Skin dimpling is an inward pulling or puckering of the skin’s surface that creates small depressions, often resembling the texture of an orange peel or the dent left when you press a fingertip into dough. It can appear anywhere on the body and ranges from a single shallow indentation to a widespread textured pattern. The causes span from the completely harmless, like cellulite or natural facial dimples, to the medically urgent, like a breast tumor pulling on tissue from below.
How Skin Dimpling Actually Appears
Skin dimpling does not look the same in every situation, and recognizing the differences matters. At its simplest, a dimple is a focal depression where the surface dips inward rather than sitting flush. In some cases, you see one isolated indentation, perhaps a centimeter or two across, with otherwise normal-looking surrounding skin. In others, the dimpling covers a broader area and creates a bumpy, uneven texture that clinicians call “peau d’orange” because it resembles the pitted surface of an orange rind. The skin in that zone may also look swollen, feel warm, or take on a reddish hue depending on the underlying cause.
What distinguishes pathological dimpling from something benign like a facial cheek dimple is context. A dimple that appears suddenly on the breast, that you never noticed before, or that sits over a firm lump beneath the surface warrants immediate attention. A dimple on the thigh that has been there for years and changes with weight fluctuation is almost certainly cellulite. Location, timing, and accompanying symptoms are the practical guide to whether dimpling is a cosmetic annoyance or a red flag.
Breast Cancer and Skin Tethering
Breast dimpling is probably the reason most people search this topic, and for good reason. When a tumor grows within the breast, it can invade or shorten the fibrous bands (called Cooper’s ligaments) that run between the breast tissue and the overlying skin. As those bands contract, they pull the skin inward, creating a visible dimple or pucker. The dimple may only show up when you raise your arm, lean forward, or press on the area around the lump. In early cases the skin can look perfectly smooth at rest, with the dimpling only becoming apparent when the breast tissue shifts position.1PubMed Central. The Pushing Sign for Early Skin Tethering in Breast Cancer
Researchers have described a clinical maneuver called the “pushing sign,” in which a doctor pushes the lump in various directions to see whether the overlying skin dimples. In many of these cases, the fat between the tumor and the skin looks completely normal on biopsy, meaning the dimpling is not caused by the cancer invading the skin itself but rather by its involvement of those deeper ligaments.1PubMed Central. The Pushing Sign for Early Skin Tethering in Breast Cancer This distinction is clinically important because skin tethering can be an early sign, present before other more obvious changes like skin thickening or nipple retraction develop.
Widespread peau d’orange texture across the breast, especially when accompanied by redness, swelling, and warmth, may point to inflammatory breast cancer, a particularly aggressive form. In this scenario, cancer cells block the tiny lymphatic vessels in the skin, causing fluid buildup and that characteristic dimpled appearance across a large area rather than at a single point. Any new dimpling on the breast, whether a single spot or a broader texture change, deserves prompt evaluation with imaging and possibly biopsy.
Cellulite, the Most Common Cause of Dimpled Skin
For most people, skin dimpling means cellulite. That lumpy, cottage-cheese-like texture on the thighs, buttocks, and sometimes the abdomen is extraordinarily common, affecting an estimated 80 to 90 percent of women after puberty. The dimpling happens because of an imbalance between the forces pulling the skin inward and the fat pushing it outward. Beneath the skin, fibrous bands called septa connect the dermis to the deeper tissue. Where those bands are short and rigid, they anchor the skin down, while the surrounding fat lobules push upward. The result is a dimple at every rigid anchor point and a bulge between them.2PubMed Central. Cellulite: Current Understanding and Treatment
In people with a higher body mass, the superficial fat layer gets taller and the forces pushing outward become stronger, which makes the dimples deeper and more pronounced.2PubMed Central. Cellulite: Current Understanding and Treatment But cellulite is not purely about body fat. Thin, athletic people get it too, because the architecture of the connective tissue matters as much as the volume of fat beneath it. Hormonal factors, genetics, and skin thickness all play a role. The dimpling from cellulite is symmetrical, affects both sides of the body roughly equally, and tends to worsen gradually with age. It does not produce lumps you can feel beneath the skin, and it is not associated with redness, warmth, or pain.
Treatment options for cellulite dimpling have historically been disappointing, but newer approaches target the actual anatomy. A procedure called subcision physically cuts the fibrous bands responsible for individual dimples. One commercially available device uses targeted, mechanically verified subcision to release specific septa that have been confirmed to cause a given dimple.3PubMed Central. Cellulite and the Aesthetic Management of the Buttocks and Thighs: 6 Cases Illustrating Targeted Verifiable Subcision as Part of a Multimodal Approach to Lower Body Rejuvenation Acoustic subcision, a noninvasive approach using focused sound energy, has also shown meaningful improvement in cellulite depressions and skin laxity from a single treatment session, with results expected to improve further over multiple sessions.4PubMed Central. Improvement in the appearance of cellulite and skin laxity resulting from a single treatment with acoustic subcision
Dimpling After Corticosteroid Injections
If you have ever received a steroid injection for joint pain, a skin condition, or tendinitis and later noticed a shallow depression at or near the injection site, you are not imagining things. Corticosteroid injections can cause localized loss of fat and thinning of the skin, producing a visible dimple that can persist for months or longer. Side effects of injected steroids like triamcinolone include subcutaneous tissue atrophy, dilated small blood vessels, and lightening of the skin color at the site.5PubMed Central. Successful treatment of lipoatrophy with normal saline
The mechanism involves several things happening at once. Steroid crystals can deposit outside the intended target, and in some cases the injected fluid partially tracks backward along the needle path. Once in the surrounding tissue, the steroid suppresses the cells that produce collagen, ramps up the enzymes that break collagen down, and can block local lymphatic flow. The combined effect is a loss of tissue volume right under the skin, creating a visible indentation.6ReumatologÃa ClÃnica. Treatment of Persistent Cutaneous Atrophy After Corticosteroid Injection With Fat Graft On biopsy, the affected skin shows thinning of the outer layers, breakdown of elastic tissue, and more prominent small blood vessels.7PubMed Central. Cutaneous Atrophy Following Corticosteroid Injections for Tendonitis: Report of Two Cases
The dimple from a steroid injection is usually smooth and circular, centered on or near where the needle went in, and the surrounding skin often looks paler and thinner than normal. In many cases the tissue gradually recovers on its own over several months as the steroid effect wears off. For persistent depressions, fat grafting and filler injections have been used to restore volume.
Autoimmune and Inflammatory Causes
Several inflammatory and autoimmune conditions can damage the fat layer or connective tissue beneath the skin, leaving behind depressions that look like dimpling or pitting.
Localized scleroderma, also called morphea, is a chronic inflammatory condition in which patches of skin become thickened and hardened, and then eventually thin out and scar. Over time, this process can destroy the underlying fat, leaving depressed, atrophic areas. MRI studies of morphea patients show fat atrophy in roughly seven out of ten cases, with either skin thickening or thinning at the surface.8PubMed. Localized scleroderma: anatomic MRI findings of morphea with inter-reader analysis The dimpled areas in morphea tend to have a waxy or shiny appearance, may feel hard or bound down, and are often surrounded by a characteristic lilac-colored ring during the active phase. Current treatments aim to slow the inflammatory process, and newer approaches like fractional laser therapy and hyaluronic acid fillers can help address the skin atrophy and volume loss left behind.9PubMed Central. Advances in the Management of Localized Scleroderma: A Systematic Review of Laser Therapy and Injectable Filler Approaches
Lupus panniculitis, sometimes called lupus erythematosus profundus, is a form of lupus that specifically attacks the fat beneath the skin. It produces firm, painful nodules that eventually resolve and leave behind deep, dished-out depressions and scars. The overlying skin may look red and can sometimes ulcerate before healing with dimpling and atrophy.10PubMed. Novel diagnostic imaging features of facial lupus panniculitis: ultrasound, CT, and MR imaging with histopathology correlate Lupus panniculitis most often affects the face, upper arms, and thighs. Unlike the dimpling from cellulite, it tends to be asymmetric and can worsen in flares. Imaging studies can distinguish the fat destruction of lupus panniculitis from other causes by revealing characteristic changes in the subcutaneous layer.
Lymphedema and Peau d’Orange
When the lymphatic system cannot drain fluid effectively, the resulting swelling can produce widespread skin dimpling. Lymphedema, whether caused by surgery, radiation, infection, or obesity, leads to fluid accumulation in the tissue just under the skin. As fluid pressure builds, the skin swells between the points where it is tethered to deeper structures, creating that orange-peel texture. In severe or chronic cases, the tissue itself becomes fibrotic and thickened.
A striking example occurs in massive localized lymphedema, a condition seen almost exclusively in people with severe obesity. It presents as a large, often hanging mass, typically on the inner thigh or lower leg, with overlying skin changes that include peau d’orange dimpling, warty thickening, and sometimes ulceration. The chronic obstruction of lymphatic flow leads to fibrosis in the tissue, producing skin dimpling that differs from cellulite in that it is localized to the affected area, associated with significant swelling, and does not improve with weight changes alone.11PubMed Central. Massive localized lymphedema: an emerging dermatologic complication of obesity
In milder forms of lymphedema, you can test the dimpling by pressing a finger into the swollen area. If it leaves a temporary dent (called pitting), the edema is still in an early, fluid-dominant stage. As fibrosis develops over time, the tissue becomes too firm to pit, and the dimpling becomes permanent rather than transient.
Congenital Dimples and When They Matter
Not all skin dimples are acquired. Some people are born with them, and the clinical significance ranges from zero to potentially important depending on location.
Sacral dimples, small indentations near the base of the spine just above the crease of the buttocks, are among the most common findings on newborn exams. Most are completely benign. A simple sacral dimple, defined as a single midline depression less than about 5 millimeters across and located within a couple of centimeters of the anus, with no other skin changes nearby, carries a very low risk of any underlying spinal abnormality and does not require imaging.12PubMed Central. Sacral dimple: clinical perspectives of lesions hidden beneath the skin In one large review, only about 1 percent of infants who underwent spinal ultrasound for a simple sacral dimple were found to have a tethered cord or other abnormality requiring intervention.13PubMed Central. Evaluating the Diagnostic Utility of Spinal Ultrasound in Neonates With a Simple Sacral Dimple: An Eight-Year Retrospective Study Routine ultrasound screening of simple dimples has been shown to generate unnecessary costs and family anxiety without meaningful benefit.14PubMed. Screening for Spinal Dysraphisms in Newborns With Sacral Dimples
The picture changes for atypical sacral dimples. If the dimple is large, deep, located off the midline, or accompanied by other skin markers like a tuft of hair, a small hemangioma, or a skin tag, imaging is warranted because the risk of an underlying spinal abnormality is substantially higher.12PubMed Central. Sacral dimple: clinical perspectives of lesions hidden beneath the skin
Cheek dimples, by contrast, are purely cosmetic and entirely harmless. They form because of a variation in the muscle that pulls the corner of the mouth upward during a smile. In some people this muscle is split into two bundles, and the lower bundle has an attachment partway along its length that tethers to the overlying skin. When the muscle contracts, that tethering point pulls the skin inward and creates the dimple.15Clinical Anatomy. Double or bifid zygomaticus major muscle: Anatomy, incidence, and clinical correlation These dimples only appear during facial expressions and are static features of anatomy, not signs of disease.
Skin Growths That Cause Dimpling
Certain benign skin lesions can produce localized dimpling. A dermatofibroma is a common, firm, button-like growth in the skin, typically on the legs. When you squeeze the skin on either side of a dermatofibroma, the center dips inward rather than popping up, a clinical sign known as the “dimple sign” that helps distinguish it from other bumps. In rare atrophic variants, the dimpling can be present without squeezing. In one documented case, staining of the tissue revealed an almost complete loss of elastic fibers at the center of the lesion, and that loss of elastic support was thought to explain the persistent skin depression.16Karger Publishers (Case Reports in Dermatology). A Rare Case of Atrophic Dermatofibroma Featuring Linear Skin Dimple Dermatofibromas are harmless and do not require treatment unless they are bothersome.
Dimpling After Cosmetic Procedures
Liposuction is one of the more common cosmetic procedures worldwide, and surface irregularities including dimpling are a well-recognized complication. After fat is suctioned out, the tissue heals with bands of scar tissue (fibrosis) that can tether the skin inward at uneven points. If fat removal is uneven or the skin does not contract smoothly, the result is a bumpy, dimpled surface. Correcting these irregularities often requires a combination approach: additional liposuction of residual fat pockets, direct surgical removal of the fibrotic bands, and skin tightening through procedures like abdominoplasty.17PubMed Central. Surgical Correction of Abdomen Irregularities after Liposuction: Case Series
The dimpling from a cosmetic procedure tends to be localized to the treated area, may feel firm or ropy when you press on it (that is the scar tissue), and generally does not change in size over time once healing is complete. It is visually distinct from cellulite in that it follows the pattern of the surgical procedure rather than occurring in the symmetric, widespread distribution that cellulite produces.
Aging and the Structural Changes Beneath the Skin
As skin ages, the collagen fibers that provide structural support become stiffer and harder. Research measuring the physical properties of collagen bundles in aged skin found that stiffness and hardness increased by roughly 175 percent and 145 percent, respectively, compared to younger skin.18PLOS ONE. Age-related changes in dermal collagen physical properties in human skin While stiffer collagen might sound like it should hold things together better, the reality is more complicated. Stiff, rigid fibers are less resilient and less able to redistribute forces evenly. Combined with thinning of the fat layer and loss of elasticity, aging skin becomes more susceptible to dimpling from underlying structural irregularities that would have been invisible beneath younger, plumper, more elastic tissue.
This is why cellulite often becomes more visible with age even if body weight remains stable. The fat lobules may not change much, but the skin’s ability to smooth over the uneven landscape beneath it declines. It is also why dimpling from things like old scars, minor fat atrophy, or fibrous bands tends to become more pronounced over time.
When Skin Dimpling Needs Medical Attention
Most instances of dimpled skin do not require medical evaluation. Cellulite, facial dimples, simple sacral dimples in babies, and known injection-site reactions are well-understood and benign. The situations that warrant a visit to a doctor fall into a few clear categories:
- New breast dimpling: Any puckering, tethering, or peau d’orange texture on the breast that you have not seen before should be evaluated promptly, especially if it is accompanied by a palpable lump, nipple changes, or skin redness.
- Dimpling over a lump: A skin depression that sits directly over a new or growing lump anywhere on the body, not just the breast, suggests something beneath the surface is pulling on the skin.
- Painful or worsening dimples: Inflammatory conditions like lupus panniculitis or morphea produce dimpling that may be tender, change over time, or be surrounded by discolored or hardened skin.
- Dimpling with swelling: Peau d’orange texture in combination with significant edema, especially if it is one-sided, may indicate lymphatic obstruction and should be investigated.
- Rapid onset: Dimpling that appears suddenly and without an obvious explanation like recent weight change or a procedure is worth having examined.
For a single dimple that has been stable for years, sits in an area like the thigh or buttock, and is not associated with any lump, pain, or skin changes, the most likely explanation is a particularly adherent fibrous band or minor fat irregularity. These are cosmetic concerns, not medical ones. The key differentiator in nearly every case is whether the dimpling is new and changing or old and stable, and whether there are accompanying features like lumps, pain, swelling, or skin color changes that point to an active process beneath the surface.