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Chapter 128 min read

Gummy Smile: Alleviating the Gum-Showing Smile

Excessive gum visibility when smiling ("gummy smile") is an aesthetic complaint for many patients. Botox is the safest way to alleviate this complaint without surgery.

Main ideas in this chapter

  • Excessive shortness of the levator labii superioris alaeque nasi (LLSAN) muscle is the main cause of gummy smile.
  • A very low dose is sufficient; 1-2 units per side, a total of 2-4 units.
  • An overdose impairs upper lip movement and can lead to difficulty pronouncing letters like "s" and "b".
Gülümseme çerçevesinde dudak ve diş eti çizgisi
Image:The framework of a smile ends with the gums; the correct proportion reflects confidence.· Unsplash (royalty-free)

What is a gummy smile and what causes it?

A "gummy smile" is defined as the visibility of more than 3 mm of gum above the upper lip framework during a smile. The cause can be multiple: a short upper lip, overly strong upper lip elevator muscles, a high gum line, or a short crown structure. Aesthetic complaints are often not due to a single factor, but a combination of two or three.

Therefore, a gummy smile examination does not end with just botox. A joint evaluation with a dentist may be necessary. However, the most common muscular component is the overactivity of the LLSAN (levator labii superioris alaeque nasi) muscle – in this case, a low dose of botox yields dramatic results.

Injection technique

The injection site is the small triangular area between the base of the nose and the upper lip (just next to the nasolabial sulcus). 1-2 units are applied to each side; the total dose does not exceed 2-4 units. This area is very narrow, requiring experience – a wrong placement can create smile asymmetry or impaired lip movement.

The effect becomes noticeable in 5-7 days. During a smile, the upper lip does not rise sufficiently, covering the gums. This change is dramatically visible in a frontal photograph; the result lasts for 3-4 months.

Attention:An excessive dose overly restricts the range of motion of the upper lip. In this case, the smile becomes "locked," and speech becomes difficult with letters like "s" and "b." These symptoms subside within 2-3 weeks but are uncomfortable for the patient. That's why I always start with the minimum dose.