Botox Units Needed to Correct Gummy Smile?

Question

How many units of Botox is needed to reduce the amount of lifting of the upper lip when smiling, so as to correct a gummy smile?

Trevor M. Born, MD · Answer

Dear Ozgirl
Botox is very good for treating the 'gummy smile'.  It is placed in the muscles that are beside the nose- weakening the upward pull and thus the amount of lift of your lip.  If too much is place then you may have an incomplete smile.
Usually 1 to 2 units are placed per side.  You should have a check at 2 weeks.
With Warm Regards,
Trevor M Born MD

Whitney Florin, MD · Answer

I typically inject 4-8 units to relax a gummy smile. Typically there are 4 injection points (2 per side) and we can inject 1-2 units per injection point depending on "how gummy" the smile is, or how strong your muscle pull is. Be sure to go someone experienced in this procedure as the muscles around the mouth are complicated.

J. Jason Wendel, MD, FACS · Answer

A typical Botox dose to address a gummy smile is anywhere between 4-6 units to the upper lip, and if needed, 4 units right under the nose area.

Michael A. Persky, MD · Answer

Good Day Oz Girl,
It takes about 5-6 units of Botox to treat the gummy smile, even in Aussies.  Make sure that you choose a physician who is experienced in this area of injections.  
Good luck and be well.
Dr. P

William Bruno, MD · Answer

If you truly have a gummy smile, Botox is not the definitive treatment for you. Although it may be temporary, it could distort your smile slightly and create some asymmetry while you are at rest.
The treatment of a gummy smile is surgical, and I recommend consulting with a plastic surgeon and/or an oral surgeon trained specifically in orthognathic surgery, which is they type of surgery involved in treating you condition.
Best wishes.

Camille Cash, MD · Answer

Botox and other neuromodulators are a great option to treat the look of a gummy smile.  Relatively little product is needed for a result that lasts three to four months.  Generally two to four units per side is the dose used for treatment.  Always see an expert injector for your Botox.

Joshua Wall, MBBS · Answer

To reduce the amount of lifting of the upper lip when smiling and to correct a gummy smile - 2-3 units of Botox is needed on each side of the upper lip.

Tanya Kormeili, MD · Answer

As a woman I totally understand the importance of well contoured lips and smooth skin!
As a dermatologist, I can tell you that different anatomy in each patient make me decide on whether I combine Botox (how much and exact placement) with deciding to add fillers to balance thin lips that pull up in gummy smiles. Together they two can create a very natural contour and very sexy appearance - if done correctly.
The key is to make sure you communicate what you are trying to achieve and ask specific questions from the doctor as the risks for that treatment.

I do many gummy smiles and they can be successfully treated with Botox/Dysport when performed by expert injectors. Injection of a low dose into precise points on the upper lip to reduce the “gum” showing without affecting any other motion. I have my patients smile several times, and animate their face as they are talking to me during the consultation. Where exactly I place it (and how much product) depends on the anatomy of the patient.
Factors to consider include how thin/thick the upper lip is (and if you use fillers on the upper lip you need to consider balancing the lower lip to avoid the "duck lip" tragedy!). How much the lips are pulled up and how many millimeters of gum are exposed. Any asymmetries during movement or at rest will also have to be taken into account.
I think the key is the consult to show you in the mirror what to expect. In this case Botox/Dysport may lower the upper lip so that you are not be able to show the gum line when you smile.  Because there is some risk of lowering too much, (which could affecting your singing or playing of a wind instrument, for example), using low doses and making sure that you receive precise injections by a highly qualified and certified professional are very important!
Best of luck!

Jason R. Lupton, MD · Answer

Botox can work very well to correct a gummy smile. Caution must be taken, however, as excessive Botox in the lower face may have very obvious cosmetic and functional impairment. I always start conservatively in this area - you can always add more if needed. I usually use a dose of 2 units on each side and ask the patient to return to my office in a week to evaluate. I strongly urge you to go to someone who has experience injecting the lower face with Botox and feels comfortable dealing with muscle denervation in this area. Good luck.

Hassan Galadari, MD · Answer

I start very conservatively. I always tell my patients that when we were kids, we studied addition before subtraction and that holds true especially with Botox, where no antidote other than time is available.
I start off with 3-5 units on each side and would see the patient again in a week's time, if a touch up is needed, it is injected then. Also the extent of the gummy smile is also taken into consideration. There are people with such a significant gummy "show" that more should be injected from the first setting. In any case, patients should be told that the effect lasts about 4 months and that they may feel funny when smiling as the lack o movement can come as quite a surprise to some of them.

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