If you’ve ever felt self-conscious about showing too much gum when you smile, you’re far from alone. A gummy smile, where more than three to four millimetres of gum tissue is visible above the upper teeth when smiling, is one of the more common concerns I see in my clinic. And the reassuring news is that in the majority of cases, surgery is simply not needed.
Let me explain what actually works.
Gummy Smile at Health & Aesthetics
What causes a gummy smile?
It’s rarely down to one single thing. The upper lip is controlled by a group of muscles working together, and when any of these are overactive, the lip lifts higher than ideal on smiling. The main culprits are the levator labii superioris alaeque nasi, the levator labii superioris, and the zygomaticus minor. In some patients the orbicularis oris, which controls the overall movement and shape of the lips, also plays a role. Beyond muscle activity, a short upper lip, the way the upper jaw has developed, or the size and position of the teeth can all be contributing factors.
Understanding the cause properly matters enormously, because it determines which treatment will give the best result. I always take time at consultation to assess this carefully rather than offering the same approach to every patient who walks through the door.
Gummy Smile patient at Health & Aesthetics
Botulinum toxin: my first choice for most patients
In the majority of cases I see, the gummy smile is caused by overactivity in the levator labii superioris alaeque nasi and the levator labii superioris. These muscles run from the nose and cheekbone down to the upper lip and, when they contract too forcefully, the lip lifts well above the gum line on smiling, revealing more than the patient would like.
Small and precise doses of botulinum toxin injected into these muscles work extremely well. The muscle activity reduces, the lip sits slightly lower on smiling, and the gum exposure decreases noticeably. In patients where the zygomaticus minor is also contributing, this can be addressed at the same time with careful and targeted placement.
Results typically last three to four months and the treatment itself takes only a few minutes. I won’t pretend it suits every single patient. Using too much product, or injecting in the wrong place, risks affecting neighbouring muscles and can make the smile look unnatural or interfere with speech. The anatomy in this area is unforgiving, which is precisely why this treatment should only be carried out by someone with a thorough understanding of the facial musculature. In experienced hands, however, this is one of the most rewarding treatments I offer, because the results can be genuinely life-changing for patients who have spent years hiding their smile.
Dermal filler: a helpful addition
Where a short or thin upper lip is part of the problem, carefully placed hyaluronic acid filler can add a little volume and projection, bringing the lip slightly lower and improving the overall proportion between lip and gum. The filler works with the natural structure of the orbicularis oris rather than against it, which is why placement and technique matter so much. Used on its own, filler may not fully resolve a pronounced gummy smile, but combined with botulinum toxin it can give a much more complete result.
I’ll be straightforward here: the upper lip is not the place for heavy-handed treatment. Poorly placed or excessive filler looks obvious and can make matters worse. A subtle approach, carried out by someone who understands the anatomy, makes all the difference.
When non-surgical treatment isn’t the right answer
Not every gummy smile is suitable for non-surgical management, and I think it’s important to be upfront about this. If the underlying cause is significant jaw development or a dental issue, I will say so and refer to the appropriate specialist. Attempting to mask a structural problem with injectables rarely gives a satisfying outcome and does the patient no favours in the long run.
My opinion
Botulinum toxin targeting the levator labii superioris alaeque nasi and levator labii superioris remains the most effective non-surgical option available and, in my clinical experience, is genuinely underutilised. I have seen patients who have been told there is nothing that can be done short of an operation, which simply isn’t the case for a good number of them. A proper assessment, the right treatment, and a doctor who truly understands the facial muscles and their interactions can make a significant difference to how someone feels about their smile.
If this is something you’ve been considering, my advice is to seek a consultation with a medically qualified practitioner who will take the time to assess your individual anatomy and give you a candid, honest opinion.
