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Anatomical Skin Dimples

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Innovative Journal of Medical and Health Science 5:1 January - February (2015)15 – 18.
Contents lists available at www.innovativejournal.in
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 (Bı-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
Study of Ilorin, Kwara State of Nigeria. (2010)
International Journal of Biomedical and Health Sciences
6:4; 241-244.
3. Vercillo K: Why Some People Have Dimples and Others
Don’t. 82. Available online at :
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.
Kosif/Anatomıcal Skin Dımples
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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): 144–147.
9. Hanawa Y, Iwahira Y, Maruyama Y. Congenital Skin
Fossae in the Zygomatic Region. (1993) Plast Reconstr
Surg. 91(1):150-3.
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.
... There are also existing works on dimples by other authors who have worked on its dimensions, and surgical creation. [6][7][8][11][12][13] ...
... Again, this current study did not show increase in dimples with age as reported by Pentose et al., [13] as such differed from the reports of Pentose. In addition, this present differed from the report of Kisof et al., [12] who showed in their study that a great proportion of the population did not have dimples. ...
Anthropological Survey of Dimple among the Idoma & Other Indigenous Tribes of Benue State, Nigeria
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  • Nov 2022
Introduction: Dimple is a major marking on the face when present. A dimple, also called a gelasin (from Latin gelasinus) is a small natural indentation in the skin on a part of the human body, most notably in the cheek. Cheek dimples when present, show up when a person makes a facial expression, such as smiling, whereas a chin dimple is a small line on the chin that stays on the chin without making any specific facial expressions. The presence or absence of dimple is an important anthropological feature of the human face that can be used as a means of identification on the living, for a family, group of people, and tribes. The paucity of literature on the prevalence /distribution of dimple among the Idoma people and the other tribes in Benue State informed this study. Results and discussions: The survey showed that 60.3% of the indigenous tribes had dimple. Again, the distribution of the dimple among the population showed that 59.9% had cheek dimple, while 40.1% had chin dimple. The most dominant age group was 33-47 years, the most common religion was Christianity, participants who had tertiary education were more predominant, for marital status, the dominant group were married/cohabiting. The comparison of dimple distribution and the sociodemographic characteristics showed that only level of education significantly (p=0.04) associated with dimple distribution. Conclusion: The survey showed that 60.3% of the indigenous tribes had dimple. The distribution of the dimple among the population showed that 59.9% had cheek dimple, while 40.1% had chin dimple. The survey shows that three in five persons had dimple in the population, one in four persons had chin dimple, and three in eight persons had cheek dimple. The result of this study could be used as a baseline data for the Idoma people.
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... To the best of our knowledge, the effect of the dimple of Venus on spinopelvic junction anatomy/pathoanatomy has not been previously reported. Individual structures of the sacral morphology, PIA, facet joint angle and genetic inheritance of the dimple of Venus suggest that these parameters may be related to one another [1,8,9]. We aimed to examine possible relationships between the dimple of Venus and the spinopelvic junction anatomy/pathoanatomy including the PIA, sacral slope, facet joint angle/tropism/degeneration, and intervertebral disc degeneration/hernia at the level of L5-S1. ...
Dimple of Venus Is Associated with the Increased Pelvic Incidence Angle and More Sagittally Oriented Facet Joint
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Full-text available
Objectives: The present study aims to investigate whether the dimple of Venus affects the anatomy of spinopelvic junction. Subjects and methods: The inclusion criteria were having a lumbar MRI examination in the last one year, being older than 18 years of age and being able to radiologically evaluate the whole vertebral colon and pelvic girdle. The exclusion criteria were having congenital diseases of the pelvic girdle/hip/vertebral column and history of fracture or previous surgery in the same anatomic regions. The patients' demographic data and low back pain were noted. At radiological examination, the pelvic incidence angle was measured by lateral lumbar X-ray. The facet joint angle, tropism, facet joint degeneration, intervertebral disc degeneration and intervertebral disc herniation at the level of L5-S1 were examined on lumbar MRIs. Results: There were 134 male and 236 female patients with a mean age of 47.86 ± 14.50 years and 48.49 ± 13.49 years, respectively. We found that the patients with the dimple of Venus had higher pelvic incidence angle (p<0.001) and more sagittally oriented facet joint (right facet joint p:0.017, left facet joint p:0.001) compared to those without the dimple of Venus. There was no statistically significant relationship between low back pain and the presence of the dimple of Venus. Conclusions: The dimple of Venus affects the anatomy of the spinopelvic junction and is associated with an increased pelvic incidence angle and a more sagittally oriented facet joint angle. Key words: Dimple of Venus; Pelvic incidence angle; Facet joint angle; Spinopelvic junction anatomy; sacral slope.
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... Fossae lumbales laterales (dimples of Venus), which are considered to be hereditary, manifest themselves as symmetrical indentations on the lower back, above the gluteal cleft. 14) The dimples of Venus, a sign for the identification of the posterior superior iliac spine (PSIS) below the fascia and ligament, are formed by a short ligament that extends between the PSIS and the skin. 15) They are useful in describing the sacroiliac joint. ...
Reliability of Fossae Lumbales Laterales and Pelvic Incidence for Estimating Transsacral Corridors Assessed Using Reconstruction Computed Tomography
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  • Jul 2022
Background: The present study aimed to evaluate the effect of fossae lumbales laterales and pelvic incidence (PI) on transsacral corridors. Methods: Patients who underwent pelvic computed tomography (CT) during routine therapy in a single center between 2015 and 2020 were retrospectively reviewed. The patients' age and sex were documented during CT examination. Measurements were performed for both the upper and second sacral segments. Height and weight of the patients were determined using appropriate tools and body mass index (BMI) was calculated. Transsacral corridors were identified in true coronal and true sagittal planes and their width was determined as the maximum gap measured so that no screws could come out of the transacral corridors. PI was measured. Results: Our study included 244 (57%) male and 184 (43%) female patients, who had a mean age of 49.3 ± 14.15 years (range, 18-89 years) and a mean BMI of 26.57 ± 2.38 kg/m2. No statistically significant correlation was found between the detection of the dimple sign in physical examination and the presence of an adequate corridor. The PI was statistically significantly higher in the patients with dimples (p < 0.001). PI of the female patients was higher than that of the male patients (p = 0.026). The correlation between PI and the existence of adequate corridors for S1 and S2 screws was not statistically significant (p = 0.858 and p = 0.129, respectively). On the relationship between the presence of adequate S1 and S2 corridors where transsacral screws could be sent, an inverse relationship was detected: if the S1 transsacral corridor was adequate, the S2 corridor was inadequate or vice versa. Conclusions: We could not obtain meaningful results on the use of the dimples of Venus or PI instead of CT to evaluate the adequacy of transverse corridors. Nevertheless, we confirmed that an increased PI was associated with the presence of dimples of Venus.
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... It is an indentation of muscles on the cheeks. Dimples are a dominant trait that transfers to the next generation is only due to a single gene (Kosif, 2015). In some people, dimples last only until adolescence, while this trait is a lifetime for some people (Omotoso et al., 2010). ...
Hardy-Weinberg equilibrium study of six morphogenetic characters in a population of Punjab, Pakistan
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Hardy-Weinberg equilibrium is the study of the distribution of allelic and genotypic frequencies in a population. The objective of this study is to evaluate the allelic and genotypic frequency of different qualitative traits of men and women in Punjab, Pakistan. A total of 909 individuals were recruited for this study. In population, the frequency order of the blood group is B > O > A > AB and the same in both males and females. Rh-positive is more elevated (86.03%) than the negative (13.97%) in the whole population. Tongue rolling ability is higher in both males (58.92%) and females (61.46%). The presence of free earlobe (71.29%) and straight hairs (52.81%) is more in the whole population. Straight hair is more common in the population than the wavy (30.14%) and curly (17.05%), the male and female order is the same as in the whole population. In the whole population, the ear lobe is non-significant but other traits are significant. This study indicated that the alleles for the ear lobe are in equilibrium in the population, based on a Mendelian ratio. Hence, only the ear lobe follow the Mendelian ratio in the population of Punjab, Pakistan.
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... It is usually formed by a small defect in the buccinator muscle of cheek, such as dermocutaneous insertion of the fibers on the inferior bundle of the bifid zygomaticus major muscle. [5,6,8] Dimple surgery is performed by skilled cosmetic surgeons, oral, and maxillofacial surgeons under local anesthesia or general anesthesia. Numerous surgical approaches exist for doing dimple creation, such as transcutaneous sutures or by an open technique that is performed through intraoral approach, which would show no scar formation. ...
Facial Dimple Creation Surgery: A Review of Literature
Article
Full-text available
  • Dec 2017
Cosmetic surgery is not a new thing. The boom of cosmetic surgery is at its pace in India; people have been getting habituated to esthetics for so many years. Esthetic adjustment of various body parts such as rhinoplasty and lip modifications are more common nowadays. A dimple is a small depression on the surface of the body which can be easily noticeable; people appreciate the presence of dimple on the face and believe that it is a sign of good fortune and prosperity. With the advancements in the cosmetic surgery, there has been a upsurge in having artificial dimple on face. With this increased demand in having facial dimples in people, surgeons now are in an idea of creating an artificial dimple with dimple surgery or “dimpleplasty.” The procedure of dimpleplasty is as simple as making a cut in the skin, suturing the underside of the skin to a deeper layer to create a small depression. The suture creates a permanent scar which maintains the dimple. It is a thumb rule that any surgery has minor risks which are avoidable; the current review enumerates the various procedures for dimpleplasty and their outcomes. This article emphasizes on routine as well as recent procedures used for dimpleplasty and its relative complications.
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Sacrococcygeal dimple: New classification and relationship with spinal lesions
Article
Full-text available
This study aims to ascertain which specific types of sacrococcygeal dimples are associated with underlying spinal cord malformations. From 2008 to 2011, we prospectively examined children less than 2 years old with sacrococcygeal dimples. Each patient underwent clinical assessment of dimples and magnetic resonance imaging. We devised the following new classification of dimples according to their location: type 1, dimples located within the gluteal crease, including coccygeal pits; type 2, dimples located at the upper edge of the gluteal crease with associated curving or deformity of that crease; and type 3, dimples located well above the gluteal crease. We evaluated 142 patients with sacrococcygeal dimples. Although we identified spinal malformations such as spinal lipomas, filum cysts, and thickened fila terminalia in only 17 % of infants with type 1 dimples, we 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. We propose a new classification of sacrococcygeal dimples. Although type 2 dimples have previously been classified as simple dimples that require no further investigation, we have identified that they are strongly associated with spinal deformities, comparable to atypical type 3 dimples. Thus, both types 2 and 3 dimples warrant radiological investigation.
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Management of Sacral Dimples Detected on Routine Newborn Examination: A Case Series and Review
Article
Full-text available
  • Apr 2007
Isolated sacral dimples are a common occurrence in Caucasian newborns and there has been a concern about their association with occult spinal dysraphism. A retrospective study was carried out in which infants born in a regional hospital during the year 2003 with a diagnosis of sacral dimple were examined. Twenty-six infants (0.5%) were identified from 5,440 live births. There was a female predominance (61.5%) and all infants were born at term. A tuft of hair close to the dimple was described in 6 babies, but none had any neurological deficit. Only 4 infants underwent ultrasonography or magnetic resonance imaging. No abnormality was detected. None of the 16 children who had been followed up (median 25.7 months) had any neurological deficit. A review of the current literature strongly indicates that isolated sacral dimples are innocuous and imaging study for occult spinal dysraphism is not indicated. A diagnostic strategy on the selective use of ultrasonography as a screening examination in atypical cases is proposed.
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“Dimple”-matically correct – Revisiting the technique for the creation of a chin dimple
Article
Full-text available
The boom in cosmetic surgery has ushered in the age of the "designer dimple." In the current scenario where an increasing number of Indians are seeking cosmetic surgery, we present our technique for creation of chin dimples. We used this simple and straightforward technique in one patient. The principal steps of the technique include thinning the skin flap, creating a concave indentation in the mandibular symphysis, and obtaining an adhesion between the thinned skin flap and the indented bone. An aesthetically pleasing chin dimple was achieved. We propose that the bony contouring improves the chances of creating a permanent chin cleft or dimple. Our technique for creation of chin dimples aims to give an aesthetic and permanent result by altering the underlying contour of mandibular symphysis and achieving accurate skin coaptation with non-absorbable sutures.
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Spinal sinuses, dimples, pits and patches: What lies beneath?
Article
  • Oct 2006
Skin lesions such as lipomas and hairy patches found over the spine are well recognised as markers of rare, concealed underlying spinal abnormalities—otherwise known as occult spinal dysraphism (OSD) (table 1). Detection of OSD in infants is difficult because an abnormal neurological examination is often not apparent until the child becomes ambulatory, or even later. The associated spinal abnormalities include intraspinal lipomas, cord tethering and split cord malformation or diastematomyelia. Skin and neural tissues have common ectodermal origins, therefore anomalies of both may occur simultaneously. The discovery of a midline skin lesion in an otherwise well, asymptomatic neonate or child often prompts a search for OSD using imaging. However, it is sometimes not clear which lesions warrant imaging—particularly in the case of skin dimples, and so-called birth marks or cutaneous vascular lesions that are all common in infants. The purpose of this article is to clarify the indications for imaging, describe the advantages and disadvantages of the two main imaging modalities, and demonstrate some of the imaging findings that may be reported in these patients. View this table: Table 1 Cutaneous lesions associated with occult spinal dysraphism (OSD) Infants and children with OSD may develop symptoms as they grow due to distortion of the spinal cord and nerve roots. This results in neurological sequelae in the lower limbs, urinary and bowel symptoms. In the tethered cord syndrome (TCS) cord traction occurring as a result of growth is thought to impair the microcirculation of the cord leading to progressive cord ischaemia.1 Surgical intervention for spinal lesions such as cord tethering or split cord malformation before the onset of symptoms may prevent irreversible neurological damage.2,3 However, some clinicians advocate lifelong surveillance with surgical intervention only after the onset of symptoms.3 Patients with anorectal and urogenital malformations including VATER (vertebral anomalies, anorectal malformations, tracheo-(o)esophageal …
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Cheek dimples in Greek children and adolescents
Article
  • Oct 2004
In 14141 male and 14141 female Greek children and adolescents ranging in age between seven and fifteen years the presence of cheek dimples was investigated. Neither sex (12.6% in both female and males) nor side differences when expressed unilaterally were observed. There was however a significant increase of dimples with age as well as significantly higher numbers of asymmetric than symmetric expressions in all age groups. With respect to these observations hypotheses of origin of cheek dimples and related effects of age are discussed.
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Skin abnormalities of the Apert syndrome
Article
  • Oct 1993
This paper reports on skeletal abnormalities in 38 patients with Apert syndrome. Analysis includes alterations in the shoulders, humeri, elbows, hips, knees, rib cage, and spine (except the cervical spine). Some patients had subacromial dimples and elbow dimples during infancy. Mobility at the glenohumeral joint was limited. Progressive limitation in abduction, forward flexion, and external rotation with growth was virtually a constant finding. The acromioclavicular joint was prominent and sometimes had an angular, pointed appearance clinically. This was often associated with atrophic musculature and winging of the scapulae. Limited elbow mobility was common and usually mild in degree. Decreased elbow extension was most often found with decreased flexion, pronation, and supination occurring less frequently. Limited elbow mobility did not change significantly with growth in contrast to the increasing severity observed in the shoulder joint. Short humeri were a constant finding beyond infancy and genua valga of mild degree were present in many cases. Radiographic examination strongly suggests that the Apert syndrome is characterized by a multiple epiphyseal dysplasia. We found delay in appearance of postnatal ossification centers, particularly in the humeral head, greater tuberosity, capitulum, and radial head. Subsequently, these bones became abnormal in shape. Glenoid dysplasia was observed consistently. The neck of the scapula was very short or absent and the inferior margin of the glenoid cavity was poorly demarcated from the infraglenoid tubercle. The humeral head became oblong in shape with relative prominence of the greater tuberosity which compromised abduction. In the elbow, the capitulum was often small and the radial head was flat in many instances. Subluxation or dislocation of the radial head or angulation of the radial neck was observed in some cases. In the hip joint of some adults, the femoral necks were short and broad with prominence of the greater trochanters. Less common radiographic findings are also discussed. © 1993 Wiley‐Liss, Inc.
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Congenital Skin Fossae in the Zygomatic Region
Article
A unique case of a congenital skin fossa in the zygomatic region in a 3-year-old girl is reported. 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." This is the first report of a skin fossa located in the zygomatic region, as far as we know.
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Occult Spinal Dysraphism in Neonates: Assessment of High-Risk Cutaneous Stigmata on Sonography
Article
  • Oct 1999
In this study, we evaluated the incidence of dorsal cutaneous stigmata in a healthy neonate population; we also assessed whether specific types of cutaneous stigmata are associated with underlying spinal dysraphism. From July 1993 through December 1996, we prospectively examined term neonates with dorsal cutaneous stigmata. Each neonate underwent spinal sonography and clinical assessment of the cutaneous stigmata. Incidence of dorsal cutaneous stigmata in a healthy neonatal population was determined by dividing the number of neonates with cutaneous stigmata by the total number of neonates examined. The incidence of cutaneous stigmata in the healthy neonate study population was 4.8%. We examined 207 neonates with 216 cutaneous stigmata, the most common of which was the simple midline dimple (74%). None of the neonates with only a simple midline dimple had spinal dysraphism. Of the 207 neonates we examined, 16 had spinal dysraphism. Clinical examination revealed 180 dimples and 36 other types of cutaneous stigmata (e.g., hemangiomas, hairy patches, masses, tails, lesions). Fourteen (39%) of 36 other cutaneous stigmata were positive for spinal dysraphism. Eight (40%) of 20 atypical dimples were positive for spinal dysraphism. Three were large clefts (>5 mm); the remaining five cases were seen in combination with other lesions and were all located more than 2.5 cm from the anus. Six (67%) of the nine neonates with multiple cutaneous stigmata had spinal dysraphism. Simple midline dimples are the most commonly encountered dorsal cutaneous stigmata in neonates and indicate low risk for spinal dysraphism. Only atypical dimples are associated with a high risk for spinal dysraphism, particularly those that are large (>5 mm), high on the back (>2.5 cm from the anus), or appear in combination with other lesions. High-risk cutaneous stigmata in neonates include hemangiomas, upraised lesions (i.e., masses, tails, and hairy patches), and multiple cutaneous stigmata.
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Multiple Congenital Symmetric Skin Dimples
Article
  • Feb 2002
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.
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