tissue augmentat ion of the facial area.

Dimple creation technique using Ellanse – DCTE, can simulate the natural occurring process of dimple creation.

DCTE can be done on any type or size cheek. Although the cheek is the usual place that patients might request a dimple, the chin is also a frequently requested site. It is possible to make chin dimples as well without any incisions on the outside skin.

DCTE - Dimple creation technique using Ellanse is safe and effective, but also potentially fully reversible. There have been no reported complications of the 33 cases which Dr Ayham Al-Ayoubi has performed at London Medical and Aesthetic Clinic.

A rare side effect could be a little bit of swelling and bruising. Patient should be able to resume normal activities in the same day after the DCTE procedure.

There is no need for the patient after DCTE to take oral antibiotics.

So how exactly create a dimple using Ellanse?

To create a dimple, a small painless injection of Ellanse using a 0.30x13mm 30Gx1/2" needle or 27 G1 ¼ needle used to introduce Ellanse deep into the dermis where the dimple is desired.

This filler injection causes a dimpling in the overlying skin. At first there is a dimple present even without smiling, but in most cases after 2 days, the dimple is only present will smiling or moving the face. However some of the patients still had a dimple present for more than 3 weeks.

The minimum scarring between the inner skin and muscle will cause a permanent dimple even after the Ellanse product is fully absorbed.

The injection is made through the skin to the cheek and there is no incision or scar on the outside skin. A small amount of Ellanse (0.3-0.5 ml) is injected deep into the dermis and just above the muscles, lying under the surface of the skin where the dimple is desired.

DCTE can be done in outpatients clinic under local anaesthesia. Patients are awake and comfortable during the entire procedure. The DCTE usually takes about 10-15 minutes to perform and patients can go to work or home right away after the procedure.

Why would anyone consider getting Dimple creation technique using Ellanse?

The procedure is done under local anaesthesia in outpatient clinic and there is no need for incision, cut or suture and relatively painless and very effective procedure using a very safe product (Ellanse - Poly-caprolactone – PCl) which has a very high safety profile.

Patients can resume going to work in the same day after the procedure. And just to compare the DCTE with the traditional dimple creation surgery Dr Ayham Al-Ayoubi explains in a brief the surgical technique.

Dimple Creation Surgery

The surgical procedure used to create dimples is, in itself, a fairly simple one, straightforward when done properly and is commonly done as a minor surgical procedure in operating day case theatre.

The procedure involves simulating the natural way a dimple is formed, by forming a connection between the skin and the cheek muscle, such that when the muscle contracts, it pulls the skin inwards to form a dimple.

So how exactly is a dimple surgically created?

A punch biopsy instrument is placed against the buccal mucosa (inner cheek) and circular motions are made to cut through the mucosa, sub mucosal fat, and cheek muscle. A circular core composed of these tissues is removed, leaving the skin intact, which will create a shallow cylindrical-shaped defect under the skin. [4]

This 'defect' then is closed by placing an absorbable suture through the cheek muscle on one side of the defect, then through the dermis layer of the skin and finally through the cheek muscle on the side of the defect. A surgical knot is tied, which in turn will result in dimpling of the skin even without smiling.

The skin will, however, flatten out in a week or two when the suture is absorbed. The internal scarring which takes place will connect the muscle to the skin, creating a dimple when one smiles.

The surgery can be performed on any kind of cheek, be it chubby or not. It would be easier if the cheeks are not too chubby. If someone wants dimples that are very prominent, a bigger punch biopsy will be used to be able to remove a bigger core of soft tissue.

Usually performed under local anaesthetic, the surgery takes about 30 minutes, and normal activities can be resumed straight after the procedure. You walk in without a dimple and leave with your desired facial indents.

There is usually minimal swelling after, and the aftercare steps are just as simple and uncomplicated as the procedure. The aftercare usually involves regular mouth rinsing with Betadine oral antiseptic solution or Bactidol (chlorhexidine) solution, and antibiotic intake.