Rhinoplasty - Gummy Smile 1 Year Post Op

Question

I had a revision rhinoplasty a little over a year ago, and ever since then, my smile has become gummy. Before the surgery, my gums never showed when I smiled, but now when I laugh or smile naturally, my upper lip tends to roll under, exposing my gums. If take a selfie and put on a fake smile it looks normal, but when I genuinely smile or laugh it’s gummy. This was my second open rhinoplasty. Will it ever go away? What can I do? What should I know about this?

Ali Sajjadian, MD, FACS · Answer

Thanks Curious_Wonder for your question! A gummy smile after rhinoplasty, especially after a revision, can be concerning. It can be caused by a few factors like swelling in the upper lip and surrounding area which is common after rhinoplasty. Sometimes, this swelling pulls the lip upward, highlighting the gums.  Meanwhile, if surgery is performed on the base of the nose or the columella (the skin between your nostrils), the muscles controlling the upper lip may become temporarily weaker. The way your lip glides when you smile may be impacted by this deficiency.  Following surgery, scar tissue may develop, which occasionally limits upper lip mobility as well. Lastly, the location of the upper lip may occasionally be impacted by modifications made to the nasal structure during rhinoplasty.   
In most cases, a gummy smile after rhinoplasty is temporary and will resolve as the swelling subsides and the muscles regain their strength. Several weeks or even months may pass during this time. The gummy smile, though, can be permanent in some situations.   If the gummy smile is still present after a year, it is less likely to resolve on its own. Here are a few potential avenues for treatment:
-Use of Botox to relax related muscles.

-Steroid Injections: By lowering swelling and inflammation, steroid injections can help make the gummy grin seem better.   
-Surgery: To address the gummy smile surgery can be required in some situations. Depending on what caused the issue, there are a few different surgical techniques that can be used.
Hope this was helpful!
Best wishes,
Dr Ali Sajjadian

Eric M. Joseph, MD · Answer

Believe it or not, most people will have temporary heaviness of their upper lip and decreased ability to elevate their upper lip after rhinoplasty surgery due to cartilage grafting that is placed at the base of the nose. Please consider re-asking a question with both before and after photos for a more definitive evaluation. Thank you. Sincerely, Dr Joseph

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Pictures of your nose would be helpful here. The best answer that this will be determined by your tip rotation position. If your tip needs to be de-rotated, then that could potentially help with the smile. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Barry M. Weintraub, MD, FACS · Answer

Thank you for posting such an easy question that does not even require that I see photos of you! Gummy smiles can be effectively improved with Botox injections. Please do your research, however, and find a qualified injector with many years of experience.

Mustafa Aydinol, MD - Account Suspended · Answer

I’m sorry you’re dealing with this.
What you’re describing sounds like temporary weakening or disruption of the muscles around the upper lip, specifically the levator labii superioris. During rhinoplasty, especially open procedures, the muscle that controls your upper lip can be affected, causing the lip to roll under or lift higher than usual, resulting in a gummy smile.
The good news is that this often improves with time as the muscles heal and regain strength. Since it’s been over a year, if the issue persists, there are a few options: • Botox – A small amount of Botox in the upper lip can relax the muscle and reduce how much the lip lifts when you smile. • Lip filler – Adding subtle volume to the upper lip can help balance the smile and prevent the lip from rolling inward. • Surgical correction – In rare cases, a minor lip-lowering procedure can help if the issue is more structural.
I’d recommend consulting with a facial plastic surgeon or injector experienced in post-rhinoplasty concerns. You’re not alone in this, and there are definitely ways to improve the appearance of your smile!

Rhinoplasty - Gummy Smile 1 Year Post Op

Answers (5)

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