A gummy smile, where more gum shows above the upper teeth than you would like, has several possible causes, and Botox treats only one of them. This page covers the Botox option. For the full picture, including gum contouring, crown lengthening and orthodontics, start with our gummy smile treatment page.
At Shield Dental Care in Burke, VA, Dr. Ghorbani uses Botox for a gummy smile when the upper lip is the reason, as part of our Botox service.
When Botox is the right tool
Several small muscles lift the upper lip when you smile. The main ones are the levator labii superioris, the levator labii superioris alaeque nasi, which runs down the side of the nose, and the zygomaticus minor. In some people these muscles are strong enough to lift the lip well above the teeth, exposing a band of gum. Relaxing them a little lets the lip come down, so less gum shows.
That only helps when the lip is the cause. If the gum shows because there is extra gum tissue, because the teeth are short or partly covered, or because of how the upper jaw has grown, Botox will not fix it, and one of the other treatments on our gummy smile page is likely to suit you better. A gummy smile can have more than one cause. Working out which applies to you is the first job at the consultation, and it is where a dental exam matters.
How the treatment works
A small dose is placed on each side, usually close to where the side of the nose meets the cheek. The published studies used a small number of injection points per side, and doses vary with how much gum shows and how strongly the lip lifts. The smile itself still works; the lip simply rises less far.
An off-label use
No botulinum toxin product is FDA-approved for a gummy smile. BOTOX® Cosmetic is approved for frown lines, forehead lines, crow’s feet and neck bands, and Dysport and Daxxify for frown lines only, so using any of them here is off-label. That is legal and common, and we explain it as part of consent before treatment.
Results and how long they last
Most of the change shows within about two weeks. Botox for a gummy smile is temporary: in a 2022 systematic review, the effect lasted between 12 and 36 weeks, depending on the study. A 2023 review found that results fade gradually but were still clearly better than before treatment at 12 weeks. Keeping the result means repeating the treatment, no more often than every three months. If you want something that lasts, one of the dental or surgical options may be the better choice, and we will talk that through.
Side effects
Most people have nothing more than small bumps, redness or a bruise at the injection points. The side effect specific to this area is the upper lip sitting too low or unevenly when you smile, if the effect is stronger than intended or spreads to a neighboring muscle. The reviews describe side effects in gummy smile treatment as mild and temporary, and like all Botox effects it wears off. We start with a cautious dose for that reason.
All botulinum toxin products carry an FDA boxed warning: rarely, the effect can spread away from the injection site, causing trouble swallowing, speaking or breathing, vision problems or general muscle weakness, hours to weeks after treatment. These are medical emergencies. If they happen, get help immediately.
Who should wait
- Anyone pregnant or breastfeeding. Cosmetic botulinum toxin has not been adequately studied in pregnancy, so we recommend waiting.
- Anyone allergic to a botulinum toxin product, or with an infection or skin problem where the injections would go.
- Anyone with a nerve-and-muscle condition such as myasthenia gravis, Lambert-Eaton syndrome or ALS.
- Tell us if you take blood thinners, have recently taken aminoglycoside antibiotics, or have had any botulinum toxin treatment in the last four months.
A gummy smile is often one part of a bigger smile plan. See our smile makeover page, or read about the Botox lip flip, which works on the edge of the upper lip rather than the muscles that lift it.
Frequently Asked Questions
Does Botox fix a gummy smile for good?+
No. It wears off over a few months, and keeping the result means repeating it. Gum contouring, crown lengthening or orthodontics can give a longer-lasting result when they suit the cause.
Will I still be able to smile normally?+
Yes. The aim is for your upper lip to rise less far, not to stop you smiling. If the effect is stronger than intended, the lip can sit low or uneven for a while before it wears off.
How do I know if Botox will work for my gummy smile?+
It helps when the upper lip lifts too high. If extra gum tissue, short teeth or the shape of the jaw is the cause, Botox will not fix it. A dental exam is how we tell which it is.
Is Botox for a gummy smile FDA-approved?+
No. It is an off-label use for every brand. That is legal and common, and we discuss it before treatment.