Are Botox injections near nostril the only way to treat gummy smile or can injections across top lip help as well? (Photo)

I had Botox a second time for gummy smile. The first time, 8 units were injected close to my nose in 2 spots. This time, 8 units were injected across top of my lip in 4 spots (diff Doctor). It has been 1 week and I can't drink through a straw, whistle, pucker my lips, or rub them together. No change in my smile! I want to know if where I was injected this time will help with my smile? Will I notice a change in my gummy smile or must I wait to get Botox injected closer to the bottom of the nose?

Doctor Answers 15

Not at all!

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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!


Los Angeles Dermatologist

#Botox for #GummySmile

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Dear rmm34:

By injecting a small dose of Botox in the levator labii superioris alaeque nasi muscles just to the side of the nasal alae, one can relax the muscles that pull the lip up and improve a gummy smile.  Botox can also be injected in the perioral muscles to evert the lips, making your lips appear fuller, and to smooth lip lines, but this would not help gummy show very much if at all.

I hope this is helpful!  Dr. Clark

Sheryl D. Clark, MD
New York Dermatologist
4.7 out of 5 stars 10 reviews

Gummy Smile -- Botox/Dysport/Xeomin Around Mouth

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Precise placement of botox around the mouth is the best treatment for gummy smile.  I suggest you see an expert for a consultation.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

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Gummy smile

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Hi rmm34, The best way to treat a gummy smile is surgically.  Botox injections are used sometimes as a temporary treatment but these wear off relatively quickly.  The surgical procedure involves removing a small strip of attached mucosa of the upper gum and is very simple, straightforward and successful.Best,Dr Nettle

Are Botox injections near nostril the only way to treat gummy smile or can injections across top lip help as well?

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Thanks for your question and photo and it appears that you have two different experiences in trying to treat the same concern.  The first injector was much more correct than the second and so therefore, make sure that you are consulting with a board certified dermatologist or plastic surgeon as we are the group that best understands the anatomy in the area that needs to be treated and understands the areas which should be injected.  It appears the second injector did not know what exactly to inject, and made things worse from a drinking point of view.  See an expert each and every time you want facial injections.

Michael Gold, MD
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Are Botox injections near nostril the only way to treat gummy smile or can injections across top lip help as wel

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Thank you for your question.  Botox injection that helps with the gummy smile is an injection just lateral to your nostril.  An injection across the top of the lip will not drop the upper lip but it will affect the orbicularis oris muscle.  An injection in this muscle will weaken your ability to purse your lips (affect drinking out of a straw).  Make sure you go to a Board certified plastic surgeon for your injections.  Best Wishes

Gummy smile injection

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The muscle that causes the gummy smile is the levator superioris labii alaeque nasi muscle. This is not treated with the injections you received. The injections you just got treat the orbicular oris muscle. That is why you are having trouble closing your mouth around things. I use a maximum dose for this injection of about 5 units of Botox. I use about 2 units are either side of the nose to help gummy smile. I don't think your doctor was experienced enough to know how to do this or the anatomy.

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the correct injection was more like the first and the second will not really work for what you want, but there is a trick not known to all and that is to inject the pyriform sulcus at the top of the Nasolabial fold in addition to under the nose. Be sure you see a board certified dermatologist or plastic surgeon

Melvin Elson, MD
Nashville Dermatologist
5.0 out of 5 stars 7 reviews

Botox injections for smile and wrinkles

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it sounds like you got Botox injections like we use to treat wrinkles.  The first ones you got sound more like the ones to treat a gummy smile.  Did you like the effects of the first treatment?  If so, you can communicate that to future doctors you may see to help get the results you want. 

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Botox for gummy smile

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To treat gummy smile Botox is placed just to the side of each nostril to relax the muscle that is pulling up the lip.  Injections in the upper lip itself are used to treat vertical lip lines like "lipstick lines" and "smoker's lines". They have the unfortunate effect, sometimes, of making it hard to pucker the lip or use a straw. You can still have the appropriate injections performed, however, while you wait for the lip effects to wear off. Good luck!

Justin Cohen, MD
Washington DC Otolaryngologist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.