In traditional Asian folklore, the presence of a dimple suggests good fortune and fertility, while in the West it is more simply viewed as a cute and unusual facial curiosity. For whatever reason, surgical creation of a dimple, or dimpleplasty, is an often mentioned form of Asian body modification, even though dimples seem to occur no more or less commonly in Asians than in others.

Natural dimples occur on both sides of the face, and are generally present only when the face is animated, often to an unnaturally exaggerated degree. They are caused by an inherited split in the zygomaticus major facial muscle that normally raises the upper lip. When the muscle contracts with smiling, it splits apart and allows the overlying skin to indent.

Surgical dimpleplasty is simple and takes less than a half hour. Almost any number of dimples can be created, although having more than one made per side can appear distracting. The procedure requires forming a connection between the skin and the cheek muscle. When the muscle contracts during smiling, an indentation occurs in the overlying skin.

An instrument normally used to remove a core of tissue during biopsy of a suspicious lesion (a biopsy punch) is placed against the inside surface of the cheek. Circular movements are then used to cut through the cheek's inner lining, the fat just below it, and into the muscle. The skin above is left intact with a missing core beneath it.

This wound is closed with a suture. The eventual scar connects the skin and underlying muscle and creates an indentation when the muscle moves, a process that mimics but does not exactly replicate the normal mechanism of natural dimple formation. If too much tissue is removed, the dimple may be obvious even without facial movement and look like a dent.

Alternatively, some surgeons simply cut into the muscle from the lining of the mouth and place a suture. Not removing a full tissue core lessens the risk of creating too large an indentation but also increases the risk that the dimple will not form. It does, however, allow for easy reversibility during the first few weeks if a patient decides that undergoing the operation was a frivolous but highly visible mistake, like getting a face tattoo after a night of one too many drinks.

Dimpleplasty does have its drawbacks. For one, surgical dimples don't look very natural. Instead of a cleft in the tissue, they're too much just localized dents. For another, surgical dimples may degenerate into creases as the years pass by. While a dimple may look cute to some people, a line doesn't.