Does your upper lip lift so high when you grin that several millimeters of gum show? A small dose of targeted Botox can relax the muscles that over-elevate the lip, softening a gummy smile without surgery, usually within a week.
What dentists and injectors mean by a “gummy smile”
A gummy smile, or excessive gingival display, typically refers to more than 3 to 4 millimeters of gum visible above the upper teeth when you smile. It is not always a cosmetic issue alone. The cause can be skeletal, dental, or muscular. Skeletal means a long upper jaw or vertical maxillary excess, dental means short or worn teeth or altered passive eruption, and muscular means overactive elevator muscles that pull the lip too high. Botox for gummy smile addresses only the muscular cause by temporarily weakening those hyperactive elevator muscles.
Understanding the driver matters because it guides the treatment plan. If your upper jaw is long relative to your facial proportions, neuromodulators will not fix it, though they can camouflage it. If your teeth are short due to wear or altered eruption, a dentist might suggest crown lengthening or restorations. If the lip itself is short, Botox can help, but filler or surgery might be more effective. In practice, many patients have a mixed picture. A skilled Botox provider will assess you both at rest and during a full, genuine smile to decide whether you are a good candidate.
How Botox changes the smile mechanics
When you smile, a group of muscles lifts the upper lip. The prime movers are the levator labii superioris alaeque nasi, levator labii superioris, and zygomaticus minor, with support from the zygomaticus major and levator anguli oris. People with a gummy smile often show a strong pull from the “LLSAN” along the sides of the nose, which yanks the upper lip upward and outward. Small Botox injections into these muscles reduce the lift just enough to let the lip drape a bit lower over the teeth. The goal is not to freeze your smile, but to dial down the amplitude so the gums peek less or not at all.
The technique has an art to it. Too superficial and you get no effect. Too deep or too lateral and you can blur the smile or cause an https://botoxmorristownnj.blogspot.com/2025/09/what-to-expect-before-and-after-botox.html undesired flattening. The right dose varies by muscle strength, sex, and facial structure. An experienced injector will also consider symmetry. Most people have a dominant side that pulls higher; a touch more units on that side can even things out.
The injection map for gummy smiles
There are several patterns that trained injectors use. The most common targets the “Yonsei point” near the alar base, a small area lateral to the nostril where the LLSAN is accessible. Some practitioners add a microdose into the levator labii superioris slightly lateral to that point to tame the midline lift. For patients whose gummy display concentrates near the canines, the injection sits a bit Morristown NJ botox lower and more lateral. For a very central gum show above the incisors, some providers place a tiny central injection at the base of the columella, although that increases the risk of affecting nasal tip dynamics and must be done judiciously.
Doses are small. Typical starting ranges are 2 to 4 units per point with onabotulinumtoxinA (Botox Cosmetic), 1.5 to 3 units with incobotulinumtoxinA (Xeomin), and 5 to 8 units with abobotulinumtoxinA (Dysport), accounting for potency differences. Many first-time patients need a total of 4 to 8 units of Botox across both sides. Stronger muscles, thicker skin, or a high-energy smile may require 10 to 12 units total. I start conservatively, evaluate at two weeks, then consider a touch up. Overcorrection can drop the upper lip too much, so creeping up on the result protects your expression.
What the appointment feels like
After a consultation and dynamic assessment, the injector may mark the sites. Numbing cream is optional because the needles are small, typically 31 to 33 gauge. If you are sensitive, topical anesthetic or an ice tap is enough for painless Botox. The injections take a few minutes. You might feel a brief sting or pressure at each point. Expect slight pinpoint bleeding and tiny bumps that fade within 10 to 20 minutes. Most people go straight back to their day.
I ask patients to avoid heavy exercise, rubbing the area, steam rooms, or face-down massages for the rest of the day. These are standard Botox aftercare precautions that reduce the chance of product spread into unintended muscles. Makeup can go on gently after a couple of hours if the skin looks calm.
When results show and how long they last
Botox results for gummy smile start to appear within 3 to 5 days. The peak effect arrives around day 10 to 14. Photos taken while smiling with the same effort show the difference clearly. The upper lip sits a few millimeters lower and the gums recede from view. Your smile should still look like you, only softer at the top edge.
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Longevity varies by metabolism, muscle strength, and dose. Most patients hold their improvement for 10 to 12 weeks, and some for up to 16 weeks. First-time users may metabolize faster, especially if the dose was cautious. Repeated treatments can modestly extend Botox longevity, as the muscles learn to relax and the habitual over-elevation weakens. Plan for Botox maintenance three to four times per year if you want steady control of the gummy display.
Who is a good candidate, and who is not
I look for a muscular etiology first. If I can see the lip snap high when you say “eee” and the greatest lift comes from the side of the nose, you are likely a candidate for Botox injections. If your upper lip is unusually short or your upper jaw is vertically long, Botox may help, but results will be partial. For those cases, combining treatments often works better.
Certain medical conditions or medications can be red flags. Active infections near the injection sites, neuromuscular disorders, pregnancy, or breastfeeding are typical reasons to postpone. Patients with a history of significant asymmetry after neuromodulators require extra caution.
Side effects, risks, and how to avoid them
Temporary redness, swelling, or bruising at injection sites are the most common side effects. A dull headache that day is possible. Asymmetry can occur if one side responds more strongly than the other; it is often correctable with a small touch up. The main risk unique to gummy smile treatment is over-relaxation of the upper lip, which can make the smile look flat or hamper enunciation of certain sounds for a few weeks. Very rarely, diffusion into nearby muscles can alter the shape of the nose or upper lip in unexpected ways.
Technique minimizes these risks. Small, precise doses placed into the correct depth, a light hand on the first treatment, and a planned follow up reduce surprises. You also play a part. Follow reasonable aftercare and communicate your typical smile intensity during the consultation. If you are a high-intensity smiler, your injector may stage the dose, with an initial treatment followed by a Botox touch up at two weeks.
Comparing Botox to alternatives and adjuncts
Other neuromodulators such as Dysport, Xeomin, and Jeuveau work similarly. Some clinicians prefer Dysport for faster onset, while Xeomin’s simpler protein structure can be helpful for patients worried about antibody formation, though true resistance with cosmetic use is uncommon. Botox vs Dysport often comes down to injector familiarity and the patient’s prior experiences. Results and longevity are comparable when dosing is adjusted for potency.
Filler can support the upper lip and balance proportions. A micro-aliquot of hyaluronic acid placed at the vermilion border or in the lateral lip can tilt the smile toward the teeth rather than the gums. A Botox and fillers combination can be elegant for patients who also want a gentler lip flip. For those with altered passive eruption or short clinical crowns, a dentist might propose gum contouring or restorations to lengthen the teeth. For pronounced skeletal causes, orthognathic surgery remains the definitive approach, though it is a major undertaking with long recovery.
What realistic “before and after” looks like
I like to set expectations in millimeters, not miracles. If you show 5 to 6 millimeters of gum, Botox can often cover 2 to 4 millimeters when smiling fully. If your gums show only at the canines, targeted injections can smooth that arc so the gumline peaks less aggressively above those teeth. The best Botox results preserve your natural expression. Friends may say you look relaxed or that your smile looks “balanced,” not that your face seems different.
Photos tell the story, but they need discipline. Take your “before” and “after” under the same light, same angle, and with the same wide smile. Many clinics create a standard “EEE” or “CHEESE” prompt to normalize effort. When the setup is consistent, the improvement is easy to appreciate.
Cost, pricing structures, and what “cheap Botox” can really mean
Botox prices vary widely by region and provider. Clinics charge per unit or per area. For gummy smile, per-unit pricing is common because doses are small. In most US cities, per-unit Botox cost ranges roughly from 10 to 20 dollars. A typical gummy smile treatment might use 4 to 12 units, yielding 40 to 240 dollars at the low-mid end, and 80 to 240 dollars in many metropolitan practices. Dysport is often priced per unit at a lower dollar amount, but you use more units to achieve an equivalent biological effect.
Beware of surprisingly cheap Botox deals. Sometimes the product is over-diluted, expired, or not sourced through a legitimate distributor. I have seen “Botox specials” where the per-unit price looks great, but the injector compensates by using more units than necessary or upselling areas you do not need. If a clinic’s pricing seems too good to be true, ask to see the vial, the lot sticker, and talk through the planned units. Affordable Botox does not mean low quality, but transparency matters.
Clinics may offer memberships, packages, or group discounts that smooth costs for regular users. These can be sensible if you plan to maintain results over the year. Financing is rarely necessary for such small doses, but some offices offer payment plans for full face Botox or combination treatments.
Techniques that separate a good result from a “meh” result
In my practice, the best outcomes come from three habits. First, I assess the smile in motion and at rest, looking at the lip’s resting height and the speed of elevation during a genuine smile. Second, I dose asymmetrically when needed, often adding a unit to the stronger side. Third, I schedule a check at two weeks. That visit gives us a chance to compare before-and-after photos, fine tune with a unit or two, and bank the dosing pattern that worked for you.
Understanding Botox injection sites and the anatomy beneath your skin guides these choices. For instance, a narrow philtrum column may need caution with central dosing to avoid a pulled-down filter look. A wider alar base with heavy smile lines may benefit from splitting the lateral dose into two micro-sites to spread the effect. These are subtle distinctions, but they prevent over-suppression and preserve character.
Can a lip flip replace gummy smile treatment?
Botox for lip flip targets the orbicularis oris at the vermilion border. It relaxes the lip sphincter so the red portion flips outward slightly, creating the illusion of volume without filler. A lip flip can modestly reduce gum show in patients whose smile tension comes from the lips curling inward. However, the main driver in gummy smiles is usually the elevator muscles, not the sphincter. A small, thoughtful combination can be beautiful, but a full lip flip in a gummy smile patient risks speech changes or difficulty with sipping through a straw. Keep doses conservative and sequence treatments so you can attribute effects to the right area.
What about men, different ages, and prior Botox users
Men can be excellent candidates, though their smile muscles are often stronger. Brotox for gummy smile is less talked about because men tend to have less gingival display, but when they do, dosing is usually a touch higher. Younger patients seek preventative Botox for wrinkles, and while preventatives have a role, gummy smile treatment is corrective rather than preventive. The 20s and 30s are common decades for first-time treatment. Older patients may have additional factors like dental wear or lip thinning that change the plan.
If you already receive Botox for forehead lines, crow’s feet, or a brow lift, adding a gummy smile treatment is manageable. Full face Botox requires careful mapping so the cumulative doses preserve natural movement. Communicate your entire treatment history, including Dysport, Xeomin, or Jeuveau, so your provider can match expectations for onset and duration.
Pain, downtime, and the “feel” of your smile afterward
On a ten-point scale, most rate the pain as a two or three. Using ice or a quick tap technique, it is closer to a one. There is essentially no downtime. You may notice your upper lip feels less “bouncy” at maximum grin after a week. Speech typically remains normal. If the dose is heavy or placed too low, certain consonants like “P” and “B” can feel soft for a few days, which is a sign to dial back in future sessions. This is why Baby Botox dosing, smaller and more precise, often wins for gummy smiles.
Safety and product choice
All FDA-approved cosmetic neuromodulators have solid safety profiles when used correctly. Botox safety depends more on injector expertise and sterile technique than on brand. Dysport spreads a bit more in some hands, which can be beneficial for broader areas but unwanted near the lip elevators if you are not careful. Xeomin’s lack of accessory proteins has theoretical advantages for repeat exposure. Jeuveau behaves similarly to Botox in most clinical settings. The differences are subtle and usually secondary to placement skill.
Medical Botox for migraines or excessive sweating uses higher total units in different regions and is typically billed to insurance when criteria are met. Cosmetic Botox for gummy smile is not covered by insurance.
How to choose the right provider
Look for a Botox specialist who treats smiles often, not just foreheads. Request to see Botox before and after photos specifically for gummy smile. Ask how many units they typically use, whether they stage dose and touch ups, and how they handle asymmetry. A thoughtful answer signals experience. A Botox consultation should include a mirror, dynamic assessment, and a frank talk about limits. If someone promises a permanent fix with Botox injections alone, that is a red flag.
When Botox is only the first chapter
Some patients start with Botox as a reversible trial. If the change boosts confidence but falls short of their goal, we layer treatments. Gum contouring by a periodontist can reduce gingival display in cases of altered passive eruption. Orthodontics and restorations can lengthen short teeth. In rare, severe skeletal cases, a surgeon may discuss maxillary impaction. Botox still plays a role during or after those treatments to fine tune the smile arc.
Maintenance rhythm and smart scheduling
Because the effect lasts around three months, the practical cadence is quarterly. If you combine areas, synchronize your Botox appointment so forehead lines, frown lines, and gummy smile peak together. This keeps your expressions cohesive. Over time, you may find the gummy smile requires fewer units as the habit relaxes. I have patients who started at 8 to 10 units and settled into 4 to 6 units per session after a year.
A quick, practical checklist before you book
- Identify your main concern in a mirror: central gum show, canine peaks, or a general high lift. Gather consistent smiling photos in good light to show at your consult. Ask your provider about dosing strategy, follow-up policy, and typical Botox longevity for your case. Plan for two weeks before a big event so peak results land on time. Verify product authenticity and unit pricing to avoid false “Botox deals.”
Common myths I hear in clinic
“Botox will make my smile stiff.” Not if dosed and placed correctly. The aim is to relax a narrow set of elevator fibers, not freeze your expression. Natural movement remains.
“Botox is only for wrinkles.” While Botox for forehead lines, crow’s feet, and frown lines are the most familiar, gummy smile, bunny lines, chin dimpling, and neck bands are all fair cosmetic targets. Medical indications like migraines, excessive sweating, TMJ-related clenching, and masseter muscles for bruxism show the range of applications.
“Once I start, I can’t stop.” You can stop anytime. The effect wears off in a few months, and your smile returns to baseline. There is no rebound worsening; what you see after it fades is your original muscle activity.
“Dysport lasts longer.” Some individuals report longer duration with one brand over another, but controlled comparisons show similar outcomes when dosing is equivalent. Your personal experience matters more than generalized claims.
Real-world scenarios and trade-offs
A 28-year-old woman with a wide, high-energy smile showed 4 to 5 millimeters of gum centrally and at the canines. We used 3 units of Botox per side at the Yonsei point and added 1 unit centrally. At two weeks, her gum show dropped by about 3 millimeters, with a smooth arc across the upper lip and minimal impact on speech. She maintained quarterly and now holds with 2 units per side.
A 41-year-old man had modest central gum show but complained more about a sneer-like pull on the right. We treated only the dominant right LLSAN with 3 units and the left with 1 unit. The asymmetry resolved, and his result lasted just over three months.
A 35-year-old with short upper teeth from erosion wanted a permanent change. Botox helped, but we referred her to a prosthodontist for restorations to lengthen the teeth. The combination corrected both the mechanical cause and the muscular habit.
These cases illustrate that Botox techniques evolve with the person in front of you. Dose, sites, and brand are tools, not templates.
Final guidance for the best outcome
Gummy smile treatment with Botox can be elegant, quick, and reversible. When performed by an experienced Botox injector who understands facial anatomy and respects dosage, results look natural and last around three months. Costs are modest compared to surgery, but value tracks with expertise. If you want to maximize results, come in with clear photos, align expectations in millimeters, start conservatively, and commit to a two-week follow-up for fine tuning. For many, that small adjustment in muscle activity unlocks a confident, balanced smile.
If you are weighing Botox vs fillers or exploring Dysport, Xeomin, or Jeuveau, speak the language of outcomes rather than brand loyalty. Ask about how, where, and why the product will be placed, not just what is in the vial. Good planning, careful technique, and honest communication are what make the difference between a quick fix and a refined result that stands up, smile after smile.