Botox Placement for Gummy Smile?

Question

I've seen two procedures advertised for correcting a short upper lip and gummy smile. A "lip flip" where botox is injected at four points, two on the left and two on the right at the lateral vermillion border. And "gummy smile botox" with injections on either side of the nose. Is one placement better than the other? Do they achieve different things?

Nick Slenkovich, MD · Answer

Hi, I’m Lauren, the aesthetic injector here at Colorado Plastic Surgery Center.
To treat a gummy smile, Botox is injected the muscles located just beside the sides of the nose. Relaxing these muscles helps reduce the elevation of the upper lip when smiling, minimizing gum show for a more balanced appearance.

Ran Y. Rubinstein, MD · Answer

Hello and thank you for your question. Yes, both the lip flip and gummy smile techniques serve different purposes. A lip flip is when neuromodulators such as Botox are used to prevent the upper lip from curling under when smiling. This gives the appearance of more red lip showing, or a fuller upper lip when smiling. The gummy smile injections are used when the muscle that lifts the upper lip is hyperactive revealing excessive gum show. Relaxation of this muscle minimizes the upward pull and results in less visible gum exposure. Hope this helps clarify! Esther Litenatsky AGACNP-BC on behalf of Dr. Ran Y. Rubinstein, MD facial plastic surgeon in Newburgh, NY and Montvale, NJ.

Anna Petropoulos, MD, FRCS · Answer

Hi lauren 664! Thank you for your question. A gummy smile can be troubling for many patients. It is necessary to see someone in action- talking, expressing, smiling, etc- in order to determine the right course of action to adjust a gummy smile- botox, filler, or both. For a lip that curls under when speaking or smiling, a botox lip flip would be the simplest thing to try- it only takes 2-5 units and will allow the lip to relax and avoid disappearing. It also does not last too long due to the mobility of the mouth area, so if you decide you don't like the look or feel it will fade in 4-8 weeks (for most). There is also a muscle called the levator labii superioris alaeque nasi that can contribute to a gummy smile and can be targeted with botox as well. This will help keep the upper lip from showing the gums when smiling, but it will not relax the upper lip- sometimes both of these injections are necessary to achieve the patient's preferred results (I'm one of those people!) Best of luck in your search! Genie Alexander RN BSN, for Dr. Anna Petropoulos MD FRCS, Center for Classic Beauty, Boston and Danvers, MA.

Laurie A. Casas, MD, FACS · Answer

Some patients pull their upper lip up dramatically while smiling, which reveals a large part of the gingival tissue, which is referred to as a "gummy smile". Injecting just lateral to the nose treats the gummy smile. A  'lip flip" helps with perioral wrinkles due to repeated puckering motion from speaking or smoking and with aging. Injecting Botox relaxes the muscle in the upper lip, causing the lip to "flip" and giving the appearance of a fuller upper lip.

Whitney Florin, MD · Answer

The injection technique is different for these two concerns so they achieve different outcomes. Injections for a "gummy smile" will relax the muscles pulling on the upper lip and will then relax the upper lip when smiling. This is useful for a person who shows "too much" gums when smiling, also known as a gummy smile. This should not change the appearance of the smile but just relax the position of the upper lip so less gums show. 
Injections for for a "lip flip" target a different muscle around the lip. This helps relax the ability to make a "kissy face" which contributes to vertical lines or wrinkles above the upper lip ("smoker's lines"). This also has the effect of gently pulling up the upper lip which can allow the upper lip to look longer or thicker ("more lip show"). In effect, it is flipping the upper lip out ever so slightly which can make the upper lip look fuller ("lip flip"). Hope this helps! Lip flip with botox can be done instead of or along with filler to the lips. Choosing between these techniques depends on your goals and your anatomy.

Anna Chacon, MD, FAAD · Answer

Both Botox treatments you mentioned, the "lip flip" and "gummy smile botox" are indeed used to address a short upper lip and gummy smile, but they target different areas and may achieve slightly different results.1. Lip Flip: This procedure uses Botox to relax the orbicularis oris muscle, which controls the movement of the mouth. The Botox is injected at four points along the lip line at the lateral vermillion border. This causes the upper lip to "flip" upward, revealing more of the lip and less of the gums when smiling.2. Gummy Smile Botox: This procedure involves injecting Botox into the levator labii superioris muscle, which is located on either side of the nose. This muscle controls the lifting of the upper lip. By relaxing this muscle, the upper lip stays lower when smiling, thus reducing the exposure of the gums.
The best procedure for you would depend on your specific needs and desired outcome. For instance, if you are more concerned about revealing more of your upper lip, a lip flip might be more suitable. On the other hand, if your primary concern is reducing gum exposure when you smile, the gummy smile botox procedure might be the better option.

Nelson Lee Novick, MD · Answer

I have been injecting Botox for aesthetic reasons since 1991. And you are quite correct that a microdroplet of Botox placed in the appropriate site on each side of the nose is used to treat a gummy smile. You are also correct about the placements of the microdroplets of Botox for a Botox Lip Lift. However, a lift lip treatment is to be distinguished from the gummy smile treatment. Each addresses a different problem, and each approach is not intended to treat both problems. Hope this clarifies the issue. Both are advanced injection techniques, so you would be wise to seek out an experienced, board certified cosmetic dermatologist injector. with extensive Botox experience, rather than bargain basement venues.  Best of luck.

Camille Cash, MD · Answer

The injection points vary based on the desired effect of treatment.  For those who have the upper gums show when smiling, a treatment of Botox near the nose helps to relax and minimize this effect.  It's often referred to as a gummy smile.  A lip flip is different as the Botox injection helps the lip to "flip" up exposing more of the red part of the lip.  It can make the lip appear fuller.

Anshul Gambhir, MD · Answer

Hi there - the placement of lip flip botox vs gummy smile botox depends on the muscle pull of the patient. For a patient that smile and shows a lot of gum, gummy smile botox neat the nose is a better option. For a patient that has an upper lip that curls under when they smile - lip flip botox above the lip is the better option. Hope this helps!

Darice W. Fadeyi, MD · Answer

Dear LaurenI can see how this would be confusing. The injection pattern along the vermillion border of the upper lip is a lip flip. This relaxes the superficial fibers of the orbicularis oris muscle resulting in less pronounced smokers’ lines, greater lip eversion and the appearance of lip fullness. 
The injection of two points on either side of the nose is intended to correct the “gummy” smile. These two injections target the levator labii superioris, zygomaticus minor and levator labii superioris alaeque nasii muscles that raise and shape the lip into a smile. Additional lateral injection points target the zygomaticus minor more thoroughly to address gummy exposure at the back of the smile (posterior gummy smile).
 In summary, the lip flip and gummy smile treatment are two completely different procedures for two different reasons. See a board certified dermatologist to make sure you have expert injections for the correct indication. I hope this helps!Dr. Fadeyi

Botox Placement for Gummy Smile?

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