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A complete guide to gummy smile treatment — what causes excessive gum show, which cases Botox fixes vs which need dental or surgical intervention, dosing, and realistic results.
· By MedSpot Editorial · 5 min read
#injectables · #botox · #face · #guide
A gummy smile — where the upper gum shows excessively when smiling — affects approximately 10–15% of adults to a degree they find aesthetically bothersome. The cause matters enormously for treatment selection. Not all gummy smiles are the same problem, and Botox only fixes one type.
There are four distinct anatomical causes of excessive gingival display on smiling:
1. Hyperactive upper lip muscle: The levator labii superioris alaeque nasi (LLSAN) lifts the upper lip excessively on smiling, exposing more gum than typical. This is the only type that Botox directly addresses.
2. Short upper lip (anatomical): The lip is structurally short and does not cover adequate gum at baseline. Botox does not lengthen the lip structure.
3. Vertical maxillary excess (skeletal): The upper jaw (maxilla) is positioned lower than ideal, causing the upper teeth and gum to be lower in the face. This is a skeletal issue requiring orthognathic surgery or orthodontics.
4. Gingival hypertrophy: The gum tissue itself is enlarged or overgrown (can be hereditary, medication-induced, or from poor oral hygiene). This is a dental/periodontal issue — treated by a periodontist with gingivectomy (gum reshaping).
Assessment: A qualified provider should distinguish which type is present before treating. Botox for a case driven by skeletal anatomy or gum overgrowth will produce disappointing results. Many providers do this assessment; many do not.
When the gummy smile is caused by excessive LLSAN muscle activity, Botox injection into this muscle reduces the lip's upward travel during smiling — the gum show decreases.
Dose: 2–4 units per side (4–8 units total). This is a very small dose.
Placement: The injection is placed at the nasal alar base area where the LLSAN inserts. Precise placement is critical — the muscles in this area are small and adjacent to other muscles that control facial expression. Off-target injection can cause:
Results: Typically visible within 1–2 weeks. The smile looks more relaxed; gum show reduces or eliminates.
Duration: 3–4 months. Many patients retreat on the same schedule as their standard Botox.
Cost: $150–$400. Often an add-on to a broader injectable session rather than a standalone appointment.
Touch-up: Essential. The ideal dose varies by patient. Most experienced injectors start conservative (2 units per side) and touch up at 2 weeks if more reduction is needed.
Ideal result: The upper lip still rises on smiling (natural); it just doesn't rise as far. The smile looks normal — not frozen.
Over-treatment: Too many units creates a smile where the lip barely moves. This looks unnatural and can feel strange to the patient. Conservative dosing prevents this.
Asymmetry risk: The LLSAN is close to the zygomaticus (which creates the smile lift itself). Injection in the wrong location or with too much spread can temporarily cause a smile that's weaker on one side. This resolves when the toxin wears off.
Not for lip augmentation: The lip flip (covered in our lip flip guide) is a separate procedure targeting a different muscle for a different goal — don't confuse the two.
A minor oral surgery procedure that permanently repositions the upper lip to reduce its upward travel on smiling. Involves making small incisions at the gum junction and suturing the lip to a lower attachment point.
Best for: Patients with hyperactive upper lip who want a permanent solution rather than ongoing Botox.
Cost: $1,500–$4,000 depending on geographic market and surgeon.
Recovery: 1–2 weeks of swelling and limited mouth opening.
If the teeth appear short because the gum line is too low (gingival hyperplasia, "short teeth" from gum overgrowth), a periodontist can remove excess gum tissue to reveal more tooth. This doesn't reduce gum show on smiling — it improves the tooth-to-gum ratio at rest.
For vertical maxillary excess (skeletal cause), maxillary impaction surgery (LeFort I osteotomy) repositions the upper jaw upward, reducing the gum show at baseline and during smiling. This is a major oral surgery procedure — appropriate for patients with significant skeletal component.
Adding volume to the upper lip makes it slightly longer, which can reduce gum show by creating more lip tissue between the gum and the lip edge. This is an indirect approach — not as effective as Botox for a truly hyperactive lip, but useful when patients want fuller lips anyway.
If your gummy smile has a component driven by:
Med spa treatment with Botox addresses only the muscle-driven component. A thorough provider will tell you if your gummy smile has multiple contributing factors.
Looking for a Botox provider experienced with facial aesthetics? Browse injectable providers on MedSpot →