What options do I have to correct my gummy smile? 43 y/o (photo)

She is correct that using TADs may help reduce the gummy smile, but orthognathic surgery is a more predictable option. There really isn't any other options available that are not extreme (extreme meaning something like extracting all of your teeth, doing a alveoplasty, and then placing an implant supported denture). I definitely do not recommend any extreme options. If you really want to fix your gummy smile, a Lefort impaction is the way to go (orthognathic surgery). If you are just concerned about the narrow maxilla, then a MARPE may be an option for you, but it wouldn't move your maxilla up significantly, just expand it.

In your case for a perfect answer, cephalometric analysis is a must because it is a surgical case. but if you do not want to go under orthognathic surgery, your orthodontist's plan of braces with TADs is the best option. One more point take into consideration is your age, with age bone becomes dense and that's why tooth movement is slow, so treatment duration may be prolonged.