A gummy smile can be charming, but when more than 3 to 4 millimeters of gum shows above the upper teeth, many people feel their smile looks unbalanced. If the cause is hyperactive lip-elevating muscles rather than short teeth or excessive gum tissue, a small dose of botulinum toxin can soften the elevation and create a more proportionate grin. I have treated patients who wanted just a subtle change for photos and speeches, and others who had been hiding their smile for years. In the right hands, botox for gummy smile is precise, quick, and reversible. In the wrong hands, it can make you feel like your upper lip is stuck. Technique and judgment carry the day.
When botox suits a gummy smile, and when it doesn’t
Not every gummy smile is a muscle problem. Determining candidacy starts with a focused exam. I watch the natural smile, then a full laugh, and measure gingival display. I check incisor length and gum line height. I palpate how strongly the lip lifts and where the pull concentrates. If the teeth are short due to wear or delayed eruption, you might need crown lengthening with a periodontist or adhesive bonding. If the upper jaw itself is vertically long, orthognathic surgery corrects the underlying structure. Fillers can camouflage mild discrepancies by adding volume to the upper lip, but they cannot weaken the lifting muscles. Botox treatment is the right tool when the upper lip elevates too far from muscular overactivity.
The most common muscle culprits are the levator labii superioris alaeque nasi, the levator labii superioris, and the zygomaticus minor. In simple terms, these are the vertical elevators along the nose and cheek that hike the upper lip when you smile. If they contract too strongly, the lip rides up and shows extra gum. Calming these muscles with tiny botox injections allows the lip to settle a few millimeters lower at peak smile. That small change usually makes a big visual difference.
How the technique works, anatomically and practically
I explain the plan chairside and map the injection points with you in a mirror. The goal is not to paralyze the smile. We want to tame the top part of the movement without blunting your expression. Typically I target the “Yonsei point” along each side of the nose, where a small bolus reaches the overlapping elevators. In cases with lateral gum show, I add a minute amount slightly more lateral to catch the zygomaticus minor. If gum exposure centers just around the front teeth, a nose-adjacent pattern alone often suffices.
Dosing is conservative. For a first treatment, the total is commonly 2 to 4 units per side in women and 3 to 5 units per side in men, with slight adjustments for muscle mass and smile amplitude. Some practitioners use micro botox techniques that divide the dose into multiple subpoints for even spread. I prefer a two to three point micro-depot approach, which lowers diffusion risk and refines symmetry. The needle is fine, typically 30G or 32G, and the botox injections are intramuscular but shallow. The angle and depth matter: too superficial and you waste dose; too deep and you risk affecting muscles we do not want to touch, like the levator labii superioris near the midface or the zygomaticus major that creates your smile lift at the corners.
There is no need for numbing in most cases. The botox procedure feels like a few brief pinches and takes less than five minutes once mapped. I ask patients to smile lightly during placement so I can see where the lip jumps. That real time assessment helps me place the product cleanly and avoid unnecessary passes. If you have had botox for eyes or botox for frown lines before, this will feel even quicker.
What to expect from appointment to results
Botox does not work instantly. You walk out looking the same, which is one advantage if you have a meeting or a dinner planned. The early onset starts at around 48 hours. Most people notice the first signs at day three: the upper lip doesn’t jump up quite as far in the mirror. The full effect settles by day seven to ten. A few take up to two weeks to reach their peak. I schedule a botox consultation and first visit, then a follow-up at two weeks for a check and any micro-adjustments.
The expected drop in gingival display ranges from 1 to 3 millimeters. That may not sound like much, but in facial aesthetics millimeters are the entire story. A 2-millimeter change can transform a gummy smile into a balanced one. I show botox before and after photos under the same lighting, with relaxed face, soft smile, and full smile. Consistent photography helps you see the true shift. When we aim for natural looking botox, the smile still looks like you, just less gingival. The lip shows a bit more fullness at peak smile because it no longer stretches as far vertically.
Longevity and maintenance
How long does botox last in the upper lip elevators? Generally 8 to 12 weeks for first timers, sometimes longer for those who maintain regular botox maintenance. With repeated sessions, many patients experience a longer interval, 12 to 16 weeks, as the muscle adapts to lighter use. I plan the second botox session around the three month mark, then adjust. When to get botox again comes down to your tolerance for the gummy show returning. Some prefer a strict schedule for consistently smooth results. Others watch for botox fading signs and book a botox appointment when they notice the lift creeping back.
Botox longevity varies by metabolism, dose, activity, and even the way you animate during speech. Athletes with high metabolic rates sometimes experience a slightly shorter botox timeline. Going too high with dose can create a more frozen effect without a proportionate increase in duration, so I stick with the minimum effective dose and invite you in for a small touch up if needed. A botox touch up at two weeks is common when we are calibrating a new patient. After that, the touch up interval extends to full maintenance sessions.
Crafting a natural result
One reason gummy smile correction succeeds is that the rest of your facial expression remains free. You can still smile, laugh, and show warmth, just without the uneven lip ascent. The art lies in balancing the central and lateral lifts so you do not trade a gummy smile for a flat smile. If the product spreads too far into the zygomaticus major or the risorius, the corners of the mouth can look blunted. On the other hand, if you under-treat the central elevators, you might get a “seagull” smile where the center drops but the sides still pull high. I use video clips during the consult because they show your dynamic motion better than stills. That informs not only the botox dosage but the exact botox procedure steps.
In a few cases, I suggest combining botox and fillers together. A small hyaluronic acid filler in the upper lip body can create a soft ledge that visually reduces gum exposure while enhancing lip shape. This is not the same as a botox lip flip, which targets the orbicularis oris to evert the lip. A lip flip can be helpful if you want a hint more show of the vermilion without more volume, but in patients with a strong gummy component, weakening the elevators is more impactful than rolling the lip border. When we blend approaches, I stage treatments, starting with botox and adding filler two weeks later if needed to fine tune.
Safety, side effects, and risks specific to gummy smile correction
The safety profile for botox cosmetic in the midface is generally favorable, but you should know the trade-offs. Common side effects include pinpoint bruising, mild swelling, and transient tenderness at injection sites. These clear in days. Headaches are uncommon with such low doses and locations. The most relevant local risk is over-relaxation of the upper lip, which can make it harder to show the upper teeth when you smile or enunciate certain sounds crisply for a week or two. That effect tends to soften as the product settles and usually resolves well before the botox effect duration ends. Difficulty with drinking from a straw can occur if dosing creeps too far into the orbicularis oris, which we avoid.
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Asymmetry can appear if one side grips more than the other at baseline, or if the botox injections do not land evenly. This is why first time botox for a gummy smile is best approached conservatively with a planned review. Diffusion into nearby muscles may create a short-lived change in nasal flare or cheek lift. I counsel singers and professional voice users about the small chance of altered upper lip articulation. While extremely rare, allergic reactions to components in the vial can occur. Systemic spread is extraordinarily unlikely at cosmetic doses in healthy adults, but it is contraindicated if you have certain neuromuscular disorders or are pregnant or nursing.
Patients sometimes ask about botox long term use. In my practice, sustained treatment over years has not produced worsening of baseline smiles, and many appreciate that the habit of over-lifting eases. Still, I encourage breaks if you feel your expression is starting to look different from what you want. The goal is subtle botox, not a signature “treated” look.
Aftercare that actually matters
The aftercare instructions for botox are simple. Avoid pressing or massaging the treated area for the first day. Keep your head elevated for a few hours and skip hot yoga and vigorous exercise until the next day. You can work out after botox the following morning without issue. Makeup can go on lightly after a few hours if the skin looks calm. If you bruise, a cold compress for short intervals helps. Arnica can be used if you are a believer, though data is mixed. What not to do after botox includes facials, deep tissue massage near the nose and cheeks, or any dental work that requires mouth retractors for 24 hours, since stretching could shift product microscopically.
If something feels off at day three to five, send a note with photos. Most small variances even out by the two week check, and if not, a micro touch up of 1 to 2 units can balance the outcome. I prefer to avoid chasing every minute asymmetry in the first few days because you can overshoot and end up too flat. Patience is part of the craft.
Cost, value, and the reality behind “deals”
Botox price for a gummy smile typically reflects the small dose, so it often costs less than treatment for forehead lines or botox for crow’s feet. Practices bill either per unit or per area. In cities with higher overhead, you might see a per-unit price of 12 to 20 dollars, and a total dose in the 4 to 10 unit range. That places the botox cost for gummy smile in the low hundreds rather than four figures. Be cautious with botox deals, botox specials, and botox offers that seem too good to be true. Cut-rate pricing sometimes implies high dilution, inexperience, or hurried technique. A top result depends more on the injector’s judgment than the product alone.
If you are searching botox near me, vet the provider’s credentials, ask how many gummy smile treatments they do monthly, and look at their botox before and after gallery for smiles, not just foreheads. An honest consultation should include alternatives and a discussion of botox risks, botox side effects, and botox recovery expectations. You should not feel rushed. When budget is tight, I Ann Arbor botox would rather do fewer, correctly placed units at full strength than chase a bargain and compromise technique.
Alternatives, adjuncts, and when fillers or surgery make more sense
Botox is one path among several. Dental procedures like crown lengthening improve tooth show and can reduce gum exposure when teeth are short. Orthodontics with intrusion of anterior teeth sometimes helps, though skeletal considerations limit this. If the maxilla is vertically excessive, no amount of botox will change the bony foundation. In those cases, surgery is the definitive solution, and I refer to a maxillofacial surgeon for a full workup. For mild cases or those seeking minimal change, fillers along the upper lip or in the anterior nasal spine region can tilt the balance toward more tooth and less gum show, but results are more subtle and rely heavily on anatomy.
Some ask about botox vs fillers for gummy smile. Fillers add volume and shape; botox changes muscle pull. Many gummy smiles need the latter, sometimes with a hint of the former. We also discuss botox alternatives such as lip repositioning surgery, which reduces upper lip retraction by anchoring mucosa lower. It is more invasive than an injection but can last years. Each carries its own risk profile; we pick based on anatomy, goals, and tolerance for downtime.
Special cases and common questions
Smokers, those with thin upper lips, and people whose careers depend on crisp articulation deserve extra caution. In a very thin lip, even a small drop in elevation can hide upper incisors at rest, changing your smile aesthetic. In that case, I might combine a micro dose of botox with a tiny filler to preserve incisor show. For public speakers, I bias slightly lower on dose and always schedule the botox session well before any performance so you can adapt during the botox results timeline.
Does botox hurt? These injections are among the least uncomfortable in the face given the small volume and fine needle. Can botox be reversed? Not directly. We must wait for the effect to fade, which is why conservative dosing and staged adjustments are key. If you experience botox gone wrong with an over-treated lip, time and careful follow-up are the remedy. How much botox do I need? That depends on your smile mechanics; most patients land in the single digits of total units. What to expect with botox is a smooth two week ramp up, then a steady plateau for two to three months, followed by a gradual return.
People who already receive botox for forehead lines, botox for frown lines, or botox for facial wrinkles often ask whether treating multiple areas at once is safe. It is, provided total dosing is within typical cosmetic ranges and placement respects anatomy. Treating multiple zones in one visit has the benefit of a unified botox timeline, which makes botox maintenance simpler.
Preventing issues and getting the best result
You can influence outcomes more than you think. Arrive without heavy makeup so mapping is accurate. Avoid aspirin and high-dose fish oil for several days if your physician approves, as they can increase bruising. Share prior treatment doses and timelines. If you had botox for nose lines or a botox brow lift, those patterns can clue me into how your muscles respond. Bring reference photos of how much gum show bothers you, measured in millimeters if possible. Clarity prevents overcorrection.
I keep notes on exact injection sites and botox dosage, along with how quickly you noticed the shift and when you felt it started to fade. On subsequent visits we use that record to fine tune within a narrow range. Some patients respond briskly to even tiny doses. Others need a unit more. Trying to leap to a large change at visit one invites stiffness. A smooth two-visit calibration yields a better, more natural smile.
Real-world outcomes
A 28-year-old woman with 5 to 6 millimeters of gum show at full smile, strong central lift, and normal tooth length came in before her wedding photos. We placed 3 units per side at the nose-adjacent points and 1 unit per side laterally. At day ten her gingival display measured 2 to 3 millimeters. She kept her expressive smile, and her photographer commented on the balanced lip line. She returned at three months reporting a gentle fade and booked again for the next season.
A 41-year-old man with asymmetric gum show and a thin upper lip wanted subtle botox for smile correction. We started with 2 units on the higher side and 1.5 units on the lower, plus a 0.3 milliliter micro bolus of hyaluronic acid to support the philtral columns. His speech felt normal, and at two weeks the smile looked even, with 1 to 2 millimeters of gum show bilaterally.
These cases illustrate the core reality: success depends on tailored dosing and precise placement, not on a one-size map.
Where this fits in a broader aesthetic plan
Botox for gummy smile often joins a light program of botox for crow’s feet or a small botox brow lift to refresh the upper face. When planning across regions, I emphasize restraint. You can stack subtle improvements without tipping into an overdone look. Preventative botox and baby botox have their place, but a gummy smile correction is not preventive; it is corrective by design. If you are new to injectables and worried about an unnatural feel, this is one of the best introductions because it softly adjusts a specific movement rather than changing your entire expression.
Patients with TMJ issues or jaw tension sometimes receive botox for masseter reduction or botox for teeth grinding. That treatment slims the lower face and can make the upper smile look more prominent by contrast. Coordinating both areas can balance the vertical third proportions. Again, sequence matters. I prefer to stabilize the smile first, then contemplate lower face changes.
Myths, facts, and expectations
A few myths persist. One is that botox for gummy smile will make you unable to smile. If you can’t smile, it was either overdone or poorly placed. Another is that botox spreads unpredictably. When diluted and delivered properly, spread is modest and consistent. A third myth holds that only fillers fix smiles. Fillers have a role, but they cannot tone down an overactive elevator muscle.
Facts you can count on: botox results appear within days, peak by two weeks, and last around three months at this site. Side effects are usually mild and short-lived. Natural looking botox requires conservative dosing and a light hand. If you expect a dramatic overhaul from one or two units, you’ll be underwhelmed. If you expect a Homepage tidy, millimeter-level improvement that brings balance, you’ll likely be pleased.
A short checklist for choosing a provider
- Shows detailed before and after photos of gummy smile cases with consistent lighting Explains anatomy and sets a conservative starting dose Offers a two-week review and small touch up if needed Documents units and exact points for future refinement Discusses alternatives like dental work or surgery when appropriate
The bottom line on technique, risks, and results
Gummy smile correction with botox is a focused, high-yield treatment for the right anatomy. The technique hinges on precise mapping of the levator complex, small and symmetrical dosing, and a willingness to stage adjustments. The risks are mostly local and temporary: bruising, mild swelling, transient stiffness, or asymmetry. When things go wrong, time and judicious touch ups usually set them right. The results, at their best, look like you on your best day, with less gum and more confidence when you laugh.
If you are considering it, schedule a thoughtful botox consultation. Bring honest photos, share your priorities, and ask to see examples of botox results in smiles, not just brows and foreheads. A skilled injector will respect millimeters, plan for maintenance rather than miracles, and deliver improvement that your friends notice only as a more relaxed, balanced expression.