What do I need doing to my lips to enable them to cover my bottom teeth when I smile? (Photo)

Question

Please see the pictures - my lips are quite down turned and when I smile they don't cover my bottom teeth properly? And when I smile with my mouth closed sometimes a gap forms in the middle and you can see my teeth slightly? What can I get done to fix this and make them plumper and how much on average will this cost?

Ross A. Clevens, MD, FACS · Answer

Thank you for your question. I suggest that you consult with a board certified facial plastic surgeon to learn more about the lip augmentation fillers available to you. Increased volume to your lips can help cover your teeth.
Best wishes,

Douglas Wu, MD · Answer

I'm sorry you are feeling self-conscious about your smile. If you would like to create a little more volume in your lower lip so that it covers your teeth when you smile, I'd recommend a slight augmentation with the hyaluronic-acid based dermal filler Volbella. It looks and feels natural. You may also need a little Botox to relax some of the muscles around your mouth, as they may be overpulling and causing the gap in your smile. Consulting with a board-certified dermatologist will allow you to determineyour best options for getting the smile of your dreams.

Robert F. Jackson, MD · Answer

Thank you for your question and photos. You’ll need an in-person evaluation from an experienced cosmetic surgeon, but you may be a good candidate for BOTOX®, fillers or a combination of the two. BOTOX® can help with any muscle over-activity you have in the lower face, while fillers can augment the lips so they cover more of your teeth. Good luck!

Michelle Ellern, DO · Answer

It is hard to make a complete recommendation without a full in person exam. You may have some overactive musculature in your chin and lower face that can be helped with a little Botox. Also some lip volume may help to cover the visible teeth. I would see an experienced physician to discuss you issues after an in person exam and develop an appropriate plan.

Omar N Hussain, MD · Answer

Hi MeganLizzy,
First of all, you have a beautiful smile and lip shape. I can see your teeth showing in the pictures you sent. I would need to perform a thorough consultation in person with examination to give specific recommendations. Confirming normal dentition and maxillary height (upper jaw bone) is necessary. If there is hyperactivity of the muscles that move your lips, they can be treated with Botox. If there is an adhesive band of tissue between your lips and the gums, it can be divided in a procedure known as a frenulectomy. Most likely, it is only a lack of volume which can be increased with the injection of filler. My preference would be giving you just enough to correct the deficiency without changing the shape of your lip. This would give you a natural, fuller appearance that typically lasts 12-18 months depending on the filler. The price varies by type of filler, amount. and location. This can generally cost $500-$1500.
I hope this helps explain the general approach. I wish you the best!
Sincerely, 
Dr. Hussain

Amiya Prasad, MD - Account Suspended · Answer

Thank you for your question. You submitted several photos that are extremely helpful. You’re asking about what you can do to help improve the coverage of your teeth and the appearance of your lips at rest, when you are smiling, and when you’re smiling with your lips together.
I can share with you my approach to counseling my patients for this very popular procedure of lip enhancement in my practice. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Injectable fillers are a big part of my practice, and helping people with lip aesthetics is extremely popular. At the same time, people are very concerned about not appearing unnatural, which is often referred to as duck-like after having lip enhancement. I think it’s important to follow the principle of defining the problem before you define the solution.
What you have observed as demonstrated by your photos is when you are smiling, there’s a variability between the way the lip is retracting on one side compared to the other, with the amount of exposure of the teeth. When you think about how to address these issues, there are basically two principal ideas of anatomy to understand. One is the action of muscles on the lips, where  proper muscle function and action are important. However, you can manipulate muscle function for enhancement. 
Without giving you all the details of muscle anatomy, let’s get specific on how the lip retracts on one side compared to the other when you smile. That area of retraction is the activity of a muscle called the depressor anguli oris muscle or DAO. This muscle can be selectively relaxed with a neurotoxin such as Botox®, Dysport®, or Xeomin. When you relax this muscle, that part of the lip elevates, resulting in the area of the teeth you want to see improved with more coverage. People are very concerned about doing Botox® around the mouth, which is understandable basis because you don’t want disfigurement or irregularities. This procedure is often referred to as the lip lift or the Botox® lip lift where the corners of the mouth can elevate as a result of relaxing the depressor anguli oris muscle. 
The dosing of neurotoxins can be very minimal, and can be added if needed. Generally in our practice, although there is a pretty safe dosing range for this particular muscle, we see our patients after two weeks to evaluate. We have the patient do actions such as showing their lower teeth to see the effect of that muscle action, and then have them smile, or just see what the lips look like at rest to sense the effectiveness of the neurotoxin. Sometimes you have to tweak a little and add a bit more to get the full result or refine. 
The other aspect of this is looking at the lips and seeing where there is an opportunity to add volume for further teeth coverage. Judging by the photos,there may be some opportunity to add volume in the outer aspect of the lower lip. This assessment is based on photos and not on a physical exam and evaluating you in person, but it is important in lip volume to understand proportionality. 
The principle of the Golden Ratio is so important in lip aesthetics. This ratio is also known as phi or 1:1.6, applied to the relative size of the upper lip in comparison to the lower lip. A way a bit easier to remember is one-third to two-thirds. You want to add volume strategically so the lips look very natural, which is typically done with a filler such as the hyaluronic acid filler Restylane. 
You can combine a neurotoxin and a filler on the same visit. Our goal is to minimize bruising and minimize swelling. I generally employ a technique using blunt cannulas to enhance lips so the patients can see the improvement, and get fewer pokes. That’s a personal approach and I don’t in any way want to put down anyone else’s approach because every doctor chooses what they like and what works for them. In 20 years of practice, I found a lot of techniques along the way, and using blunt cannulas for lip enhancement has been very nice. It’s an extension of what we were doing before injectable fillers with fat where we use blunt cannulas to place fat. In the modern world, we have wonderful options with fillers, and I really don’t use fat for lip enhancement now. 
Learn more about these options, meet with doctors, and see how comfortable you are with the doctor you go to. You can always start conservatively to see how things look. Also understand that the human body is naturally asymmetric, and review the photos with your doctor. What I do usually is place the photos up in the screen, and review them with my patients so they see what their lips look like before, then in follow up, and review again to see the before and after which is often a lot of fun. I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

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