36, what would be the best option for gummy smile, asymmetry & jowls? (Photos)

Question

I am 36 years old and have used Invisalign to help with my overbite and lip competence but I still have quite a gummy smile, some lip incompetence, facial assymetry, and jowls. What would be the best options for this?

Anna Petropoulos, MD, FRCS · Answer

Hello Brooke1946,

Thank you for your question. Firstly, you're gorgeous! In our office we frequently treat patients with your concerns. However, our approach begins with the upper face, in order to maintain overall balance of your features. Strategically placed filler in the upper cheeks and temples can give a surprisingly significant lift that can soften jowling without adding more volume to the lower face. The gummy smile is treated several different ways, depending on the patient. This could be lip filler, botox in the upper lip, botox in a muscle near your nose (called levator labii superioris alaeque nasi) or some combination of the three. Best of luck in your search! If you would like to learn more or see how we would approach your concerns, please feel free to contact our office and schedule a consultation. We would love to meet you! All the best, Genie Alexander, RN BSN for Dr. Anna Petropoulos, MD FRCS Center for Classic Beauty 80 Lindall St. Danvers MA 396 Commonwealth Ave. Suite A1 Boston, MA 978-739-9500

Anna Chacon, MD, FAAD · Answer

At 36, what you're describing can involve several different factors, so I would approach each concern separately rather than looking for one procedure to correct everything.

For the gummy smile, the first question is what is causing the excessive gum show. In some people, the upper lip elevates excessively when smiling, while in others the teeth, gums, or vertical position of the upper jaw contribute. If the primary issue is an overactive upper lip, a small amount of neuromodulator such as Botox can reduce excessive elevation and decrease gum exposure. The effect is temporary, and treatment needs to be conservative so that the smile and lip function remain natural.

For lip incompetence, it is important to distinguish whether this is primarily from the lip muscles, dental positioning, or skeletal anatomy. Since you've already completed Invisalign, the remaining appearance may be related to your underlying facial structure rather than something that additional orthodontic movement would necessarily correct.

Regarding facial asymmetry, mild asymmetry is extremely common. If the asymmetry is primarily from differences in soft-tissue volume, strategically placed filler can sometimes balance the two sides. If it is related to the jaw or skeletal structure, however, filler can only camouflage the difference rather than change the underlying anatomy.

For the jowls, this can be influenced by early volume loss, skin laxity, and the position of the facial fat compartments. At 36, I would generally be cautious about jumping directly to surgery unless there is significant laxity. Depending on the anatomy, conservative filler placement along the chin/jawline or other structural areas can sometimes improve definition and provide better support to the lower face. In selected patients, treatments that address skin laxity may also be useful.

Overall, I would prioritize diagnosing the cause of each concern before treating it. Your gummy smile, lip position, asymmetry, and jowls may not have the same underlying cause, and treating them independently tends to produce a more natural result than trying to correct everything with one procedure.

Scott Trimas, MD · Answer

Hello! At your age I would recommend pursuing a comprehensive injectables plan including Botox for your gummy smile as well as chin and DAO. I recommend a complete assessment of the face for facial balancing- some midcheek filler may be beneficial for correcting assymetries along with lower face filler- possibly chin/jaw.

Camille Cash, MD · Answer

Botox can help with gummy smile as well as help slim the jawline with masseter Botox injections.  Fillers can be used to help improve asymmetry and give support to the jowls.  You can also consider Morpheus8 which combines RF technology with microneedling to improve overall skin tone and texture.  Three treatment sessions are recommended for optimal results.

Vibha Gambhir, MD · Answer

Hello and thank you for your question! I think a great option for you would be botox for gummy smile and the AOD. With only a few strategic units placed, it would inhibit the muscle from pulling the gum up so high and showing your gums. AOD botox would be a few units placed below the lower lip and in the AOD muscle to prevent the downturn of your mouth. This would be a great place to start for you! Good luck on your journey

36, what would be the best option for gummy smile, asymmetry & jowls? (Photos)

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