Is it true that cheekbone surgery causes an Indian wrinkle?

Hello, this is Director Hyunwoo Jo of IPT Plastic Surgery.

One of the questions patients often ask is, "Does cheekbone surgery cause Indian wrinkles?"

Or, "I heard that shaving can cause Indian wrinkles. Is that true?" I get questions like this a lot.

Today, I’ll give you the answer.

First, what are Indian wrinkles?

It seems the name came from the fact that they look like the striped markings that Native Americans are said to draw on their faces.

This is the kind of wrinkle I mean.

Indian wrinkles are caused by support ligaments under the skin. They form because ligaments that extend all the way to the bone and muscle are attached there.

For some people, these ligaments are very firmly attached, while for others they are almost nonexistent.

Just as people’s appearances differ, the shape, position, and degree of firmness of these ligaments also differ, and you can think of them as normally being present in our faces.

These firmly attached ligaments, stretching from the bone to the skin, help prevent the skin tissue from sagging.

As we age, the skin starts to sag and the fuller-looking fat diminishes, making the ligaments appear more prominent.

So why do people say Indian wrinkles appear after cheekbone surgery?

I think it is because, just as reduced fat volume makes Indian wrinkles stand out more, reduced cheekbone volume makes Indian wrinkles appear more prominent.

A common misunderstanding here is that 3D cheekbone surgery, meaning surgery done through an intraoral incision, does not cause them, while shaving does. That is not correct.

Both surgeries reduce the volume of the cheekbones, so there is a possibility that they can appear.

As I mentioned earlier, these ligaments can be strong or weak depending on the person, so they may appear more pronounced in some people and less in others. The idea that one specific surgery will definitely cause Indian wrinkles is a myth.

By the same principle, even if fat is removed from the Indian wrinkle area through liposuction, the wrinkles may appear more prominent.

So how should Indian wrinkles that have appeared be addressed?

There is actually a bit of a dilemma here.

If the 45-degree cheekbone area looked too broad and was reduced, then in order to remove the Indian wrinkles, the conclusion is that volume needs to be added back.

It is a really frustrating situation, but if the Indian wrinkles are bothering you a lot, one option is to make them look less noticeable by using fat grafting or filler injections below the area where the wrinkles have formed.

As shown in this illustration, filling in the area with some material can make the wrinkles look softer.

Another option is vertical thread lifting. If the skin is pulled upward vertically using short threads, the Indian wrinkles may appear less noticeable.

However, I think improving them through thread lifting is somewhat less effective.

Finally, there is a surgical method.

This involves cutting the firmly established ligaments.

Depending on the patient, the Indian wrinkle is often very short and tightly connected, and in such cases, even if filler is injected, it cannot go into that exact spot and may spread sideways, which can make the Indian wrinkle look even more pronounced.

In such cases, through a surgical technique called subcision,

If the ligament is stretched or cut and then filler or fat grafting is performed again, you may see better results.

Today, we looked into the rumor that cheekbone surgery causes Indian wrinkles.

The saying that shaving causes them while osteotomy does not seems to be somewhat incorrect, and it seems that depending on the patient, they may appear or may not.

If Indian wrinkles do appear, there are several ways to improve them, so there is no need to worry too much.

Thank you.