Dental Aesthetics (Gummy Smile Botox)

The appearance of more gum tissue than usual around the upper front teeth when smiling is referred to in the literature as excessive gingival display (EGD). In everyday use, this condition is commonly described as a gummy smile. The amount of gingival display can vary from person to person and does not, by itself, indicate a disease. However, in some individuals, the amount of gum visible while smiling may be considered an aesthetic concern.

Various factors may play a role in the development of a gummy smile, including upper lip movement, lip anatomy, the eruption and position of the teeth, gingival level, and the vertical structure of the upper jaw.

Gummy smile Botox is a temporary treatment involving botulinum toxin that may be considered particularly in cases where upward movement of the upper lip during smiling plays a significant role in the appearance of the gums.

Botulinum toxin temporarily reduces nerve-muscle communication in specific muscles in the treated area. As a result, movement of the upper lip during smiling may decrease, which can reduce the amount of visible gum. However, since gummy smile can have different underlying causes, botulinum toxin may not produce the same result in every case. Personal anatomical characteristics and smiling dynamics should be evaluated when determining the appropriate treatment option.

What Is a Gummy Smile?

A gummy smile refers to a condition in which the gum tissue located above the upper front teeth is noticeably visible when smiling.

A certain amount of gum visibility during smiling can be physiological. Increased gingival display may be associated with different anatomical or functional factors. Factors that may contribute to a gummy smile include:

• Excessive upward movement of the upper lip during smiling
• Anatomical characteristics of the upper lip
• Activity of the muscles that move the upper lip
• Tooth eruption characteristics
• Differences in gingival level
• The vertical structure of the upper jaw
• A combination of multiple factors

Therefore, when evaluating a gummy smile, it is important to assess not only the amount of visible gum but also the underlying causes of this appearance.

What Is Gummy Smile Botox?

Gummy smile Botox involves the injection of botulinum toxin to temporarily reduce the activity of specific muscles that contribute to upper lip movement during smiling. Botulinum toxin temporarily reduces the transmission of signals from the nerve endings to the muscles. As the activity of the targeted muscles decreases, the upward movement of the upper lip during smiling may also be reduced.

As a result, the amount of visible gum in the upper front region may decrease. An important point is that botulinum toxin does not alter the gum tissue or change the structure of the teeth. Its effect is primarily on muscle movement and the resulting position of the upper lip.

How Does Gummy Smile Botox Work?

Different facial muscles contribute to the upward movement of the upper lip during smiling.

Botulinum toxin may temporarily reduce the activity of these muscles. As muscle movement decreases, the upper lip may elevate less, which can result in reduced gingival display.

The effect does not reach its full extent immediately. The effects of botulinum toxin develop over time, and clinical studies have reported that the most noticeable effect is generally evaluated during the 2–4-week period after treatment.  

Which Muscles Are Treated with Gummy Smile Botox?

The muscles targeted in gummy smile Botox treatment may vary according to individual anatomical characteristics and the patient’s smiling pattern.

Scientific studies have particularly investigated the following muscles:

• Levator labii superioris alaeque nasi (LLSAN)
• Levator labii superioris (LLS)
• Zygomaticus minor

A systematic review and bibliometric analysis published in 2024 evaluated 13 prospective controlled clinical studies on gummy smile Botox and reported that these muscles were among the frequently evaluated targets in the literature.

However, it cannot be said that a single injection point or a single muscle is appropriate for all patients.

How Is Gummy Smile Botox Applied?

Before treatment, the movement of the upper lip during smiling and the amount of visible gum are evaluated. The assessment may also take into account facial symmetry, lip anatomy, tooth visibility, and the possible cause of the gummy smile. Once the treatment plan has been determined, botulinum toxin is administered through small injections into the muscle or muscle groups considered appropriate. The effects of botulinum toxin gradually become apparent after the procedure.

Because the treatment plan may vary from person to person, injection points and the amount used should not be considered a standardized prescription.

Is There a Standard Dose for Gummy Smile Botox?

There is currently no single standard dose that applies to all patients in the scientific literature. Different doses, injection points, and target muscles have been used in studies.

A systematic review published in 2022 evaluated studies on gummy smile Botox and reported that, although effective applications have been described, there is no standardized injection protocol that can be applied in exactly the same way to everyone. Therefore, the dose and injection points should be determined according to the individual’s anatomical characteristics.

How Effective Is Gummy Smile Botox?

Clinical studies and systematic reviews have evaluated the effects of botulinum toxin on gummy smiles. A systematic review and meta-analysis published in 2023 reported a reduction in the amount of visible gum during smiling following botulinum toxin treatment. The analysis reported an approximate average reduction of:

• 3.22 mm at 2 weeks
• 2.70 mm at 3 months

However, because there was a high degree of variability among the studies, these values should not be used to predict an individual patient’s outcome.

When Does Gummy Smile Botox Start to Show Results?

The effects of botulinum toxin do not reach their maximum level immediately after treatment. The effects may take time to begin and become more noticeable. Systematic reviews have reported that the most pronounced effect is generally evaluated around 2–4 weeks after treatment.

Therefore, the appearance during the early period after treatment may differ from the appearance several weeks later.

How Long Does the Effect of Gummy Smile Botox Last?

The effect of gummy smile Botox is temporary. The effects of botulinum toxin gradually decrease over time, and muscle activity returns. As a result, upper lip movement and the associated gingival display may gradually approach the initial level.

A 2021 meta-analysis and meta-regression reported that the effect was pronounced at 2 weeks and gradually decreased over time, potentially approaching baseline values at around 24 weeks. A 2024 systematic review also reported that in many studies, the effect lasted approximately 12–24 weeks. These timeframes do not guarantee individual results.

Are Gummy Smile Botox Results Permanent?

No. The effect achieved with botulinum toxin is temporary. As the neural activity of the muscles gradually returns over time, the effect of the treatment decreases.

Therefore, gummy smile Botox is not considered a treatment that permanently eliminates the anatomical cause of a gummy smile. Different treatment options may be considered, particularly when the underlying cause is skeletal, dental, or gingival.

Is Gummy Smile Botox Suitable for Every Gummy Smile Case?

No. The underlying cause of a gummy smile can vary from person to person.

For example, if excessive movement of the upper lip is the primary cause of gingival display, botulinum toxin may be considered. In contrast, if tooth eruption characteristics, gingival level, or the vertical structure of the upper jaw is the determining factor, different treatment options may be necessary.

Systematic reviews and meta-analyses published in 2024 reported that non-surgical methods may be used particularly in cases with milder initial gingival display, while surgical approaches may be more appropriate for more pronounced skeletal cases. Therefore, the treatment method should be evaluated according to the cause and severity of the gummy smile.

Is Gummy Smile Botox the Same as Gum Aesthetics?

No. Gummy smile Botox primarily affects muscle activity and upper lip movement. Gum aesthetics, on the other hand, may refer to different periodontal procedures related to the level, shape, or visibility of the gum tissue.

If the cause of the gingival appearance is related to the gum tissue itself, applying botulinum toxin alone may not address the underlying problem. Therefore, the relationship between the teeth, gums, lips, and jaw should be evaluated together when assessing a gummy smile.

What Is the Difference Between Gummy Smile Botox and Orthodontic Treatment?

Botulinum toxin temporarily affects muscle movement. Orthodontic treatment is a different treatment approach aimed at correcting the position of the teeth and jaw relationships. If the position of the teeth contributes to the gummy smile, an orthodontic evaluation may be necessary. Since multiple factors may be present in some individuals, the treatment plan should not be determined solely by the amount of visible gum.

What Is the Difference Between Gummy Smile Botox and Surgical Treatments?

Botulinum toxin is a temporary, non-surgical treatment. Surgical treatments, on the other hand, may aim to create more lasting changes targeting specific anatomical causes of a gummy smile. For example, orthognathic surgery may be considered in cases involving significant skeletal abnormalities of the upper jaw. Therefore, botulinum toxin and surgical treatments are not necessarily alternatives to one another in every case. The choice of treatment should be based on the underlying anatomical cause of the problem.

Is Gummy Smile Botox Safe?

Scientific studies have reported that botulinum toxin is generally a well-tolerated treatment for gummy smile. A systematic review published in 2022 reported that the adverse events described were mild and temporary. However, this does not mean that the procedure is completely risk-free.

Because the treatment affects facial muscle movement, temporary asymmetry, unwanted changes in upper lip movement, or local reactions at the injection site may occur. The individual’s medical history and current condition should be evaluated before treatment.

What Are the Possible Side Effects of Gummy Smile Botox?

Temporary effects may occur at the injection sites after treatment, including:

• Redness
• Tenderness
• Swelling
• Bruising

Temporary asymmetry or unexpected changes in upper lip movement may also occur due to the effect on muscle activity.

The likelihood and nature of side effects may vary depending on the treatment area, product used, dose, and individual characteristics. If an unexpected or persistent symptom develops, a healthcare professional should be consulted.

When Should the Effect of Gummy Smile Botox Be Evaluated?

Since the effects of botulinum toxin develop over time, the results are generally not evaluated immediately after treatment. In clinical studies, the 2–4-week period is one of the commonly used timeframes for evaluating treatment effectiveness.

The assessment may consider not only gingival display but also:

• Upper lip movement
• Smile symmetry
• Facial expression
• Tooth visibility

Can Gummy Smile Botox Be Repeated?

Since the effects of botulinum toxin are temporary, repeat treatment may be considered for some individuals after the effects begin to diminish.

However, whether repeat treatment is necessary and when it should be performed depends on individual clinical assessment.

The generalization that “the duration of the effect definitely becomes longer after each treatment” is not supported by the current scientific evidence. Decisions regarding repeated treatments should be made by considering the outcome of the previous treatment and the individual’s current anatomical characteristics.

Scientific Evidence on Gummy Smile Botox

Clinical studies and systematic reviews have investigated gummy smile Botox. Current evidence indicates that botulinum toxin may reduce the amount of visible gum, particularly in gummy smile cases where excessive upper lip movement plays a role. However, there are differences among studies in terms of the doses used, injection points, target muscles, and follow-up periods.

Therefore, although scientific evidence supports the effect of botulinum toxin, it does not establish a single standardized treatment protocol that applies to all patients.

2024 Systematic Review

A systematic review and bibliometric analysis published in 2024 evaluated 13 prospective controlled clinical studies on gummy smile Botox. The studies reported initial anterior gingival display of approximately 3.5–6.8 mm. The most pronounced effect was generally observed between 2 and 4 weeks, and some studies reported that gingival display could be reduced to approximately 3 mm or less. In some studies, the effect was reported to continue for 12–24 weeks.

2023 Systematic Review and Meta-Analysis

A systematic review and meta-analysis published in 2023 evaluated the effect of botulinum toxin on gummy smile. An average reduction in gingival display of approximately 3.22 mm at 2 weeks and 2.70 mm at 3 months was reported. Due to the high heterogeneity among the studies, these findings should not be interpreted as an individual patient outcome.

2021 Meta-Analysis

A meta-analysis and meta-regression published in 2021 evaluated 17 studies. An average reduction of approximately 3.42 mm was reported at the second week. The effect was reported to decrease over time and could approach baseline values at around 24 weeks.

Is There a Standard Treatment Protocol?

There are differences among existing studies regarding doses and injection points. A systematic review published in 2022 reported that, despite effective outcomes being described for gummy smile Botox, a single standardized and reproducible injection protocol has not yet been established. Therefore, the scientific literature supports planning the treatment based on individual assessment.