Upper cheek dents, often called high-set dimples, are a common anatomical variation visible when a person smiles or laughs. These indentations result from a minor difference in the structure of the facial muscles and their connection to the overlying skin. This phenomenon is entirely normal and represents a benign developmental feature, not a sign of any underlying health issue. These specific facial depressions typically appear higher up on the cheek near the cheekbone, distinguishing them from traditional dimples located closer to the corners of the mouth.
Muscular and Connective Tissue Causes
The physical mechanism creating upper cheek dents centers on a variation of the zygomaticus major muscle, which is the primary muscle responsible for pulling the corners of the mouth up into a smile. In most people, this muscle runs as a single bundle from the cheekbone to the corner of the mouth. However, in individuals with cheek indentations, the muscle often presents in a split or bifid form, known as the bifid zygomaticus major muscle. This anatomical configuration is a natural deviation from the typical muscle structure.
The bifid muscle divides into two distinct bundles as it travels down the cheek. One bundle inserts at the mouth’s corner, while the second bundle attaches directly to the dense connective tissue of the skin, or dermis, along its mid-portion. This connection to the dermis creates a tethering effect that pulls the skin inward.
When the muscle contracts during a smile, the tethered point remains fixed while the surrounding tissue moves, causing the characteristic depression. This dermal tethering is the direct cause of the cheek dent, which is why the indentation is only apparent during facial expressions that engage the muscle. The location of the split and the dermal insertion point determines whether the resulting depression is a traditional dimple or a higher-set upper cheek dent. The depth and size of the dent vary significantly depending on the strength of the muscle contraction and the precise nature of the skin attachment.
Genetics of Facial Indentations
Facial indentations, including both cheek dimples and upper cheek dents, are strongly influenced by hereditary factors. The specific anatomical variation of the bifid zygomaticus major muscle is often passed down through families. This trait is frequently described as following a pattern of dominant inheritance, meaning a child has a reasonable likelihood of inheriting it if one parent possesses the trait.
However, the pattern of inheritance is considered more complex than a simple dominant trait, potentially involving multiple genes or exhibiting incomplete dominance. This complexity explains why the trait does not appear in every generation or why its expression can vary widely. For instance, a person might inherit the trait but only exhibit a dent on one side of the face, known as a unilateral presentation.
The appearance of the indentation is also influenced by factors that change over a person’s life, such as the amount of subcutaneous fat in the cheeks. Many infants have dimples due to baby fat, which often disappear as the facial structure matures and the fat diminishes. Conversely, the dent may only become noticeable later in life as facial muscles develop or as the skin’s structure changes with age. The genetic predisposition remains, but its physical manifestation is modulated by developmental changes and tissue composition.
Aesthetic and Health Perspectives
From a health perspective, the presence of lifelong upper cheek dents is considered a normal, benign anatomical variation that requires no medical intervention. These features are congenital, meaning they have been present since birth, and are not associated with any medical conditions. The dents are a stable characteristic of the face’s musculature and soft tissue structure.
A sudden, new facial indentation or asymmetry should be evaluated by a healthcare professional, as a sudden change in facial symmetry can sometimes indicate a neurological issue. Conditions such as Bell’s palsy or a stroke can cause sudden weakness or drooping in the facial muscles. If a smile becomes uneven overnight, or if other symptoms like numbness or difficulty speaking accompany the change, immediate medical attention is appropriate.
Aesthetically, these indentations are often perceived as a desirable and attractive feature, contributing to a distinctive and expressive smile. For individuals who wish to modify their appearance, cosmetic options exist for both accentuating and minimizing the dents. Procedures like dimple creation (dimpleplasty) can surgically replicate the tethering effect of the bifid zygomaticus major muscle. Conversely, non-surgical options like injectable dermal fillers or fat grafting can add volume beneath the indentation, softening its depth.