Gummy Smile Treatment
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A gummy smile — where more than 2 to 3mm of gum tissue is visible above the upper teeth during smiling — affects around 10% of adults and is one of the most common cosmetic brought to aesthetic practitioners. The good news: a non-surgical treatment using small precisely-placed doses of can reduce gum show in many patients, with the treatment taking less than 10 minutes and results lasting 3 to 4 months.
But not every gummy smile responds to the same treatment. The cause matters: some gummy smiles are driven by muscle (which responds well to anti-wrinkle injection); others are driven by short upper lips, excessive gum tissue, or skeletal factors (which need different interventions). This guide explains exactly what causes a gummy smile, when anti-wrinkle injection is the right answer, what the procedure involves, and when alternatives like lip filler, surgical lip lift, or dental procedures are more appropriate.
What counts as a "gummy smile"
A gummy smile is generally defined as showing more than 2 to 3mm of gum tissue above the upper teeth when smiling broadly. The amount of gum show varies considerably between individuals:
The cosmetic impact varies. Some patients with mild gum show find it bothersome; others with more substantial gum show aren’t concerned at all. Treatment is appropriate when the patient is genuinely bothered, not just because the measurement falls above a threshold.
Gummy smiles can also be asymmetric — more gum show on one side than the other. This adds complexity to treatment planning and is one reason why a thorough consultation matters.
The causes of a gummy smile
Understanding the cause the right treatment. Several factors can contribute, often in combination:
A small muscle called the levator labii superioris alaeque nasi (LLSAN) — along with muscles around the upper lip — lifts the upper lip during smiling. In some patients, these muscles contract too strongly, pulling the upper lip excessively high and exposing more gum than would be visible.
This is the most common single cause of gummy smile and the one most amenable to anti-wrinkle injection . By partially relaxing the LLSAN, the upper lip rises less during smiling — and gum show decreases.
Some have a naturally shorter upper lip — the vertical from the base of the nose to the top of the upper lip is less than average. Even with normal muscle activity, a short upper lip simply exposes more gum during smiling than a longer lip would.
Treatment for this cause may include:
Some patients have an excess of gum tissue covering the teeth — making the teeth appear shorter and the gum appear more prominent. This is a dental rather than in most cases.
Treatment options include:
The position and development of the upper jaw bone (maxilla) influences gum show. Excessive vertical growth of the maxilla, or an overly protruded upper jaw, can produce significant gum visibility during smiling.
Treatment for skeletal causes:
Naturally shorter upper teeth can create the illusion of a gummy smile even when the gum tissue itself is normal. Dental restoration to lengthen teeth (veneers, crowns) can improve .
Some patients have very flexible upper lips that move higher during smiling than average — even with normal muscle activity. This often responds well to anti-wrinkle injection.
Family patterns are common — gummy smiles often run in due to inherited combinations of muscle activity, lip length, and skeletal anatomy.
A thorough consultation identifies the dominant cause(s) for each patient and the most appropriate combination.
How anti-wrinkle injection treats gummy smile
The treatment uses small doses of botulinum toxin placed precisely into specific muscles around the upper lip. The doses required are much smaller than typical facial anti-wrinkle injection doses — just 2 to 4 units per side, delivered to specific anatomical points.
Target muscles:
How it works:
Botulinum toxin blocks the chemical signal (acetylcholine) that nerves use to activate muscles. When the signal can’t reach the muscle, the muscle contracts less strongly. In this application, the relaxed elevator muscles raise the upper lip less during smiling — so less gum is exposed.
Importantly: the goal is moderation, not paralysis. Complete inactivation of the elevators would produce an unnatural fixed smile or impair speech. The dose is calibrated to reduce excessive activity while preserving normal facial expression.
The procedure
Consultation. Assessment of the gummy smile, including measurement, identification of dominant cause, and discussion of expected outcomes.
Preparation. Topical anaesthetic isn’t typically required — the injections are small and Nasolabial Fold (Smile Line Fillers) brief. Some practitioners use ice or cold pack to numb the skin briefly before injection. The treatment area is thoroughly.
The injections. 2 to 4 small injections per side, placed at anatomical points around the base of the nose and upper lip. Each injection is brief — a small sharp sensation lasting less than a second. The total procedure takes 5 to 10 minutes.
Immediate post-treatment. Most patients have no significant effects immediately after — perhaps slight tenderness at injection sites for a few hours. Most return to normal activities the same day.
Onset of effect. Results begin to develop within 3 to 5 days of treatment. Full effect is visible at approximately 2 weeks.
Duration. The effect typically lasts 3 to 4 months. Maintenance treatment to sustain results is required.
What to expect after treatment
Immediately: mild tenderness or small bumps at injection sites. Some patients have small . Most have no visible effects.
Days 1 to 3: no visible change yet. Continue normal activities.
Days 3 to 5: noticeable reduction in gum show begins. Smile may feel slightly different — typically described as smile feeling "natural but more controlled."
Days 5 to 14: full effect develops. Gum show is reduced. Smile feels normal but the upper lip lifts less.
Weeks 2 to 12: stable result. Most patients find this period highly satisfactory.
Months 3 to 4: effect begins to wear off gradually. Plan maintenance .
Most patients schedule their second treatment at around 3 months to maintain consistent results. Over time, with consistent treatment, some patients find the underlying muscle activity adapts and longer intervals become possible.
The "Joker smile" risk and why technique matters
The most concerning potential complication of gummy smile treatment is what’s colloquially called a "Joker smile" — an asymmetric or excessively flattened smile that develops if too much toxin is placed, or if the wrong muscles are targeted.
This typically occurs when:
For patients with this specific lip configuration, relaxing the central elevator muscles can over-correct and produce an asymmetric or unnatural smile. This is why a careful consultation, including assessment of your specific lip movement when smiling, is essential before .
At Centre for Surgery, treatment is performed by experienced injectors who:
The good news: even if a Joker smile or asymmetry occurs, it’s temporary. The effect wears off over 2 to 3 months as the toxin is metabolised, and re-treatment with adjusted technique can avoid recurrence.
Combination treatments for optimal results
For many patients, anti-wrinkle injection alone produces excellent results. For others, combining with other treatments produces better outcomes:
Anti-wrinkle injection + lip filler. Adding subtle to the upper lip can complement the muscle-relaxant effect — both reducing lip lift and slightly lengthening the apparent upper lip. This combination is particularly useful for patients with a short upper lip contributing to the gummy smile.
Anti-wrinkle injection + lip flip. A lip flip is a separate small dose of injection placed at the upper lip border to subtly evert the lip. Combined with gummy smile treatment, this can further reduce gum visibility.
Anti-wrinkle + dental procedures. For patients with excessive gum tissue or short tooth crowns, dental procedures (gum contouring, crown lengthening, veneers) can be combined with aesthetic treatment for comprehensive correction.
Anti-wrinkle + lip lift. For substantial cases where the upper lip is significantly short, surgical can be considered alongside or instead of injection. See our guides on and .
Who is a good candidate?
The ideal candidate for anti-wrinkle injection for gummy smile has:
Less suitable candidates include:
A consultation establishes which category fits your specific situation.
What if you’re not a candidate for injection treatment?
For patients whose gummy smile won’t respond well to anti-wrinkle injection alone, alternatives include:
Surgical lip lift. Permanent shortening of the philtrum, which addresses both short upper lip and dynamic lip elevation during smiling. See our guide on .
Gingivectomy or gum contouring. Dental procedure to remove excess gum tissue, exposing more of the underlying tooth and reducing apparent gum show.
Crown lengthening. More extensive dental procedure to expose more tooth surface in cases of substantial gum coverage.
Orthodontic treatment. For cases where tooth position contributes to gummy smile, orthodontic can improve outcomes.
Maxillofacial surgery. Reserved for the most significant skeletal cases — typically performed in adolescence or early adulthood when growth is still occurring.
For most patients, a combined approach involving one or two of these interventions produces excellent results.
Cost
Anti-wrinkle for gummy smile at Centre for Surgery is priced per treatment session. Treatment requires only small doses, so cost is typically lower than typical facial anti-wrinkle treatment.
Indicative pricing: from £200 to £350 per session, depending on the precise pattern .
Maintenance treatment every 3 to 4 months. Over a year, total cost typically £600 to £1050.
, including 0% APR, are across treatments. For more on the financial planning around injectables generally, see our .
Common questions
Most patients describe the post-treatment smile as feeling "natural but slightly more controlled." Speech, eating, and facial expressions remain entirely normal. The change is in how high the upper lip lifts during smile — not in muscle function for other activities.
At consultation we can discuss expected outcomes in detail and show examples. The exact result depends on individual response, so visualisations are guides rather than guarantees.
Initial within 3 to 5 days. Full effect at 2 weeks.
Minimally — brief sharp sensation at each point lasting less than a second. Most patients tolerate the treatment comfortably without topical anaesthetic.
No. Anti-wrinkle works best for muscle-driven gummy smiles. Other causes may need different or combinations. A thorough consultation identifies the right approach for your specific cause.
Unlike filler, toxin can’t be immediately reversed. However, the effect wears off naturally over 2 to 3 months. Adjustments to dose or placement at subsequent treatments can refine the result for ongoing use.
Botulinum toxin has a long safety record with decades of use. Repeated treatment every 3 to 4 months over years is and generally well-tolerated. Some patients find their muscle activity adapts over time, allowing longer intervals between treatments.
Yes. Many patients combine gummy smile treatment with anti-wrinkle treatment for forehead lines, glabella, or crow’s feet in the same visit. This is straightforward and well-tolerated.
We don’t perform anti-wrinkle injection during pregnancy or breastfeeding. Treatment can resume after.
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Centre for Surgery is a CQC-regulated private on London’s Baker Street, delivering plastic and cosmetic surgery through GMC-registered specialist surgeons. Our expertise spans facial procedures and , , for men, and body contouring procedures such as and . Patient safety, surgical excellence and natural-looking results sit at the heart of everything we do.
Centre for Surgery is a CQC-regulated private hospital on London’s iconic , offering plastic and cosmetic surgery led by GMC-registered consultant surgeons.
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