Gummy smile botulinum toxin
Gummy smile treatment delivers 4–8 units of botulinum toxin in total into the muscles that lift the upper lip too far, reducing how much gum shows when you smile.
- Procedure time
- 10 minutes
- Anaesthesia
- Usually not needed; topical anaesthetic cream on request
- Recovery
- Back to normal the same day
- Sessions
- One session · review at week 2
- How long it lasts
- 3–4 months
The target: the upper lip elevators
Several muscles pull the upper lip up when you smile. The most important is levator labii superioris alaeque nasi, a thin muscle running between the nostril and the upper lip.
When that muscle works harder than it needs to, the upper lip rises too far and a clear band of gum shows when you smile. In that picture botulinum toxin reduces the muscle’s pull and shortens the distance the lip travels.
The injection point is found by marking where the muscles converge while you smile. A single point per side is enough for most patients.
How the dose is calculated
The typical total dose here is 4–8 units, 2–4 units per side. It is the lowest-dose area in the face, because the muscles around the mouth also carry the work of speaking and eating.
The exact dose is set at examination. The height of gum visible when you smile is assessed in millimetres and the travel of the lip is measured.
- How much gum shows when you smile
- How far the upper lip travels during the smile
- Whether the gum shows at the front or spreads towards the sides
- Asymmetry between sides — doses are adjusted individually
The day of treatment
You are asked to smile naturally and the most active point of the muscle is marked just beside the nostril. One injection per side is given with a very fine needle.
Total time is around 10 minutes. This is one of the more sensitive areas of the face; a topical anaesthetic cream can be used if you would prefer.
Do not massage the area or lie down for the first four hours. You return to normal life the same day.
The timeline of the effect
The effect starts at days 3–7 and settles fully at days 10–14. It is not right to judge the result before two weeks have passed.
Around the mouth the effect lasts less time than elsewhere on the face: 3–4 months on average. These muscles work continuously while you speak, eat and smile, so the toxin wears off faster.
If the effect falls short at the week-two review, a very small addition can be made. In this area an under-dose is easier to correct than an over-dose — which is exactly why we start low.
What decides the result
The first thing that decides it is the cause of the gummy smile. Botulinum toxin works only where the picture is muscular, that is, where the upper lip lifts too far.
Where the cause is the structure of the upper jaw, the length of the teeth or the gum level, botulinum toxin will not change the appearance. That distinction is made at examination, and where it is not muscular the treatment is not offered — a crown-lengthening or orthodontic opinion is the honest answer instead.
The second factor is keeping the dose low. Too many units make the upper lip look unnaturally long and static, and the smile loses its ease. Fewer units produce a better result here than more.
Who this is not for, and what not to expect
Botulinum toxin is a prescription medicine with its own contraindications. Beyond that, this treatment is not suitable for every gummy smile; where the cause is not muscular it will not give the expected result.
If too much is given, the upper lip can lengthen, the smile can become asymmetrical and certain sounds can be temporarily harder to make. That is why the dose starts at the lower end of the range.
- Pregnancy and breastfeeding — not treated
- Neuromuscular disease (myasthenia gravis, Lambert-Eaton syndrome, motor neurone disease) — not treated
- Aminoglycoside antibiotics — they can amplify the effect of the toxin; not treated until the course is finished
- Active infection or inflammatory skin disease in the treatment area — not treated until it clears
- Known hypersensitivity to botulinum toxin — not treated
- Bleeding disorder or anticoagulant use — bruising is more likely; a doctor’s assessment is required
- Where the gummy smile comes from upper jaw structure, tooth length or gum level, botulinum toxin gives no result
This page is general information and does not replace a clinical examination. The method, dose and timescale that apply to you are decided by a doctor after examining you.
Frequently asked questions
How many units does a gummy smile take?
Does it work for every gummy smile?
Will my smile lose its natural look?
Why does it last less time?
Pre-assessment
Describe your situation and we will answer with a measurement
Send a photograph or an X-ray. A doctor in the relevant speciality will reply with a graft range, a number of teeth or a dose range in units. If you are not suitable, we say so plainly.