Fix Gummy Smile: Botox Options

Alisha here.

I want to talk about something I see a lot in my clinic, but that people often feel a bit shy to bring up: the gummy smile.

It’s that feeling when you give a big, happy laugh, but a little voice in your head makes you instinctively bring a hand up to cover your mouth. Or when you see a photo of yourself and all you can focus on is how much gum is showing above your teeth.

It can really steal the joy from a genuine, uninhibited smile. So when a patient emailed me this week asking about it, I knew I had to share my thoughts.

Why do I show excess gum when I smile?

This is the best place to start, because the ‘why’ completely determines the ‘how’. In my experience, a gummy smile is usually a combination of your unique anatomy. It can be due to one of three main factors.

First (and most common in my clinic), it’s due to hyperactive lip muscles. You have small muscles on either side of your nose, often called the ‘lip elevator’ muscles (specifically the levator labii superioris alaeque nasi – ironically, it’s a bit of a mouthful!).

Think of them as tiny purse purse strings that pull your top lip upwards when you smile. In some people, these muscles are just a bit too strong. So when you give a big, happy smile, they pull too hard and lift your lip higher than average and showing more of your gum line.

Second, it can be related to the physical length of your upper lip. Some people naturally have a shorter distance between the base of their nose and the border of their top lip. If the lip itself is anatomically short, there’s just less lip to cover your gums (even with normal muscle movement).

Third, it can be a skeletal or dental issue. In some cases, the upper jaw may be proportionally long, which naturally positions your gums lower. Or your gums might just naturally cover more of the tooth’s surface than they should.

In my clinic, I focus on that first cause – the overactive muscles. That’s because this is the most common cause of gummy smiles, and it’s also something I can treat brilliantly and safely without any surgery.

Is a ‘gummy smile’ a medical issue or is it just cosmetic?

This is a really important distinction. Medically speaking, having a gummy smile isn’t an ‘issue’ at all. It doesn’t pose any risk to your physical health, it’s simply just a variation of normal human anatomy (like having freckles or curly hair).

The only ‘problem’ is how it makes you feel.

For me, aesthetics is as much about your internal world as your external appearance. Does feeling conscious of your gums stop you from smiling freely in photos? Do you find yourself covering your mouth when you laugh? Have you ever felt a pang of self-consciousness when you see your own smile? If the answer is yes, then it’s impacting your confidence, and that makes it a valid concern worth addressing to me.

I’ll never tell someone they need to fix their gummy smile. My role is to be honest about what’s possible. If this is getting in the way of you feeling happy, then I can provide a safe, effective, and subtle solution to help you let go of that feeling. It’s not about achieving a ‘perfect’ smile by someone else’s standards but about making you feel more comfortable and confident in your own.

What solutions are there for reducing a gummy smile?

The best solution depends on the root cause we talked about earlier. While my expertise is non-surgical, it’s important you know all the options.

First, there are dental procedures. If your gums cover too much of your teeth (called ‘altered passive eruption’), a dentist can perform a surgery like a ‘gingivectomy’ or ‘crown lengthening’ to reshape your gum line. This works best when the gum-to-tooth ratio is the main problem.

Second, there’s surgery. If the problem is a long upper jaw, orthognathic (jaw) surgery is usually recommended. But as you can imagine, this is a major surgery with high cost and a long recovery time, so it’s usually for more severe cases.

Finally, there’s the non-surgical approach, which is my area. This involves using anti-wrinkle injections (like Botox®) to relax your overactive ‘lip elevator’ muscles. In my professional opinion, this is the best option for most people with gummy smiles caused by muscle pull. It’s minimally invasive, highly effective, and can give great improvements without the cost or downtime of surgery.

How does Botox fix a gummy smile?

This is where the magic really happens, and it’s a perfect example of how a deep understanding of facial anatomy allows us to create beautiful, subtle changes.

Anti-wrinkle products, like Botox, are neuromodulators. Their job is to temporarily relax the specific muscles they’re injected into. For a gummy smile, I target those two small ‘elevator’ muscles that run alongside your nose and attach to your upper lip. As I mentioned before, these are the muscles responsible for pulling your lip up high when you smile.

The treatment itself involves a tiny, precise injection of the product into a specific point on each side of the nose. By placing a small dose there, I’m not ‘freezing’ your muscle, I’m simply just reducing its pulling power. The muscle still works, but it just doesn’t contract with the same extreme force.

As a result, when you smile, your upper lip doesn’t retract as high as it used to. It gently relaxes downwards by a few millimetres, providing more coverage over the gum line. It’s a beautifully simple and elegant solution that directly addresses the muscular cause of the issue, all without any need for fillers or surgery.

How does the treatment work? And how do you protect my smile?

This is probably the most important question, because the fear of an unnatural result is super valid. We’ve all seen smiles that look a little odd after treatment, and my whole approach is about avoiding that.

Having performed so many gummy smle corrections, it’s clear that the key to a natural result is precision and subtlety. The injections should be placed carefully into the muscle on either side of the nostrils. My extensive anatomy training, including time spent on cadavers (opening up real, human faces), has given me a deep, 3D understanding of exactly where that muscle is and, just as importantly, where it isn’t.

The biggest risk is the product spreading to nearby muscles that control other parts of your smile, which could cause drooping or your smile to become asymmetrical. To avoid this, I follow two strict rules:

1. Micro-Dosing: I use the smallest effective dose, especially for your first treatment with me. This helps us learn exactly how your muscle responds so we can use this feedback to fine-tune the perfect amount for you going forward.
2. Precise Placement: The injection goes into a very specific point (based on your individual anatomy) to make sure we only relax the intended muscle.

The goal isn’t to stop your lip from moving. A frozen smile is not a beautiful smile. We’re simply just softening that upward pull so your lip lifts a little less. You’ll still have your full, gorgeous, expressive smile. The only difference is you’ll see less gum and more of your lip. For me, a successful treatment is one that nobody else can spot, just that they notice you look great.

What will my treatment journey look like?

I believe your journey is just as important as your result. It should feel clear and supportive from start to finish. Here’s how it works at my clinic:

• The Consultation.
  This is the most important part. We’ll sit down and just talk. I don’t want to just look at your smile, I want to understand how you feel about it. What do you notice in photos? What’s your goal? We’ll also go over your medical history to make sure you’re this treatment is safe for you.
• The Assessment.
  This is where my clinical hat comes on. I’ll ask you to smile and make different expressions so I can see your facial muscles in action. I’ll be assessing the degree of muscle pull, your facial symmetry, and how your lips move. This is the diagnostic step that informs the treatment plan.
• The Plan.
  Based on my assessment, I’ll explain exactly what I recommend, where I would inject, and what kind of result you can realistically expect. We only proceed if you feel 100% comfortable and informed.
• The Procedure
  This part is super quick. After cleaning and marking the area, the actual injections take less than 30 seconds. It’s a few tiny pinpricks, and then it’s done.
• The Review.
  After a few weeks, once the full effects have taken effect, you can send me some snaps. I’ll review them and log everything in your file. This info will help me fine-tune your dose over time, so we can start gently and safely, and then adjust things to give you consistent, beautiful results.

Is it painful? And what’s the downtime?

Honestly, this is one of the easiest and most comfortable treatments I do at my Birmingham clinic. Most my patients are surprised by how quick and painless it is (some of my regulars for gummy smile treatment even skip the numbing cream!).

I use a very, very fine needle. It feels like a tiny, sharp pinprick on each side of the nose that lasts just a second. Most people rate the discomfort at a 1 or 2 out of 10. It’s over before you even realise it.

As for downtime, there’s practically none. This is a true “lunch break” treatment. You can go straight back to work or your usualy activities immediately afterwards. The only visible sign might be two tiny red dots at the injection sites, which usually fade within an hour.

I usually suggest avoiding strenuous exercise, saunas, and alcohol for the rest of the day to reduce any risk of swelling. But you absolutely don’t need to book any time off work or hide away. You can walk out of the clinic and get right back to your day.

How long do the results last? And what happens to my smile as it wears off?

For most people, the results will last for approximately 3 to 4 months. The longevity can vary slightly depending on your individual metabolism and the strength of your muscles. Some people who’ve had the treatment done consistently find they can go a little longer between appointments, perhaps up to 5 months, but 3-4 months is the average in my patients.

As the product starts to wear off, the effect won’t just suddenly stop overnight. It’s a very gradual process. You’ll simply notice your lip slowly starts to lift a little higher again when you smile, gradually returning to how it was before the treatment. There is no strange intermediate phase, your smile will just revert to its original state.

I see the temporary nature as a positive. It means you’re always in complete control. It gives you the power to decide if and when you want to maintain the result, without being locked into a permanent change. Think of it like a haircut or colour. It’s something you maintain because you love how it makes you feel.

What are the potential side effects and how do you manage them?

As a medical professional, transparency about risk is my absolute priority. While this is a very safe procedure in experienced hands, no injection is without potential side effects.

The most significant risk, and the one I work hardest to avoid, is an asymmetrical smile. This can happen if the product spreads and affects a neighbouring muscle that helps control the shape of your smile. This could cause one side of your lip to move differently from the other, or for the lip to feel a little ‘heavy’ or look elongated when you talk or smile.

This is precisely why choosing an injector with an intimate, three-dimensional knowledge of facial anatomy is paramount. My job is to place the product only where it’s needed.

If an asymmetry were to occur, the first thing to know is that it is always temporary. It will fully resolve as the product wears off over the 3-4 month period. Secondly, at your two-week review appointment, we can often improve a minor asymmetry by adding a tiny droplet of product to the other side to restore balance. This is why the follow-up is so critical.

Other less common risks include a small bruise, temporary swelling, or a headache, but these are minor and resolve quickly. For me, having a plan isn’t just about managing a side effect if it happens; it’s about having the deep expertise to minimise the risk of it happening in the first place.

What qualifications should I look for in a practitioner for this treatment, and what influences the cost?

This is the most important question for your safety. In the UK, the aesthetics industry is shockingly unregulated, so the responsibility falls on you to choose your practitioner wisely.

First and foremost, you should only ever be treated by a qualified and registered medical professional. This means a Doctor, Dentist, Prescribing Nurse, or Prescribing Pharmacist. These professionals have years of university-level anatomy and physiology training, are accountable to a governing body (like the GMC, GDC, NMC, or GPhC), and are trained to handle medical complications. Although there are exceptions, most people who have only completed a short, private training course will not have this foundational knowledge.

Beyond the basic qualification, you should ask:

• How long have you been injecting?
• How many gummy smile treatments have you performed?
• Can I see before-and-after photos of your own patients? (Not stock image!)
• Are you insured, and can you manage complications?

Regarding cost, it’s crucial to understand that you are not just paying for a few units of product. The price reflects several factors:

1. The practitioner’s expertise: You’re paying for their years of training, skill, and safety record. An experienced medical professional will rightly charge more than a novice.
2. The consultation & follow-up: The cost should cover a comprehensive initial consultation, the treatment, and thoughtful aftercare. A cheap price often means some of these steps aren’t being taken seriously.
3. The quality of the product: I only use premium, licensed, pharmacy-sourced products like Botox®.
4. The clinic environment & insurance: A professional, clinical setting and comprehensive insurance are essential overheads that contribute to the cost.

A low price is almost always a red flag in this industry. When it comes to your face and your smile, you are investing in expertise, safety, and a beautiful, natural result. Please, choose wisely.

I’ve performed countless Gummy smile treatments in my Birmingham clinic. If you suffer from one and it’s bothering you, please don’t hesitate to schedule an appointment and we can work together to improve it.