Botulinum Toxin for Gummy Smile

Using Botulinum Toxin to Treat a Gummy Smile

A genuine smile can be one of our most expressive and engaging features. However, for some people, smiling reveals more gum tissue than they would like, a condition known as a “gummy smile,” or in medical terms, excessive gingival display. While harmless from a dental health perspective, it can be an aesthetic concern that affects confidence and willingness to smile freely.

Traditional treatment options, such as surgical gum contouring or orthognathic surgery, can be effective but are invasive and require longer recovery times. In recent years, botulinum toxin injections have emerged as a safe, non-surgical alternative. By precisely targeting the overactive upper lip elevator muscles, botulinum toxin can reduce excessive gum show and create a more balanced, natural-looking smile, often with minimal downtime.

This page explores how the treatment works, who may benefit, what results to expect, and why it has become a popular choice for achieving a more harmonious smile.

Understanding the Cause: The Anatomy of a Gummy Smile

A gummy smile can result from several underlying factors, but one of the most common is muscular in nature. The upper lip is lifted by specific muscles when we smile, and in some individuals, these muscles are overactive, pulling the lip higher than necessary and exposing excessive gum tissue.

Common causes of a gummy smile include:

• Muscular – Overactive upper lip elevator muscles.

• Dental – Abnormally small maxillary incisors, delayed tooth eruption, or gum overgrowth (gingival hyperplasia/hypertrophy).

• Skeletal – Excessive vertical growth of the upper jaw (maxilla).

Botulinum toxin is particularly effective for cases caused by muscle overactivity. The primary muscles involved are the Levator Labii Superioris Alaeque Nasi (LLSAN) and the Levator Labii Superioris, which are responsible for lifting the upper lip. In hyperactive cases, these muscles contract too strongly, creating the characteristic “gummy” appearance when smiling.

What Are The Types of Gummy Smiles?

Not all gummy smiles look the same, and understanding the pattern of gum exposure is important for planning the most effective treatment. The way the gums are revealed during a smile can vary depending on which muscles are involved, the dental and skeletal structure, and even the symmetry of muscle movement. Clinicians typically classify gummy smiles into several types, each with its own causes and treatment considerations.

• Anterior Gummy Smile — The most common type, where excessive gum display is concentrated at the front of the mouth. The gums are especially visible over the incisors and canines, often due to overactivity of muscles such as the Levator Labii Superioris Alaeque Nasi (LLSAN), which lifts the upper lip too high.

• Posterior Gummy Smile — In this type, the gums are more prominently displayed towards the back of the mouth, from the premolars backward. While the front teeth may appear normal when smiling, the sides reveal significant gum tissue, typically linked to the action of the zygomatic muscles, which lift and widen the corners of the mouth.

• Mixed Gummy Smile — A combination of anterior and posterior patterns, with excessive gum display both in the central and side areas. This often results from a mix of hyperactive muscles in different regions of the face and may require targeting multiple muscles for correction.

• Asymmetric Gummy Smile — Characterised by uneven gum display, where one side of the mouth shows significantly more gum than the other. This can occur due to imbalanced or asymmetric contraction of the lip-elevating muscles.

How Botulinum Toxin Works for a Gummy Smile

Botulinum toxin, when administered in precise, micro-doses, works by temporarily blocking the nerve signals that trigger muscle contraction. In cases of a gummy smile caused by hyperactive upper-lip elevator muscles, the treatment is directed at specific points to reduce excessive lip elevation.

For most patients, injections are placed into the Levator Labii Superioris Alaeque Nasi (LLSAN) muscles on either side of the nose. This approach:

• Reduces Excess Muscle Activity — The targeted muscles are partially relaxed, limiting their ability to lift the upper lip too high.

• Lowers the Lip Position — As the muscles relax, the upper lip rests slightly lower in a more natural alignment when smiling.

• Conceals Excess Gum Display — The result is a more balanced tooth-to-gum ratio, creating a harmonious smile without altering natural expression.

Because the effect is localised to the injected muscles, normal facial expressions and smile movement are preserved. The procedure is quick, minimally invasive, and the improvements are visible within days.

The Treatment Process: What to Expect

Treating a gummy smile with botulinum toxin is a quick, precise, and minimally invasive procedure carried out in a medical clinic.

• Consultation — The process starts with a detailed assessment by a medically qualified doctor. Your facial anatomy will be examined to identify the underlying cause of your gummy smile, and your treatment goals will be discussed to ensure botulinum toxin is the right approach for you.
• Injection Procedure — The treatment itself takes about 5–10 minutes. A small number of carefully placed injections are administered into the muscles at the base of the nose on both sides. Most patients feel only a brief, mild sting; a topical numbing cream or ice may be used to increase comfort.
• Recovery — There is virtually no downtime. You can return to normal activities immediately, though mild redness or swelling may appear at the injection sites. These effects are temporary and typically fade within a few hours.

Results and Longevity

• Onset of Results — The improvement is not immediate. Most patients start noticing changes within 3–7 days, with the final result typically visible in 1–2 weeks.

• Duration — The effect of botulinum toxin is temporary, generally lasting 3–6 months. How long results last depends on factors such as metabolism, muscle activity, and individual variation.

• Maintenance — To keep the desired outcome, repeat treatments are recommended every few months. Over time, regular treatments may lead to mild muscle weakening, which can extend the duration between sessions.

Safety and Potential Side Effects

When performed by an experienced medical professional, botulinum toxin treatment for a gummy smile is considered very safe.

Common Temporary Effects

• Mild bruising, redness, or swelling at the injection sites
• Minor discomfort or a slight “heavy” feeling in the upper lip

Rare but More Serious Risks

• Asymmetrical smile — uneven lifting of the upper lip
• Difficulty with lip movement — temporary issues such as trouble pursing the lips (e.g., when using a straw), usually due to the toxin affecting nearby muscles
• Reduced expressiveness — an unnatural or “frozen” smile if over-treated

Any unwanted effects are temporary and will fade as the toxin naturally wears off. The most effective way to minimise risks and achieve natural-looking results is to choose a qualified practitioner with specific experience in treating gummy smiles.

Cost and Practitioner Qualifications in Singapore

• Cost — In Singapore, treating a gummy smile with botulinum toxin typically costs between SGD $150 and $440 per session. The exact fee depends on factors such as the clinic’s location, the doctor’s expertise, and the number of units used. For this specific concern, only a small amount, usually between 4 and 8 units, is required.

• Qualified Practitioner — By law in Singapore, all botulinum toxin injections, whether for aesthetic or medical purposes, must be performed by a licensed medical doctor trained and certified in aesthetic procedures. It is illegal for beauty therapists or other non-medical personnel to administer this treatment.

If you are concerned about a gummy smile, schedule a consultation with APAX Medical to explore whether botulinum toxin is the right non-surgical solution to help you achieve a balanced, confident smile.

References:                                                                                             

1. Duruel O, Ataman-Duruel ET, Berker E, Tözüm TF. Treatment of various types of gummy smile with botulinum toxin-A. Journal of Craniofacial Surgery. 2019 May 1;30(3):876-8. 
2. Mazzuco R, Hexsel D. Gummy smile and botulinum toxin: a new approach based on the gingival exposure area. Journal of the American Academy of Dermatology. 2010 Dec 1;63(6):1042-51. 
3. Polo M. Botulinum toxin type A in the treatment of excessive gingival display. American journal of orthodontics and dentofacial orthopedics. 2005 Feb 1;127(2):214-8.