PubMed search strategy and evidence selection criteria

A targeted PubMed search was conducted for this review, including studies on cosmetic facial dimple creation surgery and related procedures. Studies were selected if they evaluated post-operative complications, aesthetic outcomes, patient satisfaction, the need for surgical revision, technical factors associated with clinical outcomes, or the safety profile of minimally invasive facial cosmetic procedures.

Given the limited availability of literature specifically addressing facial dimple creation and the lack of a sufficient number of meta-analyses dedicated exclusively to this procedure, technical reviews, clinical studies, and large case series published in PubMed were also included. This approach provided a comprehensive assessment of the main risks, reported complications, and factors associated with the quality of the final outcome.

Safety and complication profile of facial dimple creation

Surgical facial dimple creation is generally considered a minimally invasive cosmetic procedure with a favourable safety profile when performed by experienced surgeons with appropriate anatomical planning. However, the outcome depends on technical precision and appropriate management of the anatomical relationships between the skin, subcutaneous tissue, and facial muscles.

Complications reported in the literature are primarily related to aesthetic outcomes and include:

– Asymmetry or suboptimal dimple positioning;

– Variations in dimple depth or persistence over time;

– Aesthetic irregularities or patient dissatisfaction;

– Local infections and healing problems;

– Abnormal scarring;

– Need for corrective procedures or surgical revision.

Overall, the available evidence indicates that serious complications are uncommon, while the main concerns involve the predictability of the aesthetic outcome and the management of patient expectations.

Main aesthetic complications after facial dimple creation

The main complications reported after the procedure relate to the predictability of the aesthetic outcome, particularly dimple symmetry, depth, and stability over time.

Asymmetry and unsatisfactory aesthetic outcomes

Asymmetry is one of the most frequently described concerns following the procedure. It may be influenced by:

– Natural anatomical differences between the two sides of the face;

– Uneven dimple positioning;

– Variability in tissue healing;

– Differences in the response of the facial muscles.|

Even minor differences may be noticeable because of the high aesthetic importance of the facial region.

Excessive depth or loss of the result over time

Predictability of the final outcome is one of the most challenging aspects of surgical facial dimple creation. After healing, the dimple may change in depth, visibility, and persistence over time. The main variations described include:

– An excessively deep dimple or a dimple that remains visible at rest;

– Progressive reduction of the initial aesthetic effect;

– Partial or complete loss of the dimple.

Individual variability in scarring and tissue response contributes to the difficulty of accurately predicting the final outcome.

Surgical complications and management of adverse events

Although facial dimple creation is generally associated with a low complication rate, some adverse events related to the surgical procedure have been reported. The main reported complications include:

– Surgical wound infection;

– Hematoma;

– Persistent pain;

– Changes in local sensation;

– Unfavourable scarring.

Particular attention should be given to the risk of infection because the procedure involves access through the oral mucosa, which naturally contains bacterial flora.

Factors associated with complication risk and unsatisfactory outcomes

The risk of complications or an unsatisfactory aesthetic outcome depends on the interaction between individual patient characteristics and technical factors related to the procedure. The main associated factors include:

– Unrealistic aesthetic expectations;

– Individual anatomical variability;

– Surgeon experience and technical precision;

– Appropriate dimple positioning;

– Appropriate management of the post-operative period.

A thorough pre-operative assessment is essential to identify suitable candidates, establish realistic expectations, and reduce the risk of dissatisfaction or the need for revision.

Prevention of complications and optimisation of outcomes

Preventing complications in surgical facial dimple creation depends primarily on appropriate pre-operative planning and careful procedural management. A precise anatomical assessment before surgery helps determine the most appropriate dimple position and improve the predictability of the aesthetic outcome.

Establishing realistic expectations with the patient is also essential, together with the use of a standardised and precise surgical technique. Appropriate management of oral hygiene and wound healing also contributes to reducing the risk of local complications.

Regular post-operative follow-up allows the progression of the result to be monitored and potential problems to be identified promptly. Overall, a structured approach can improve procedural safety and optimise patient satisfaction.

Clinical implications in cosmetic facial dimple surgery

Surgical facial dimple creation is generally a safe procedure, but the outcome depends on appropriate patient selection, technical precision, and management of aesthetic expectations. The main clinical implications highlighted in the literature include:

– Careful patient selection: an appropriate pre-operative assessment helps identify suitable candidates and determine whether aesthetic expectations are realistic.

– Importance of technical precision: correct positioning and tissue management are essential to reduce the risk of asymmetry, unnatural results, or the need for revision.

– Management of expectations: clear communication about possible outcomes and individual variations in healing helps improve patient satisfaction.

– Post-operative monitoring: appropriate follow-up allows potential complications to be identified early and the progression of the aesthetic outcome to be assessed.

Overall, the evidence indicates that procedural success depends primarily on the balance between appropriate surgical indication, precise technique, and realistic patient expectations.