Would Botox or gum contouring be the best option for my gummy smile? (photos)

Question

I am concerned with the amount of gum tissue exposed when I smile. I am not sure if this is caused by a overactive upper lip or gums being too low or a combination of both.

Martin Jugenburg, MD · Answer

Hi. Thank you for your question. A combination of Botox and filler treatment to your upper lip and perioral area would likely be beneficial. You do need to see an expert injector for an assessment to establish treatment plan.

Aldo Guerra, MD · Answer

Hello and thanks for your question, You already have a pretty smile, but I can also see your gummy concerns. I would suggest you start with a small amount of Botox, but also consider a dermal filler combination. Most experienced injectors prefer the combination of filler and neuromodulator for best results to reduce gum show.Always see an expert for best results!Dr. ALDO

Monika Soni, MD · Answer

After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question and for sharing your photographs emplitj. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information provided here is useful.While Botox is most commonly used in the upper face, it can also be used in various areas in the lower face. Botox can be placed in the levator labii superioris alequae nasii (LLSAN) muscle located just beside the nose on either side to address what is called the gummy smile. The gummy smile is seen in some people whose upper lip elevates so high when they smile that the upper gums are seen in addition to their upper teeth. In this area 2-4 units are used per side.If I had a patient with the concern described here I would say she is a good candidate for this treatment without the need for surgery.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
  
Please consult with a doctor for specific recommendations. Good luck!

Karthik Ram, MRCS, DNB · Answer

Hi, Thank you for your question with pictures. You will have better results with BOTOX which relaxes the muscles and reduce the amount of gums exposed when you smile. Meet a board certified cosmetic surgeon to evaluate you. Good luck.

Pravin Reddy, MD · Answer

Botox or other neuromodulators are a simple and excellent treatment for a gummy smile.  By relaxing the upper lip, the result is an elongated upper lip and camouflaged gum.  Another alternative is to augment the upper lip and widening it to conceal more of the gum.  Treating the gum itself is unlikely to improve a gummy smile.

Vilma Di Maria, MBBS · Answer

Thankyou for your question. Definitely start with botox.  If you just use filler the gummy smile is still present .Good luck

Amy Miller, MD · Answer

Definitely start with botox (or dysport or xeomin).  This will probably get you the results you are after with a much less invasive treatment.  Plus you have lovely, healthy gums that you should preserve.  As humans age we tend to "get long in the tooth" or experience receding gums.  You'll appreciate those healthy gums in about 40 years!  You can't regrow the gum tissue so removing it now may not be the best idea.
Hope this is useful.  Best wishes,
Dr. Amy

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