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Innovative Journal of Medical and Health Science 5:1 January - February (2015)15 – 18.
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INNOVATIVE JOURNAL OF MEDICAL AND HEALTH SCIENCE
Journal homepage:http://innovativejournal.in/ijmhs/index.php/ijmhs
15
Revıew
ANATOMICAL SKIN DIMPLES
M.D. Rengin Kosif
Department of Anatomy, Faculty of Medicine,Abant Izzet Baysal University, Bolu, Turkey
ARTICLE INFO ABSTRACT
Corresponding Author:
M.D. Rengin Kosif
Assistant Prof.
Department of Anatomy, Faculty of
Medicine,Abant Izzet Baysal
University, BOLU, TURKEY
DOI:http://dx.doi.org/10.15520/ijm
hs.2015.vol5.iss1.45.15-18
Dimples are visiable identations of the skin and a dominant trait.
Anatomically, dimples may be caused by variations in the structure of the
some body tissue for example muscles, connective tissues, skin and
subcutaneous tissue. Dimples types of the human body: Fovea buccalis
(dimple of cheek), fovea mentalis (dimple of chin), zygomatic dimples, fossa
supraspinosus (bi-acromial dimple=dimple of shoulder), elbow dimples,
fossa lumbales laterales (dimple of back), gluteal dimples and sacral-
coocygeal dimples (pilonidal dimple). Sometimes, dimples are permanently
present, but sometimes n
ot permanent. They vanish away when the
excessive fat goes away. Dimples are not indicators good health.
©2015, IJMHS, All Right Reserved
INTRODUCTION
A dimple (also known as a gelasin) is a small
natural indentation in the flesh on a part of the human
body. Dimples may appear and disappear over an extended
period. They may be genetically inherited and have been
called a simple dominant trait.Dimples is the word given to
any natural indentation or dent on the body, but usually
refers to the face. Most notably in the cheek or on the
chin(1).They are most commonly visible when someone
smiles.
They are a genetic trait following an autosomal
dominant pattern of inheritance. Dimples are one of the
most dominant facial traits.Dimples are a dominant trait,
which means that it only takes one gene to inherit dimples.
If neither of your parents have dimples, you shouldn’t have
them either, unless you experience a spontaneous
mutation. If one of your parents have dimples, you have a
25-50% chance of inheriting the gene, since it means that
parent inherited the gene from one or both parents. If both
of your parents have dimples, you have a 50-100% chance
of inheriting the gene, depending on how they inherited
their dimple genes.The dominant genes responsible for the
inheritance of facial dimples have been suggested to be
located onchromosome 5 for cheek dimple gene and
chromosome 16 for chin dimple gene It could therefore be
inferredthat both dominant genes reside in people who
express these dominant traits. From this survey, it was
observed that25% of the subjects inherited the two forms
of facial dimples from either one or both of their parents
who alsoexpressed both phenotypes; a rate higher in
females than males (2).
Dimples could be transient or permanent,
depending on the cause or factor responsible for their
occurrence. Theprocess of growth and development could
contributes to this. Excessive fat deposition, which
disappears with theaging process, causes transient
dimples, so also is the stretching or lengthening of muscles
during growth, leading togradual obliteration of the defect.
This explains while some dimples are commoner and more
conspicuous in theyounger age groups (3).
There are different types of dimples on the human
body. Fovea buccalis (dimple of cheek), fovea mentalis
(dimple of chin), zygomatic dimples, fossa supraspinosus
(bi-acromial dimple=dimple of shoulder), elbow dimples,
fossa lumbales laterales (dimple of back), gluteal dimples
and sacral-coocygeal dimples (pilonidal dimple).
Fovea Buccalıs (Cheek Dımple): Dimple on cheeks
(also known as smiling dimple) enhance facial beauty and
expression. They ocur in both sexes with no particular
preponderance, may express unilaterally or bilaterally
anda re genetecally inhereted as a dominant trait.
Anatomically dimples are thought to be caused by a double
or bifid zygomaticus major muscle, whouse facial strands
inserts into the dermis and cause dermal tethering effect.
There are people exited in plastic surgery who had made
cheek dimple after for beauty purposes (4).
Figure 1
Daponte was reported that male and female greek
children and adolescents ranging in age between 7-15 the
Kosif/Anatomıcal Skin Dımples
16
presence of cheek dimples. It is naturally present in 35% of
adult females and 33%of adult males Neither sex nor side
differences when expressed unilaterallywere observed (5).
The truth is that dimples are actually
genetic defects that are caused by shortened facial muscles.
Dimples are caused by a fault in the subcutaneous
connective tissue that develops in course of the embryonic
development. A variation in the structure of the facial
muscle may also cause dimples.It must be interesting to
notethat dimples are inherited facial traits that are passed
from one generation to the next. Dimples often occur on
both the cheeks. A single dimple on one cheek is a rare
phenomenon.Transfer of dimples from parents to children
occurs due to just one gene. The dimple creating genes are
present in the sex cells prior to the process of reproduction.
Each parent provides one of these genes to the child. So, if
both the parents have dimples, the children have 50-100%
chances of inheriting dimple genes.
If, however, only one parent has dimple genes, the chances
of the children inheriting the genes are 50%. If neither of
the parents has the dimple genes, their children will not
have dimples (6).
Fovea Mentalıs (Chın Dımple): The terms cleft
chin, chin cleft, dimple chin or chin dimple refer to
adimple on the chin. It is a Y-shaped fissure on the chin
with an underlying bony peculiarity. Specifically, the chin
fissure follows the fissure in the lower jaw bone that
resulted from the incomplete fusion of the left and right
halves of the jaw bone, or muscle, during the embryonal
and fetal development. For other individuals, it can develop
over time, often because one half of the jaw is longer than
the other, leading to facial asymmetry.
This is an inherited trait in humans, where
the dominant gene causes the cleft chin, while the
recessive genotype presents without a cleft. However, it is
also a classic example for variable penetrance with
environmental factors or a modifier gene possibly affecting
the phenotypical expression of the actual genotype. Cleft
chins are common among people originating from Europe
(7).
It has been reported that the chin dimple results
from incomplete fusion of the two halves of the jaw during
foetal development, forming a notch in an otherwise well-
united mandibular symphysis. It can also be caused by a
dehiscence or failure of the paired mentalis muscle over the
chin to come together during development (8).
Figure 2
Zygomatıc Dımple (Higher up Dimples): A unique
case of a congenital skin fossa in the zygomatic region in a
3-year-old girl is reported by Hanawa (9). Little has been
written about congenital fossae, or dimples. They are
thought to develop in the wound resulting from the fetal
tissue being compressed between a sharp bony point and
the uterine wall. The skin and subcutaneous tissue become
compressed and adherent, and when the pressure is
released, surrounding parts can stand up, while the
attached part remains tied down, forming small dimples or
fossae, what have been called "pressure dimples (9).
Figure 3
Fossa Supraspınosus (-Acromıal Dımple): Bi-acromial
dimples(shoulder dimples), also known as supraspinous
fossae are an anatomical peculiarity that should be
considered an anatomic variation (10). They seem to have
an autosomal dominant inheritance pattern. Review of the
literature suggests that, these dimples arise due to the
entrapment of skin between the shoulder bones and wall of
the uterus. These dimples are found infrequently, and are a
solitary finding in most cases. However, bi-acromial
dimples have been reported as part of malformation
syndromes such as 18q deletion syndrome, and skeletal
dysplasias such as Apert’s syndrome (11).
Figure 4
Elbow Dımple: Upon the lateral part of the posterior
aspects of the extended elbow is a distinct dimple, which
overlies the radio-humeral articulation; this dimple along
with the hollows on each side of the olecranon. It becomes
effaced in synovial thickenings and effusions in to the joint
(12).
Figure 5
This appears to be the first case of a child
presenting congenital, symmetric dimples in three different
areas. We report on a male premature child who was seen
at the age of 2 months for the evaluation of cutaneous
depressions symmetrically located on the shoulders,
elbows and in the sacral region (13). Some patients had
subacromial dimples and elbow dimples during infancy in
Apert Syndrom (14).
Back Dımples: The dimples of Venus (also known
as back dimples, butt dimples or Venusian dimples)
Kosif/Anatomıcal Skin Dımples
17
are sagittally symmetricalindentations sometimes visible
on the human lower back, just superior to the gluteal cleft.
They are directly superficialto the two sacroiliac joints, the
sites where the sacrum attaches to the ilium of
the pelvis.The term "dimples of Venus", while informal, is a
historically accepted name within the medical profession
for the superficial topography of the sacroiliac joints. The
Latin name is fossae lumbales laterales ("lateral lumbar
indentations"). These indentations are created by a
short ligament stretching between the posterior superior
iliac spineand the skin. They are thought to be
genetic.There are other deep-to-superficial skin ligaments,
such as "Cooper's ligaments", which are present in the
breast and are found between the pectoralis major fascia
and the skin.There is another use for the term "Dimples of
Venus" in surgical anatomy. These are two symmetrical
indentations on the posterior aspect of the sacrum which
also contain a venous channel. They are used as a landmark
for finding the superior articular facets of the sacrum as a
guide to place sacral pedicle screws in spine surgery.
Figure 6
They are sometimes believed to be a mark of beauty,
alluding to the origin of their name (Venus was the Roman
goddess of beauty) (15).
Gluteal Dımples (Dimple on Butt Cheek: Above
Gluteal Region):Dimple on butt cheek present during
childhood may disappear after due to excessive weight.
Butt dimples caused by cellulite, or fat deposits right
beneath the skin's surface can make you feel embarrassed
about your appearance. The presence of cellulite on your
derriere can run in the family, or be caused by hormones or
lifestyle (16).
Figure 7
Pathologıc Dımples
Sacral and coccygeal dimples are pathologic dimples. Sacral
dimples, also known as sacrococcygeal orcoccygeal dimples
or pits, are the commonest cutaneousanomaly detected at
neonatal spinal examination. They aredefined as shallow or
deep depressions occurring at thelower sacral region close
to or within the natal cleft (17).
Figure 8
Kriss and Desai examined 160 neonates who
hadmidline sacral dimples less than 5 mm in size and
situatedwithin 2.5 cm of the anus. None had any signs of
spinaldysraphism on ultrasonography(18). On the other
hand, eightof the 20 neonates with "atypical" dimples
(larger than5 mm in size, situated farther from the anus, or
occurringwith other cutaneous markers) were found to
have occultneural tube defects. The authors thus concluded
that dimplesthat were bigger in size, located at a higher
spinal level, orassociated with other cutaneous stigmata
should beinvestigated. Their findings form the basis
ofrecommendation for investigation of atypical sacral
dimplesin a recent review (19).Cutaneous sinuses, dimples
and patchesalong the spine should be routinely searched in
theexamination of newborn as clues to an underlying
occultspinal defect (20).
Gomi evaluated 142 patients with sacrococcygeal
dimples. Although Gomi et al identified spinal
malformations such as spinal lipomas, filum cysts, and
thickened fila terminalia in only 17 % of infants with type 1
dimples, they observed them in 45 % with type 2 and 55 %
with type 3. Thus, in terms of the rate of spinal
malformations, there are significant differences between
types 1 and 2 and between types 1 and 3 (21).
Clinical significance of medically important
dimples, especially sacral dimples, its association with
occult spinal dysraphism, and a cost-effective diagnostic
strategy (22).
Skin dimples have sometimes been considered a
benign autosomal dominant trait. However, several authors
have reported these cutaneous defects in a variety of
conditions like congenital syndromes, infections, inborn
errors of metabolism and mechanical trauma. In our case,
the aetiology is unknown, even though maternal drug or
infective exposure can reasonably be excluded as well as
traumatic events (13).
Dimples could be transient or permanent, depending on the
cause or factor responsible for their occurrence.
Theprocess of growth and development could contributes
to this. Excessive fat deposition, which disappears with
theaging process, causes transient dimples, so also is the
stretching or lengthening of muscles during growth,
leading togradual obliteration of the defect (2).
Sometimes, dimples are also caused due to the
presence of excessive fat on your face. These dimples are
not permanent. They vanish away when the excessive fat
goes away. Such dimples are not indicators good health.
These dimples can be eliminated through proper diet and
exercise.
REFERENCES
1. http://en.wikipedia.org/wiki/Dimple#Characteristics
2. OmotosoGO, AdeniyiPA, Medubi, LJ.Prevalence of Facial
Dimples Amongst South-western Nigerians:A Case
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International Journal of Biomedical and Health Sciences
6:4; 241-244.
3. Vercillo K: Why Some People Have Dimples and Others
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http://hubpage.com/hub/WhySome-People-Have-
Dimples-And-Others-Dont.
4. LariAR, PanseN. Anatomical Basis Of Dimple Creation.
A New Technique. (2012)Indian journal of plastic
surgery. 45(1): 89-93.
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5. DaponteAP, ViennaA, BrantL, HauserG. Cheek Dimples
İn Greek Children And Adolescaents. International
Journal Of Anthropology. 19(4): 289-295, 2004.
6. http://www.genetic.com.au/genetic-traits-
dimples.html
7. http://en.wikipedia.org/wiki/Cleft_chin
8. MokalNJ, DesaiMF. Dimple-matically correct
Revisiting the Technique For The Creation Of A Chin
Dimple.(2012) Indian J Plast Surg. 45(1): 144147.
9. Hanawa Y, Iwahira Y, Maruyama Y. Congenital Skin
Fossae in the Zygomatic Region. (1993) Plast Reconstr
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10. Beillard C, Guillet G, Vabres P, Dagregorio G, Larregue
M. Bi-acromial Dimples: A Series Of Seven Cases.
(2005) Pediatr Dermatol. 22(5):412-4.
11. ShekhawatP. A Newborn With Bilateral Shoulder
Dimples: Case Report And A Review Of
LiteratureSociety of Hospital Medicine: RIV Abstract
Issue, 2014 Abstract Supplement 9: 24-27.
12. CunninghamDJ. Cunningham’s Textbook of Anatomy
Surface and Surgical Anatomy. 5. Edition. Pg:1449.
13. Virgili A, Tosti G, Bettoli V, Corazza M. Multiple
Congenital Symmetric Skin Dimples. (2002)
Dermatology. 204(4):293-5.
14. Cohen MM Jr, Kreiborg S. Skeletal Abnormalities in the
Apert Syndrome.(1993) Am J Med Genet. 1;47(5):624-
32.
15. Richard WinnH, Editor.(2004) Youmans Neurological
Surgery, 5th Edition. Saunders (Elsevier), Philadelphia.
16. http://healthyliving.azcentral.com/butt-dimples-
exercise-10783.html
17. Weprin BE, Oakes WJ. Coccygeal Pits. (2000)
Pediatrics105:E69.
18. Kriss VM, Desai NS. Occult Spinal Dysraphism in
Neonates: Assessment of High-risk Cutaneous Stigmata
on Sonography. (1998) AJRAm J Roentgenol171:1687-
92.
19. Williams H. Spinal sinuses, Dimples, Pits and Patches:
What LiesBeneath? (2006) Arch Dis Child Educ Pract
Ed; 91:ep75-80.
20. LeeACW, KwongNS, WongYC. Management of Sacral
Dimples Detected on Routine Newborn Examination: A
Case Series and Review. (2007) HK J Paediatr (new
series)12:93-95.
21. Gomi A, Oguma H, Furukawa R. Sacrococcygeal Dimple:
New Classification and Relationship With Spinal
Lesions.(2013) Childs Nerv Syst. 29(9):641-5.
22. Kumar A, Kanojia RK, Saili A. Skin Dimples. (2014) Int J
Dermatol. 53(7):89-97.
How to cite this article: Kosıf, M.D. Rengin. Anatomıcal Skin Dımples. Innovative Journal of Medical and Health
Science, [S.l.], v. 5, n. 1, p. 15-18, feb. 2015. ISSN 2277-4939.
Available at: <http://innovativejournal.in/ijmhs/index.php/ijmhs/article/view/45>. Date accessed: 18 Feb. 2015.
doi:10.15520/ijmhs.2015.vol5.iss1.45.15-18.
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Skin dimples are seldom observed in sites other than the face. We report on a male premature child who was seen at the age of 2 months for the evaluation of cutaneous depressions symmetrically located on the shoulders, elbows and in the sacral region. Skin dimples have sometimes been considered a benign autosomal dominant trait. However, several authors have reported these cutaneous defects in a variety of conditions like congenital syndromes, infections, inborn errors of metabolism and mechanical trauma. In our case, the aetiology is unknown, even though maternal drug or infective exposure can reasonably be excluded as well as traumatic events. At a 3-year follow-up, the patient shows a normal psychophysical development. This appears to be the first case of a child presenting congenital, symmetric dimples in three different areas.