Gummy Smile Treatment

In this guide11 sections

1. What counts as a “gummy smile”
2. The causes of a gummy smile
3. How anti-wrinkle injection treats gummy smile
4. The procedure
5. What to expect after treatment
6. The “Joker smile” risk and why technique matters
7. Combination treatments for optimal results
8. Who is a good candidate?
9. What if you’re not a candidate for injection treatment?
10. Cost
11. Common questions

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 concerns brought to aesthetic practitioners. The good news: a non-surgical treatment using small precisely-placed doses of anti-wrinkle injection can dramatically 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 overactivity (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:

• 0 to 2mm: normal range; typically considered aesthetically ideal
• 2 to 4mm: mild gummy smile
• 4 to 6mm: moderate gummy smile
• Over 6mm: significant gummy smile

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 determines the right treatment. Several factors can contribute, often in combination:

1. Hyperactive elevator muscles (most common cause)

A small muscle called the levator labii superioris alaeque nasi (LLSAN) — along with related 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 otherwise be visible.

This is the most common single cause of gummy smile and the one most amenable to anti-wrinkle injection treatment. By partially relaxing the LLSAN, the upper lip rises less during smiling — and gum show decreases.

2. Short upper lip

Some patients have a naturally shorter upper lip — the vertical distance 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:

• Anti-wrinkle injection (can help even when the underlying issue is partly anatomical)
• Lip filler to subtly increase the volume of the upper lip, making it appear longer and reducing gum visibility
• The lip flip — small dose of anti-wrinkle injection to evert the upper lip slightly

3. Excessive gum tissue

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 aesthetic concern in most cases.

Treatment options include:

• Gingivectomy or gum contouring (performed by a dentist or periodontist)
• Crown lengthening for more substantial cases
• These dental procedures are outside the scope of cosmetic aesthetic treatment but can be combined with aesthetic approaches when needed

4. Maxillary bone factors

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:

• Orthodontic intervention if early enough
• Maxillofacial surgery for significant skeletal factors
• Anti-wrinkle injection may provide partial improvement but won’t address the underlying skeletal cause

5. Tooth size and proportions

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 appearance.

6. Lip flexibility and movement

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.

7. Genetic factors

Family patterns are common — gummy smiles often run in families due to inherited combinations of muscle activity, lip length, and skeletal anatomy.

A thorough consultation identifies the dominant cause(s) for each patient and recommends the most appropriate treatment 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 — typically just 2 to 4 units per side, delivered to specific anatomical points.

Target muscles:

• The LLSAN — primary muscle responsible for hyperactive lip elevation
• The levator labii superioris (a related elevator muscle)
• Sometimes the depressor septi nasi (which can contribute to the dynamic patterns)

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 brief. Some practitioners use ice or cold pack to numb the skin briefly before injection. The treatment area is cleaned thoroughly.

The injections. 2 to 4 small injections per side, placed at specific 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 typically 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 bruises. 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 substantially 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 treatment.

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:

• The dose is too high
• The injection points are not anatomically precise
• The patient’s lip configuration was unsuitable for treatment (specifically, when the lower middle of the upper lip is naturally lower than the lateral corners)

For patients with this specific lip configuration, further 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 pattern when smiling, is essential before treatment.

At Centre for Surgery, treatment is performed by experienced injectors who:

• Carefully assess your lip configuration before treatment
• Use conservative doses calibrated to your specific anatomy
• Use precise anatomical placement
• Recommend against treatment if your lip configuration makes adverse outcomes likely

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 lip filler 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 anti-wrinkle 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 + surgical lip lift. For substantial cases where the upper lip is significantly short, surgical lip lift can be considered alongside or instead of injection. See our guides on how long does a lip lift last and bullhorn vs corner lip lift.

Who is a good candidate?

The ideal candidate for anti-wrinkle injection for gummy smile has:

• Hyperactive upper lip elevator muscles as the primary cause (or major contributor)
• Normal or near-normal lip configuration (the lower middle of the upper lip is not significantly lower than the lateral corners)
• 2 to 6mm of gum show during full smile
• Realistic expectations — meaningful reduction in gum show, not complete elimination
• Willingness to maintain results with treatment every 3 to 4 months
• Good general health, no contraindications to botulinum toxin (pregnancy, breastfeeding, neuromuscular disorders, allergy)

Less suitable candidates include:

• Patients whose gummy smile is primarily caused by excessive gum tissue (better addressed by dental procedures)
• Patients with significant skeletal causes
• Patients with a lip configuration where the lower middle of the upper lip is significantly lower (high risk of Joker smile)
• Patients with very severe gummy smile (over 8mm) — typically need surgical or orthodontic intervention
• Patients during pregnancy or breastfeeding

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 how long does a lip lift last.

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 intervention 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 injection 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 injection treatment.

See our Skin & Aesthetics price list for current prices.

Maintenance treatment every 3 to 4 months.

Finance options through Chrysalis Finance are available, subject to status, across treatments. For more on the financial planning around injectables generally, see our anti-wrinkle injections FAQ.

Common questions

Will my smile feel different after treatment?

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.

Can I see what I’ll look like before treatment?

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.

How quickly will I see results?

Initial changes within 3 to 5 days. Full effect at 2 weeks.

Is the treatment painful?

Minimally — brief sharp sensation at each injection point lasting less than a second. Most patients tolerate the treatment comfortably without topical anaesthetic.

Will the treatment work for everyone?

No. Anti-wrinkle injection works best for muscle-driven gummy smiles. Other causes may need different treatments or combinations. A thorough consultation identifies the right approach for your specific cause.

What if I don’t like the result?

Unlike filler, botulinum 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.

Are there long-term safety concerns with repeated treatment?

Botulinum toxin has a long safety record with decades of use. Repeated treatment every 3 to 4 months over years is well-established and generally well-tolerated. Some patients find their muscle activity adapts over time, allowing longer intervals between treatments.

Can I combine gummy smile treatment with other anti-wrinkle injection 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.

What about treatment during pregnancy or breastfeeding?

We don’t perform anti-wrinkle injection during pregnancy or breastfeeding. Treatment can resume after.

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Centre for Surgery · CQC-regulated · GMC-registered surgeons · 95–97 Baker Street, Marylebone, London W1U 6RN · 020 7993 4849 · Book a consultation · Finance available, subject to status

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