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imageIntroduction: We describe a novel surgical technique to enhance the aesthetics of the midface by creating malar dimples. Dimples are the natural cheek indentations that become more apparent with facial animation. The aim of this study is to present our technique to create the appearance of these natural indentations using a simple transoral approach and to assess its safety.
Methods: The transoral buccinator-pexy is done 1.5 to 2 cm superior to a point bisecting an angle formed by the projection of the lateral commissure and the lateral canthus. Local anesthetic is injected and an 18-gauge needle is introduced perpendicular through the skin marking and brought out through the buccal mucosa.
A 4-mm punch biopsy or a small incision is made in the buccal mucosa. A small amount of buccal mucosa is then excised. 4-0 Nonabsorbable suture is threaded through the needle to the desired dimple location on the skin. The suture is then rethreaded from extraoral to intraoral, taking a portion of the dermis and buccinator muscle creating the desired dimple.
Results: The procedure was done successfully without complication in our series of patients. The mean follow-up was 18 months. Cadaveric dissection demonstrated key anatomical landmarks and we created a “zone of safety.”
Discussion: Transoral buccinator-pexy deepened the submalar soft tissue. The indentations were made slightly pronounced, making the dimples visible without animation. After several weeks, the dimples were only present with animation.
Cadaveric dissection was done to illustrate the relationship of the parotid duct and buccal branches of facial nerve to the area in which it is safe to perform TBP. The position of the dimple can be adjusted based on the patient’s desires; however, identifying the papilla of Stensen duct is paramount.
Conclusions: Transoral buccinator-pexy is a safe and effective in-office procedure that can be done to produce aesthetically pleasing dimples. The technique is simple and the results are consistent.

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