What causes a gummy smile?
A gummy smile does not have a single cause. Four are most often discussed: muscles that lift the upper lip too far when smiling, a vertically long upper jaw, a short upper lip and gum tissue that covers too much of the teeth. In many people two or more of these occur together.
When you smile, muscles that pull the upper lip and the nostril wing upward work; if they are hypermobile, the lip rises more than needed and the gum above the teeth shows. Another group of causes is set by the skeleton: when the upper jaw grows long vertically, more teeth and gum are visible. A short upper lip at rest can leave the teeth exposed too high when smiling. The gum tissue itself also plays a part; if the teeth look short, the reason may be gum covering them too much. Some medicines can also thicken gum tissue.
The amount of gum that shows also depends on the type of smile. A person may have no problem with a gentle smile but notice a marked band of gum when laughing. Which cause is at work determines whether Botox will help, so the assessment starts with how the lip moves and where the teeth sit. If the cause seems to lie more in bone structure or gum than in muscle hypermobility, referral to a dentist or a jaw surgeon comes into consideration. Botox given without this distinction may not bring the change you expect.
How does Botox reduce a gummy smile?
Botox reduces, with small doses, how strongly the muscles that raise the upper lip and nostril wing work when you smile. When the muscle contracts less, the upper lip stays a little lower and less gum shows. Treatment is often given as small doses in the area beside the nostril wing on each side.
Botox temporarily reduces the signal a muscle receives from its nerve. When it is placed in the muscles beside the nostril wing that lift the upper lip, the height the lip can reach on smiling is limited somewhat, and the amount of gum exposed over the teeth in a laugh can decrease. The change is usually small, on the order of millimetres, so the effect is judged as a rebalancing of the smile. Before treatment, how your lip moves when you smile, the symmetry of the two sides and where the gum shows most are examined. Treatment is brief, and most people return to daily life straight away.
The effect starts within a few days, settles at around two weeks and fades gradually over 3–4 months for most people; this varies from person to person. The doses used in this area are small, because nearby muscles create the smile. If the dose is too high, or the toxin reaches neighbouring muscles, the natural look of the smile can be disturbed. For a first treatment a measured dose is generally chosen, the result is assessed at the review at about two weeks, and a small extra dose can be planned if needed. Botox for a gummy smile may fall outside licensed indications; you should be given clear information about this.
Who might Botox for a gummy smile suit, and who not?
Botox may be considered when the amount of gum showing is mild to moderate and the main cause is the upper lip rising too far on smiling. Its effect is limited with marked bone length, excess gum tissue or a short lip. It is not given, or is postponed, in pregnancy and breastfeeding, neuromuscular conditions and infection at the site.
The person most likely to respond well to Botox has teeth and gum tissue that look generally healthy, hypermobile muscles lifting the lip when smiling, and a gum display that is not very marked. In such a person a few millimetres of change can noticeably alter the balance of the smile. By contrast, where the upper jaw is markedly long or the gum covers the teeth a great deal, Botox alone is not enough; in those cases dental, orthodontic or jaw-surgery options are discussed. If the lip is thin and short, extra care is needed, because further lengthening of the lip could change the smile in an unwanted way.
The medical suitability rules are the same as for other Botox treatments. Treatment is not given during pregnancy and breastfeeding, or in conditions affecting nerve-to-muscle transmission such as myasthenia gravis or Lambert-Eaton syndrome. Some antibiotics and other medicines that affect nerve-to-muscle transmission may change the assessment. If there is active infection or a cold sore around the nose and upper lip, it must heal first. If your work depends on lip movement, such as speaking, singing or stage performance, you need to mention it at the consultation. Where expectations do not match the change Botox can provide, treatment may not be recommended, and this is discussed openly.
What are the risks and side effects of Botox for a gummy smile?
The common effects are redness, tenderness and small bruises at the injection points. The main risk watched for is the toxin reaching neighbouring muscles, so that the upper lip looks lengthened, the smile flattens or the two sides rise unevenly. These effects are usually temporary but can last a few weeks.
The muscles that create the smile lie close together, so point selection and dose are critical in this area. Too high a dose, or spread of the toxin, can make one side of the upper lip rise less, make the lip look too long when smiling or flatten the smile. Some people also feel heaviness in upper-lip movement, or brief discomfort when speaking or drinking. These signs mostly fade gradually; but because no medicine quickly reverses the effect of Botox, one may have to wait for weeks. Not pressing or rubbing the area in the first hours after treatment is advised.
If you notice a marked change in your smile after treatment, it is important to tell your doctor. Difficulty swallowing, speaking or breathing is very rare but needs urgent medical assessment, and care should be sought at a health facility without delay. If you take blood thinners or some supplements, the chance of bruising may be higher; do not stop them on your own, and mention them at the consultation. If your smile changed after an earlier Botox treatment, be sure to share it. The side effects and signs to watch for are also explained before treatment. Whether this treatment is suitable is therefore decided together at a face-to-face consultation.
What options are there for a gummy smile other than Botox?
Options for a gummy smile depend on the cause. Botox may be considered for muscle hypermobility, gum reshaping by a dentist when the gum covers too much of the teeth, orthodontics or jaw surgery when the upper jaw is too long and lip repositioning surgery when the lip is short. The choice is made according to the cause and expectations.
When gum tissue is excessive or the teeth look short, a dentist or periodontist may consider procedures such as gum reshaping or crown lengthening. If the upper jaw is markedly long, orthodontic treatment and, if needed, orthognathic surgery come into consideration. When the lip is short and mobile, surgical methods such as lip repositioning are discussed with a surgeon experienced in this area. The duration, recovery and risks of these methods differ from those of Botox; some give a longer-lasting change but require a more extensive procedure. Which is suitable is decided after an examination by a dentist or surgeon.
Botox does not replace these options; it is a reversible method whose effect wears off over time, and it may be considered before or alongside them. For some people, Botox can be an opportunity to see how the smile might change before deciding on a surgical procedure. Changing lip position with filler is also sometimes discussed, but this approach varies by person and added volume in the lip can create an unwanted look. For the lip turning outward and for volume, see the lip flip and lip filler pages. Going ahead on the basis of a face-to-face consultation, with the opinion of a dentist where needed, is a safe way to decide.
Frequently asked questions
When does Botox for a gummy smile start to work and how long does it last?
The effect usually starts within 2–5 days and settles at around two weeks. It fades gradually over 3–4 months for most people; because small doses are used, some people may notice it earlier. The timing of a repeat is planned by how quickly the lip returns to its earlier movement. Duration varies with muscle strength and personal features.
Will Botox for a gummy smile make my smile look unnatural?
With suitable dose and point selection the smile usually stays natural; the aim is not to freeze the lip but to limit somewhat how high it rises when smiling. Too high a dose, or spread of the toxin, can flatten the smile or make the lip look long. For that reason a measured dose is chosen at the first treatment and assessed at the review.
Will speaking and eating be affected after Botox for a gummy smile?
Most people notice no marked change in speaking or eating, because the muscles treated are those that work when smiling. Rarely, there may be a feeling of heaviness in the upper lip or brief discomfort with some sounds or when drinking. These signs are usually temporary. If speech and lip movement matter for your work, be sure to mention it at the consultation.
Should I see a dentist before having Botox for a gummy smile?
If the cause of the gum display is unclear, tooth length and the state of the gum are assessed first at the consultation. If gum covering the teeth or a jaw-structure cause is suspected, a dentist’s or orthodontist’s opinion may also be needed. This helps identify the cases where Botox will help.
Is Botox for a gummy smile the same as a lip flip?
No. Botox for a gummy smile goes to the muscles that lift the lip when smiling, to reduce how high the lip rises. A lip flip goes to the muscle around the upper lip and aims to turn the red part of the lip slightly outward. They target different muscles, and the reasons for each are separate.
Can Botox for a gummy smile and lip filler be done together?
In some cases they can be planned together, but the two treatments have different purposes. Adding volume to the lip can change how the lip covers the teeth when smiling and affect the look of the smile. The order and timing are therefore discussed separately at the consultation. For information on filler, see the lip filler page.
Is Botox for a gummy smile as effective as gum surgery?
The two methods cannot be compared directly, because they address different causes. Botox can give a temporary and limited reduction when the cause is muscle hypermobility. Gum surgery makes a structural correction when there is excess gum tissue, and its effect lasts longer. Which is suitable is decided at the consultation according to the cause.
Sources (3)
- Fatani et al., Cureus: An Approach for Gummy Smile Treatment Using Botulinum Toxin A: A Narrative Review of the Literature (2023)
- Rasteau et al., J Stomatol Oral Maxillofac Surg: Botulinum toxin type A for the treatment of excessive gingival display - A systematic review (2022)
- Global Aesthetics Consensus Group (Sundaram et al., Plast Reconstr Surg): Global Aesthetics Consensus: Botulinum Toxin Type A--Evidence-Based Review, Emerging Concepts, and Consensus Recommendations for Aesthetic Use, Including Updates on Complications (2016)
This content is for general information and does not replace a personal medical assessment.