Gummy smile is a simple phrase for a complex mix of anatomy and expression. Some people show a lot of gum when they smile because their upper lip elevates more than average, their upper jaw sits lower relative to the teeth, or the gumline itself is prominent. Most of the time the smile is healthy and expressive, just more gingival show than the person wants to see in photos. When someone asks about a quick, conservative option before considering orthodontics or surgery, I often discuss botox treatment as a targeted way to lower the lip slightly during a full smile. Done well, it softens the gummy appearance without flattening expression.
The technique is straightforward on paper. In practice, success depends on diagnosis, proper botox dosage, precise placement, and a clear conversation about trade-offs. I have treated patients who wanted just 1 to 2 millimeters less gum display and were thrilled, and others whose skeletal pattern made botox injections the wrong tool. Knowing which is which is the art.
What “gummy smile” really means
Plastic surgeons and dentists usually call it excessive gingival display. The typical threshold is more than 3 millimeters of visible gum above the upper central incisors during a natural smile. Some people show 4 to 6 millimeters. That number alone doesn’t tell the whole story. I look at lip length at rest, how much the lip elevates with smiling, the height of the teeth, gingival margin position, and the vertical dimension of the upper jaw.
Three common patterns show up:
- Hyperactive elevator muscles of the upper lip. The lip is a normal length at rest but lifts high when smiling. Think of strong levator labii superioris alaeque nasi, levator labii superioris, and zygomaticus minors doing their job a little too well. Short upper lip. Even at rest, the lip length from base of the nose to the vermilion border is shorter than average, so any elevation reveals more gum. Vertical maxillary excess. The upper jaw sits lower relative to the rest of the face, which lengthens the midface and exposes more gum even if the lip function is normal.
Botox for gummy smile helps most when the primary driver is hyperactive elevator muscles. It can help a short lip to a lesser degree. It does not change skeletal relationships, so vertical maxillary excess usually needs orthodontics, surgery, or a multidisciplinary plan.
How botox works in this specific area
Botox cosmetic is a purified botulinum toxin type A that temporarily reduces muscle contraction by blocking acetylcholine release at the neuromuscular junction. In the upper lip elevator complex, a small dose reduces the peak lift of the lip when you grin. You can still smile. You can still speak, chew, and show emotion. The aim is to decrease the highest, most gingiva-revealing part of the motion by 1 to 3 millimeters, sometimes a bit more.
Typical injection points for gummy smile target the “Yonsei point” region along the lateral aspect of the nose, and sometimes a medial point near the ala base. Many injectors use 2 to 4 units per side as a starting point for botox units, then adjust based on response. Light doses are safer for first-timers, especially people with short lips or thinner tissues. If I see asymmetry, I correct dosing side to side. If the patient has flare of the nostrils or pronounced alar lift with smiling, a tiny dose near the levator labii superioris alaeque nasi can help.
Onset takes 3 to 7 days, with full botox results by two weeks. Duration is typically 8 to 12 weeks, sometimes up to 16 weeks in this area. Because these are relatively small muscles with a dynamic role in expression, I plan for botox maintenance every 3 to 4 months. The body metabolizes the effect gradually, so the smile returns to baseline over time. That makes gummy smile treatment a low-commitment experiment for many people. If you love it, you book your botox appointment again. If you want more or less effect, we fine-tune botox dosage at the next visit.
What a consultation covers
A good botox consultation for gummy smile feels different from a forehead or crow’s feet chat. We spend more time watching you smile in different ways, from a soft grin to a big laugh, and checking symmetry, gumline height, tooth show at rest, and lip seal. I take photos from oblique angles, because the action near the alar base matters and the camera tells the truth.
I also ask about previous dental work, gum grafts, orthodontics, and any history of dry mouth or lip incompetence. If you already struggle to keep your lips closed at rest, you might not be a candidate for reducing elevator strength. We talk about other botox cosmetic areas you may have had, like botox for forehead or a botox lip flip, because combined effects can change your smile dynamics.
Then we outline expectations. If you want a 5 to 6 millimeter reduction and your gummy smile is mostly skeletal, botox is not enough. If you want 1 to 3 millimeters less gum on a hyperactive smile, botox treatment is likely to satisfy you.
Who makes a good candidate
People with a hyperactive upper lip who want a reversible, non-surgical change tend to be ideal. They have normal tooth proportions, healthy gums, and a full smile that simply lifts a bit too high. They understand that botox duration is temporary and that touch-ups will be needed. They are comfortable with mild adjustments rather than dramatic change, and they value a test drive before committing to dental surgery or orthodontics.
Age wise, candidates range from early 20s to 60s. The best age for botox is less about a number and more about stable expectations, healthy tissues, and consistent facial patterns. Men and women both do well, though men often need slightly higher dosing in other facial areas. In the lip elevator region the differences are usually small.
Who should pause or consider alternatives? People with vertical maxillary excess more than mild, especially if the upper gingival show exceeds 5 or 6 millimeters and the lip does not cover much tooth at rest. People with a short upper lip at rest combined with open mouth posture. Those with significant dry lips or a history of drooling after dental anesthesia may dislike the sensation of reduced elevator strength. Pregnant or nursing individuals should avoid elective botox injections, because safety data are limited. Anyone with a neuromuscular disorder or certain medications that affect neuromuscular transmission needs a physician’s clearance.
What happens during the botox procedure
The appointment is quick. Most clients spend more time on intake photos and discussion than on the injections. After cleaning the skin, I mark subtle dots near the alar base and along the nasolabial junction that line up with the levator complex. Some providers use vibration or ice for comfort. The needles are tiny, and most people rate discomfort as a 2 or 3 out of 10.
Dosing begins conservatively the first time. If your smile is strongly asymmetric, one side may receive an extra unit. The injection volume is small to reduce spread, since we want to influence specific muscles without affecting the zygomaticus major too much. The botox treatments in Morristown entire botox procedure usually takes less than five minutes.
Common, mild effects right after include tiny bumps at the injection sites for 10 to 20 minutes, a drop of pinpoint bleeding, or a short-lived swelling. Makeup can go on gently after two hours if the skin is intact.
Aftercare and what to expect day by day
For botox aftercare, I advise staying upright for 4 hours, skipping intense exercise until the next day, and avoiding heavy rubbing or facial massages for 24 hours. I ask patients not to schedule dental cleanings or long dental appointments the same day, because stretching the upper lip or leaning on the cheeks when numb can disperse the product. Light expressions are fine. Smiling will not “use up” the effect.
You usually notice the first change around day 3. By day 7, the lip lifts a little less at the peak of your grin. By day 14, the result is stable. I like to see a brief botox follow-up photo or in-person check at two weeks for first-timers. If one side still rides higher, a tiny touch-up can even it out.
The effect softens gradually after 8 to 12 weeks. Some people hold results for 3 months, others closer to 4. Hydration, metabolism, and muscle baseline strength all play a role. If you time botox maintenance with other aesthetic visits, spacing every 12 to 16 weeks is typical.
How many units, and why it varies
There is no single botox dosage that fits everyone. In this area, many injectors start with a total of 4 to 8 units divided between both sides. Smaller framed patients with subtle gummy smile might do well with 2 units per side. Stronger smiles often need 3 to 4 units per side. If someone has had botox for jaw clenching or masseter slimming, or botox for migraines that involves facial dosing, I reassess the interplay of muscles before setting the gummy smile dose.
The key is titration. It is better to start slightly low and add a unit or two at the 2-week mark than to overshoot and create a flat or heavy upper lip. The goal is a natural smile with less gum, not a frozen upper third. A good botox provider will explain that logic before the needle comes out.
Benefits beyond the mirror
Most people come for cosmetic reasons, but there are functional benefits for a subset. Anyone who feels self-conscious about high gum show tends to smile less or cover their mouth in photos. Even a modest improvement can restore confidence and ease. In dentistry, reduced lip elevation can also complement minor gum contouring or a veneer plan by balancing soft tissue and tooth display. It is not a substitute for dental work, but it can harmonize the final look.
Compared to surgery, botox is low risk, quick, and readily reversible. Compared to lip fillers, it does not create fullness or change the lip’s shape at rest, which many patients prefer. A botox lip flip by comparison rolls the upper lip slightly outward to show more vermilion. It can be combined with gummy smile dosing, but that combination needs care. Too much relaxation above and within the vermilion border can make drinking from a straw awkward for a few weeks.
Risks, side effects, and how to avoid trouble
Any botox injection can bruise. The nose-cheek junction has small vessels, so I warn about a 5 to 15 percent chance of minor bruising that resolves in a few days. Swelling is typically minimal. Headache can occur in a small number of patients in the first 24 hours.
The main functional risk is over-relaxation of the elevator complex. That can produce a heavy upper lip feel, slight difficulty pronouncing plosive sounds for a few days, or a smile that looks less animated than desired. This is usually dose-related and fades as the botox wears off. Precise placement reduces spread into the zygomaticus major or the orbicularis oris where it would affect lip competence or smile symmetry.
Allergic reactions are rare. Systemic adverse events with cosmetic doses around the face are extremely uncommon when proper technique is used. Still, botox safety begins with medical screening. If you have a history of neuromuscular disease, are on aminoglycoside antibiotics, or have had unusual reactions to botulinum toxin in the past, your injector should coordinate with your physician.
Botox vs alternatives for gummy smile
For a hyperactive lip, botox is the quickest option with the least downtime. Lip fillers can help a short lip appear slightly longer by adding support under the philtrum and vermilion border, though they can also accentuate gum show if placed poorly. A small amount of filler combined with botox can work when volume and movement both contribute to the problem.
Gingivectomy or crown lengthening moves the gumline apically for cases where the teeth are short because of excessive gingival coverage. That is a dental solution, not a neuromuscular one, and it can produce a striking before and after when planned correctly. Orthognathic surgery addresses vertical maxillary excess. It is the definitive fix for skeletal gummy smile, with significant recovery time and permanent change. Some patients choose a trial period with botox first to confirm how they feel about less gum before taking the surgical step.
Within the neuromodulator family, botox vs Dysport vs Xeomin vs Jeuveau often comes down to injector familiarity, spread characteristics, and patient response. In the lip elevator region I prefer a product with predictable diffusion at small doses. All four can work. If you have loved your botox results elsewhere on the face, sticking with the same brand here is reasonable.
Cost, value, and how to think about price
Botox cost varies by region and by botox clinic. Some practices charge per unit, others per area. For gummy smile, total units are modest, so you often see a lower ticket than for a full botox for forehead, frown lines, and crow’s feet package. In the United States, the per-unit botox price often ranges from 10 to 20 dollars. If you receive 6 to 8 units, that puts the fee roughly between 60 and 160 dollars in many markets, sometimes more in urban centers. Specials and seasonal botox deals may lower that. Remember you are paying for assessment and technique as much as for the milligrams in the vial. An experienced injector who prevents a heavy lip is worth it.
Insurance does not cover cosmetic botox. If you are also seeing a dentist for smile design, coordinate timing so your photos reflect the final gummy smile plan.
What a realistic result looks like
When a patient asks for botox before and after photos, I show cases with similar anatomy. The best results look like the same smile, with a little less gum showing and teeth taking center stage. You still see upper gum with a big laugh, just not as much. At rest, nothing should look altered. The philtrum and Cupid’s bow remain natural. In video, the smile should rise smoothly without a sudden hitch where the muscles load and stop.
A classic measurement is gingival display at peak smile. If we start at 4 millimeters and end at 2 millimeters, most clients are delighted. If someone starts above 6 millimeters, we manage expectations that botox can soften, not erase, the show. People with thin upper lips benefit from a conversation about whether a touch of filler or a micro botox approach in the orbicularis oris will balance the outcome. I would rather lay out a step-by-step plan than chase millimeters without a framework.
How this fits with the rest of your aesthetic plan
A smile is part of a face, and a face is in constant motion. If you already receive botox for frown lines or a subtle botox brow lift, make sure your provider sees your animated photos. Over-relaxing the midface while the upper third is glass smooth can look odd. I prefer harmony: light treatment for crow’s feet to keep eyes smiling, measured doses for forehead lines, and conservative gummy smile correction that preserves expression.
For those with jaw tension or grinders getting botox for TMJ or masseter hypertrophy, coordinate timing so you can evaluate your bite and smile together. For migraine patients on therapeutic dosing, inform your injector about injection maps you receive from your neurologist. Overlapping points are common, and spacing adjustments can maintain safety and efficacy.
Common questions I hear, answered plainly
Does botox hurt? The injections are quick pinches. Most people find them easier than upper lip waxing. If you are needle-sensitive, topical numbing cream adds a few minutes and some comfort, though it is rarely necessary.
How long does botox take to work here? Expect noticeable change by day 3 to 5, with peak effect at day 14.
How often do I need botox touch-ups? Every 3 to 4 months for most. Some stretch to 5 months with consistent treatment as muscles soften over time.
Will my smile look fake? Not if the assessment and dosing are right. The smile should look like you on a great day, not like someone pressed pause.
Can I combine this with a lip flip? Yes, but cautiously. The combination can create beautiful balance when done lightly. Overdoing both can make sipping or whistling awkward for a few weeks.
Is botox safe? For healthy adults, botox cosmetic has an excellent safety record when performed by a trained injector. Side effects are usually mild and temporary. Proper screening and placement are the safeguards.
What about “natural botox” creams or serums? Topicals marketed as botox alternatives do not block muscle contraction the way an injectable neuromodulator does. They may smooth fine lines by hydrating the skin or using peptides, but they will not lower an over-elevating lip. If you see claims of botox without needles that promises identical results, read carefully.
Choosing the right professional
Skill matters more than brand. Look for a botox provider who can describe the lip elevator anatomy without glancing at a chart, and who shows you realistic photos of gummy smile cases. Titles vary. Some of the best injectors I know are physicians, dentists, physician assistants, and nurse injectors with focused training. Whether it is a botox dermatologist in a skin-focused practice or a dentist with cosmetic training, the common thread is an eye for balance and conservative dosing. Ask how many gummy smile treatments they do each month. Ask what percentage of patients they decline. A thoughtful injector who sometimes says no is a good sign.
If you are searching botox near me and reading reviews, look beyond star ratings. Look for comments about natural smile results, steady follow-up, and responsiveness to small adjustments. Price should be fair, but not the only factor. A well-run botox center invests in training, sterile supplies, and photography, which all support safety and consistent outcomes.
When botox is not the answer
Some smiles demand more than a neuromodulator can offer. If your smile shows significant vertical maxillary excess, or your upper teeth are short from altered passive eruption, a consult with a periodontist or orthodontist may be the right first step. If gum health is compromised, treating inflammation and stabilizing periodontal status should come before any cosmetic step. If you have unrealistic expectations or dislike temporary treatments, saving for a definitive procedure may suit you better.
I have had a handful of patients who tried botox, liked the change, then chose orthognathic surgery a year later to achieve a permanent fix for a skeletal gummy smile. They described the year of botox as a valuable preview. Others made botox their maintenance routine because it solved their concern without downtime. Both paths make sense when chosen deliberately.
A practical path if you are considering it
- Schedule a consultation with an experienced injector who treats gummy smile regularly, bring photos of your broadest smile, and ask for an honest assessment of cause and expected millimeter change. Start with a conservative dose focused on the levator complex, then reassess at two weeks for symmetry and effect. Plan for two to three treatment cycles to dial in your ideal botox units and timing, then settle into a 3 to 4 month rhythm.
Final thoughts from the chair
Gummy smile is not a flaw. It is a variation in a system designed to show joy. The goal is not to silence expression, it is to take the edge off when that expression reveals more gum than you like. Botox, placed well, is a simple lever that lowers the upper lip a touch at peak smile. That lever is strongest when the cause is muscular, weaker when the issue is skeletal, and neutral when gum health or tooth position needs attention first.
If you want a reversible, measured change with little downtime, botox for gummy smile is worth a conversation. Ask good questions. Choose a thoughtful injector. Keep the smile yours, just a little less gummy at the top.