A dimple creation procedure takes an approximate 30 minutes to complete. This is carried out under local anesthesia.  The incisions are made in the inside of the cheek and there are no scars or incisions on the outside surface. A punch biopsy instrument is placed alongside the inner cheek (buccal mucosa) in lines with the location of the dimple and circular motions are made which cuts through the inner cheek, sub-mucosal and cheek muscle.  The circular tissue is removed and the skin is left intact.  The skin is positioned appropriately to create a dimple and the cylindrical gap is closed with absorbable sutures.  The sutures are placed through the cheek muscle connecting the dermis layer of the skin. A surgical knot is then tied which dimples the skin without a smile.