Dimpling refers to a small, localized indentation or depression that appears on a surface, most commonly seen on human skin. This phenomenon spans a wide spectrum, ranging from aesthetic facial features to structural skin changes and, in some cases, a physical manifestation of an underlying health condition. Understanding the cause of a dimple depends entirely on its location and how it is formed. The appearance of a dimple is always the result of an anchor point—a fibrous band or muscle—pulling the outer layer of skin inward.
The Mechanics of Facial and Chin Dimples
Facial dimples are structural variations caused by a specific muscle anomaly. Cheek dimples result from a variation in the zygomaticus major muscle, the primary muscle responsible for elevating the corners of the mouth when smiling. In people with dimples, this muscle may be bifid, meaning it has two separate bundles of muscle fibers near its insertion point. One of these muscle bundles attaches to the dermis, the inner layer of the skin, creating a tethering effect. When the muscle contracts during a smile, this dermal attachment pulls the skin inward, forming a temporary indentation.
Dimples on the chin, commonly known as a cleft chin, have a different anatomical origin related to bone structure. This indentation is caused by the incomplete fusion of the two halves of the lower jawbone, the symphysis menti, during embryonic development. Both cheek and chin dimples are genetically inherited traits.
Common Skin Dimpling and Texture Changes
The most widespread form of skin dimpling is adiposis edematosa, commonly referred to as cellulite, which creates an “orange peel” or mattress-like texture. This appearance is not a disease state but rather a structural change in the subcutaneous fat layer, particularly common among women. Cellulite forms when fat cells push outward against the skin’s undersurface.
Simultaneously, thick, fibrous connective tissue strands called septae anchor the skin to the fascia below. In female anatomy, these septae tend to run vertically, creating compartments that allow the fat to bulge outward while the septae pull the skin down at various points. This tension differential creates the characteristic dimpled texture on the surface of the skin. Hormonal factors, especially estrogen, influence this process, which is why cellulite typically begins after puberty and is far less prevalent in men, whose septae are often arranged in a crisscross pattern that better holds the fat layer uniformly.
Dimpling as a Sign of Underlying Disease
While most dimpling is benign, a sudden or unexplained dimple on certain parts of the body can be a physical sign of a serious underlying medical condition. In the breast, this change in skin texture is medically termed peau d’orange, French for “skin of the orange.” This specific appearance is caused by an obstruction of the lymphatic drainage system in the breast tissue.
When lymphatic vessels become blocked, often by invasive cancer cells, fluid accumulates in the skin, causing swelling and edema. The skin is held in place by fibrous bands known as Cooper’s ligaments, which extend from the deep fascia to the skin’s dermis. Because the skin surrounding these tethering points swells while the ligaments remain fixed, the surface develops the pitted, dimpled texture. This sign is particularly associated with inflammatory breast cancer, an aggressive and rare form of the disease where malignant cells invade the dermal lymphatics.
A tumor mass can also directly pull on these same Cooper’s ligaments, causing a focal dimple or skin tethering that does not involve generalized edema. Any new, unexplained, or persistent dimpling of the breast skin warrants immediate medical evaluation to rule out malignancy or other serious conditions. Other pathological causes of dimpling include certain connective tissue disorders or localized inflammatory processes that cause scarring and subsequent skin retraction.