Gummy Smile: Non-Surgical Treatment Options

A "gummy smile" simply means more gum shows above the upper teeth than a person would like when they smile. When the main cause is a very active upper-lip muscle, a small dose of neuromodulator can reduce how high the lip rises for a few months. When the cause is in the teeth, gums or jaw, a dentist, periodontist or surgeon is usually the right person to see.

It is worth saying clearly: showing gum when you smile is a normal variation, not a medical problem. Treatment is entirely a personal choice.

What causes extra gum display

Several different factors can contribute, and many people have more than one:

• A hyperactive upper lip: the muscles that lift the lip pull it higher than average when smiling.
• A short upper lip: the distance from the nose to the lip edge is naturally shorter.
• Excess gum tissue: gums cover more of the tooth surface than usual, making teeth look short. This is sometimes called altered passive eruption.
• Vertical growth of the upper jaw: the upper jaw bone has grown longer in the vertical direction, so the teeth and gums sit lower.
• Tooth wear or position: worn or overerupted teeth can change how much gum shows.
• Gum overgrowth from medications or inflammation: certain medicines and gum disease can enlarge the gums.

Identifying the cause matters, because each one has a different solution. A neuromodulator only helps the first.

How the neuromodulator approach works

Several small muscles beside the nose lift the upper lip when you smile. A very small dose of botulinum toxin type A, injected at precise points on each side of the nose, can relax these muscles slightly. The lip then rises less, covering more of the gum.

The goal is a modest change, not a frozen lip. Too strong an effect can make the smile look flat or unnatural, so treatment usually starts conservatively. Results typically begin within 3 to 14 days, and the effect commonly lasts around three to four months. Because the lip moves so often, some people find it wears off a little sooner. For a general introduction to how these medicines work, see What Is a Neuromodulator?

A follow-up around two weeks after treatment helps confirm the result and decide whether any small adjustment is needed at the next visit.

Some people also notice that a relaxed lip changes how the area beside the nose looks when they smile, with slightly softer creases there. This is a side effect of the same muscle relaxation rather than a separate goal of treatment.

What it cannot do

A neuromodulator will not change the length of your teeth, the amount of gum tissue, or the position of your jaw. If gum display is caused mainly by excess gum or jaw growth, injections may give little visible benefit and could make the smile look strained.

It is also temporary. People who prefer a long-lasting solution, or who would need injections indefinitely, may find a dental or surgical option more practical over time.

Some people ask about filler to lengthen the upper lip. Hyaluronic acid filler can add lip volume, but it is not a reliable fix for a gummy smile and may make the lip look heavy. Our article Lip Flip vs Lip Filler explains how these lip treatments differ.

When dental or surgical referral is better

Your physician may suggest seeing your dentist first, or alongside any injectable treatment, if:

• Your teeth look short or square, which may point to excess gum tissue
• Your gums are swollen, bleed easily or have changed recently
• You have a bite problem, such as an open bite or significant overbite
• Gum display is large even with the lips at rest
• You are taking a medication known to cause gum overgrowth

Depending on the cause, options might include gum contouring (crown lengthening) by a periodontist, orthodontic treatment, lip repositioning surgery, or jaw surgery performed by an oral and maxillofacial surgeon. Good care sometimes means the answer is not an injection at all.

Who should not have this treatment

Neuromodulator treatment is generally avoided or postponed if you:

• Are pregnant or breastfeeding
• Have an infection, cold sore or inflamed skin near the injection points
• Have a nerve or muscle condition such as myasthenia gravis or Lambert-Eaton syndrome
• Take certain medications that affect nerve-muscle signalling, such as some antibiotics in the aminoglycoside group
• Have had an allergic reaction to a botulinum toxin product before

Tell your physician about all medications and supplements. Do not stop any prescribed medication on your own.

Possible side effects

Because the dose is small, side effects are usually mild. Common ones include tiny bumps, tenderness or bruising at injection points. Less commonly, the effect can be stronger than intended or uneven, which may cause:

• A smile that looks flat, lopsided or less expressive
• A longer-looking upper lip
• A slight change in speech or difficulty with sounds like "p" and "b" for a short period
• A feeling of stiffness when eating or drinking from a straw

These effects are temporary and fade as the medication wears off, which is one reason a cautious starting dose is preferred. See side effects and risks of neuromodulator treatment for a fuller overview.

Frequently asked questions

Will my smile still look like mine?

The aim is to keep your natural smile while reducing how high the lip rises. Starting with a small dose helps keep the change subtle.

Does treatment hurt?

Most people describe a quick pinch. The area beside the nose can be a little sensitive, and a cold pack can help.

Can it be combined with other treatments?

Yes, in some cases. It is sometimes done alongside dental work or other facial treatment, but timing should be discussed with both your dentist and physician.

Exploring your options

Whether to treat a gummy smile at all is a personal decision, and many people are entirely happy with how they smile. If it bothers you, the first step is understanding the cause. At HealthPark Medical Aesthetics, a consultation includes assessing your smile at rest and in motion, and discussing whether a neuromodulator, a dental opinion or no treatment would suit you best.