A flash of gum can steal the spotlight from a beautiful smile. If more than 3 to 4 millimeters of upper gum shows when you grin, you probably know the feeling: you smile smaller, tilt your chin down in photos, or rehearse a closed-lip expression. In clinic, I meet patients who love their teeth but hide their smiles because their lips lift too high. They are not chasing perfection, just proportion. For many of them, small, strategic doses of Botox are the turning point.
What a gummy smile really is
“Gummy smile” is a descriptive term, not a diagnosis. It means the upper gingiva shows prominently while smiling. The cause varies, and that matters, because treatment has to match the reason.
I evaluate gummy smiles in four dimensions: vertical maxillary height, lip length, lip mobility, and tooth position. Sometimes the upper jaw sits lower relative to the face (vertical maxillary excess). Sometimes the upper lip is short at rest or the muscles that lift it are overactive. Sometimes the teeth and gums are fine, but the smile pattern has developed into a high pull over years. Often, it is a blend.
Botox works best when hyperactive lip elevator muscles are the main driver. Those muscles include the levator labii superioris alaeque nasi, levator labii superioris, and zygomaticus minor. When these activate strongly, the upper lip arcs upward like a window shade, and gum dominates the frame. Relax those muscles slightly, and the upper lip settles to a balanced height.
How Botox corrects a gummy smile, anatomically
Botox is a neuromodulator. It blocks acetylcholine release at the neuromuscular junction, so the muscle contracts less. In gummy smile correction, the target points are small and specific. You do not freeze the entire smile. You soften the vertical pull that overshoots the ideal lip botox SC line.
There are two classic injection patterns, chosen based on the smile pattern and anatomy.
- The “Yonsei point” technique targets the convergence point lateral to the ala of the nose, where the levator complex overlaps. A microdose at this spot reduces the upward pull without flattening the smile. A divided pattern targets both sides of the nasal base and sometimes a lateral point near the zygomaticus minor. This split approach can give more even control in patients with asymmetry or very strong elevators.
In my practice, dose ranges typically land between 2 and 4 units per side when using onabotulinumtoxinA. Microdosing matters. Too much, and the upper lip feels heavy or expression looks blunted. Too little, and gum exposure remains unchanged. The goal is not a “Botox look.” The goal is a natural smile that reveals teeth first, not gums.
Expect onset in 3 to 5 days, with peak effect around day 10 to 14. Duration runs 8 to 12 weeks on average for this area. The lip elevators are delicate and active, so results here generally do not last as long as forehead lines smoothing or frown line reduction, where muscle bulk is different.
Who is a good candidate
The best candidates are those with:
- Excess gum show mainly from lip elevator hyperactivity, confirmed by observing the smile at rest, half smile, and full smile
If your upper jaw is vertically excessive or your upper lip is structurally short, Botox can still help, but its impact will be partial. It might be part of a staged plan that includes gum contouring, orthodontics, or surgery. For patients with a full, gummy grin and a thin upper lip, pairing targeted neuromodulation with careful lip enhancement without surgery can balance the smile in two ways: reduce vertical lift and add a touch of forward lip roll to cover gum. For a few, a single syringe of hyaluronic acid strategically placed for lip line smoothing and upper lip lines can complement the effect.
People with active neuromuscular disorders, uncontrolled bleeding risks, or a history of poor response to neuromodulators are not ideal candidates. Pregnancy and breastfeeding remain conservative no-go periods. Those with significant asymmetry may still benefit, but dosing has to be individualized.
What I look for in assessment
I start with a simple sequence: face at rest, speaking, half smile, full smile, and a laugh. I watch for the exact moment the upper gingiva becomes visible and how the nose and cheeks move. If the nose tip pulls downward while the upper lip arcs strongly upward, a depressor septi component may need attention. If the gummy area is most exposed near the canines, the zygomaticus minor may be a bigger player. If the exposure is uniform under the central incisors, the central levator complex is likely dominant.
I also palpate to feel muscle activity, lightly pinch to find the most active lift points, and note asymmetry. Previous treatments, dental work, and habits like chronic mouth breathing or lip incompetence at rest all inform the plan.
A practical aside: I ask patients to bring two or three photos where they like their smile and two they do not. The contrast helps us agree on a target. It prevents overcorrection, which is the main risk in this zone.
The procedure, minute by minute
The appointment is short, often under 15 minutes for established patients. New patients take a little longer because of assessment and discussion.
Skin is cleansed. Most people do not need numbing, though I SC botox treatments sometimes use ice to constrict vessels and reduce bruising risk. I mark the planned points, ask the patient to smile, then relax, and I place microinjections with a fine needle. The volume is tiny. Stinging lasts a few seconds.
Afterward, I ask patients to avoid heavy exercise and pressure on the area for the rest of the day. Makeup can usually go on after a few hours if the skin looks calm. Small redness or pinpoint bruises may appear, but they fade.
I book a follow-up at two weeks. This checkpoint matters. If we need a small touch-up for symmetry or additional lift control, that is the safest time. Touch-ups are small, often 0.5 to 1 unit per side.
What results look like, and how long they last
Reduction of gummy exposure is visible by the end of week one. The upper lip does not sit lower at rest. It simply rises less during a smile. Most patients report they forget to think about their smile within a couple of weeks because it feels natural. Friends comment that they look “more relaxed” or that their teeth look straighter, which is a funny effect of better lip framing.
Expect 2 to 3 months of consistent effect, sometimes closer to 4. Shorter duration is common in patients with very strong smiles, frequent laughter or speaking jobs, or high metabolic activity. Over time, some people find the interval lengthens slightly as the hyperactivity calms. Others maintain a regular schedule, such as every 10 to 12 weeks, especially if they also use Botox for frown line reduction, forehead lines smoothing, or smoothing crow’s feet to keep the upper face rejuvenation harmonious.
Why Botox instead of surgery or gum reshaping
Gummy smile correction has a spectrum of options. Botox sits on the conservative end: quick, non-surgical, reversible, and precise for muscle-driven cases. Gum contouring with a laser can address excessive gingival display from long gums or short clinical crowns. Orthodontics can intrude teeth and adjust the bite. Orthognathic surgery can reposition a vertically excessive maxilla, transforming the smile and facial balance. Those are powerful tools, but they carry longer timelines, costs, and downtime.
Here is the trade-off I discuss most: Botox offers immediate, adjustable results with low risk, but it is temporary. Surgery and orthodontics can be definitive, but they are invasive, and they change bone and tooth position permanently. Many patients choose Botox as a diagnostic step. If you love the look and confirm that reducing elevator pull is your missing piece, you can continue with maintenance or explore a longer-term plan with clear expectations.
Avoiding the frozen smile
This is where technique and restraint matter. Over-relaxation leads to a flat smile or a sense that the upper lip does not move. I avoid that by microdosing, respecting each patient’s muscle map, and erring on the side of undercorrection at the first visit. We can always add, but we cannot subtract. Careful placement around the levator labii superioris alaeque nasi is key, since diffusion toward the nasalis can create an odd nose shape on laughing if doses are heavy-handed.
I also protect the lateral smile line. If you already use Botox for crow’s feet wrinkle treatment or eye area rejuvenation, we stagger and balance doses so the corners of the eyes and mouth still lift together. That coordinated movement is what keeps expressions looking like you.
Side effects and how I manage them
Common minor effects include pinpoint bruises, mild swelling, and tenderness that last a day or two. Headaches can occur in a small fraction of patients. Very rarely, unintended spread can change nearby muscle activity, such as a slight change in the nose flare or a temporary sense of lip heaviness. The risk rises with higher volumes and poor placement, which is why I keep doses modest.
If someone is prone to bruising, I advise pausing fish oil and high-dose vitamin E for a week before treatment if medically appropriate, and I use ice before and after. Arnica can help bruising fade faster. If a patient feels too much relaxation, we wait it out. It is temporary, and we lower the dose next time. Allergic reactions to Botox are extraordinarily rare, but I still keep a close eye during the first few minutes post-injection.
The art of proportion: teeth, gums, and lips working together
A pleasing smile shows the incisal edges of the top teeth, a clean lip line, and a hint of gum at most. That tiny ribbon of gingiva can look youthful, especially in your 20s and 30s. The goal is not a zero-gum smile. It is balance. When we tune the elevator muscles, the rest of the face often looks more harmonious. Cheek lifting and firming from good skincare and, when suitable, small filler support at the lip-chin junction can enhance the effect, but restraint still wins.
Patients sometimes ask about using Botox for smile enhancement across the whole lower face. While neuromodulators are useful for chin wrinkles, marionette lines from downturned corners, and jawline slimming from masseter hypertrophy, gummy smile correction must stay precise. Overextending injection patterns risks a smile that feels odd.
Where gummy smile fits in a broader facial plan
A natural smile does not exist in isolation. If you are already using Botox for forehead wrinkle removal, frown line reduction, or smoothing crow’s feet, you want harmony across the upper face. Heavy forehead dosing with minimal lateral eye movement can look robotic. Similarly, lifting brows slightly with conservative dosing while keeping the smile buoyant can brighten tired-looking eyes without the telltale frozen look. For some clients, we also address tired midface or under-eye puffiness with non-neuromodulator options, since Botox does not add volume or lift tissues against gravity.
For patients seeking a non-invasive facelift vibe, we talk about the limits. Botox for non-invasive facelift is a phrase that floats around, but neuromodulators soften lines and modulate muscle pull. They do not lift skin that has laxity. Skin elasticity improvement comes from consistent skincare, microneedling, energy devices, or collagen-stimulating fillers. I set these expectations early to keep trust intact.
Cost, schedule, and realistic planning
Pricing varies by region and clinic, but gummy smile correction typically uses a small number of units, making it one of the more affordable Botox treatments. You can expect to revisit every 2 to 4 months if you want continuous effect. Some patients choose a seasonal rhythm, aligning smile tune-ups with events or photos. Others maintain it as part of total facial rejuvenation, bundled with upper face firming or wrinkle prevention and treatment.
New patients often ask if the injections hurt. Discomfort is brief and low, comparable to a quick pinprick. Ice helps. Anxiety about outcome is more common than pain, which is why photo review and conservative first dosing make a difference. By the second visit, most people are confident about the pattern that fits them.
Case notes from the chair
A 29-year-old dentist came in unhappy with 5 to 6 millimeters of gum show centered under the incisors. Excellent teeth, healthy gums, normal lip length, and very strong levator activity. We placed 3 units per side at the Yonsei point. At two weeks, gum show reduced to 2 millimeters, and her smile looked crisp. She reported no heaviness and kept a three-month cadence.
A 41-year-old public speaker had asymmetry: right side higher lift, plus slight nasal tip pull-down on smiling. We split doses, 2.5 units on the right, 2 on the left, and added 1 unit to depressor septi. The asymmetry flattened. He described it as “my smile lines read as warmth, not tension.” He also used low-dose Botox for reducing forehead furrows, which we kept light to avoid competing cues.
A 35-year-old with thin upper lip and 4 millimeters of gum show wanted a subtle transformation without filler. We used 2 units per side and reassessed at two weeks. Good reduction, but the vermilion still looked tight. We added a small lip enhancement without surgery using 0.3 mL HA in the cupid’s bow and tubercles. The combination covered the final 1 to 2 millimeters of gum and softened upper lip lines. She stayed on a 12-week Botox schedule with infrequent filler touch-ups.
How Botox for gummy smile intersects with other concerns
People often arrive for one issue and then ask about adjacent areas. Used carefully, Botox can support:
- Eye wrinkle treatment and smoothing crow’s feet to match the relaxed, friendlier smile line Forehead lines smoothing and frown line reduction to remove the visual “stress” that competes with a confident grin Chin lifting and softening of chin dimpling that can sharpen the lower third when you smile broadly
On the other hand, requests like botox for face tightening, botox for sagging skin treatment, or botox for neck rejuvenation need honest counseling. Neuromodulators do not tighten loose skin. They can refine bands in the neck in some cases and improve neck contouring when platysmal activity is prominent, but firmness comes from other modalities. Keep each tool doing its best job.
Two things to do before you book
- Check your smile in a mirror at rest, half smile, and full smile, then measure gum show roughly in millimeters using a photo and a ruler on screen. Note where the gum shows most: central, canine area, or uniformly. Gather two favorite smile photos and two you do not love. Show them to your injector. The pattern guides exact injection points and dose.
Botox myths that get in the way
“Botox will make my smile fake.” Not if placed correctly and dosed conservatively. The best outcomes look like you on your best day, not a different person.
“It will stretch my skin over time.” Skin does not stretch from neuromodulation. If anything, reducing repetitive folding can help maintain smooth skin texture around the nose and mouth edges. That said, if static lines are already etched in, Botox alone will not erase deep skin folds. You may need resurfacing, filler, or time.
“It’s permanent, so I should try the smallest dose.” It is not permanent. Starting small is smart, but the correct dose is the one that achieves balance. Under-treating can lead to disappointment and the false belief that Botox “doesn’t work.”
Technique pearls that protect results
We avoid intranasal or too-superior placement, which can change nasal flare in a way patients do not like. We place injections slightly lateral to the ala for even distribution. In very animated speakers or performers, I reduce the starting dose by 0.5 to 1 unit per side to protect diction feel and natural laughter. For those already on regimens for reducing crow’s feet and wrinkles, I stagger sessions by a week or dose lower laterally so the smile corner still crinkles a bit. That tiny movement sells authenticity.
If someone has a history of lip filler migration or a heavy filter column, I adjust plans to avoid compounding heaviness. Sometimes that means skipping filler and relying solely on Botox for smile line reduction, or spacing treatments so we can judge each effect separately.
Beyond the smile: what not to expect from Botox here
Botox for gummy smile correction does not whiten teeth, change tooth alignment, or fix gum recession. It does not add facial volume restoration or treat under eye circles. It will not lift mid-face tissues. Its job is specific: reduce the vertical pull that shows too much gum. Paired with dental care and, when indicated, selective filler or energy-based tightening elsewhere, it can help create a cohesive, refreshed look. But it is one piece.
If you are considering more global changes like enhancing facial symmetry, improving facial contour, or addressing a sagging jawline, your plan likely extends beyond neuromodulators into orthodontics, filler, collagen stimulators, or surgery. I find that clarity here prevents overpromising and underdelivering.
When Botox is not enough
There are cases where neuromodulation underwhelms. If the gum line sits very low relative to the upper lip, you may reduce gum show by a couple of millimeters and still feel it is too much. If your teeth appear short because of excess gum coverage over enamel, a periodontal lift can expose more tooth and change proportions even without touching muscles. If the upper jaw is vertically long, a surgical consult may be the right step. Some choose Botox as a bridge to see how a lower-lip-line smile feels before pursuing a permanent option.
Confidence as the endpoint
The measure that matters is not the millimeters of gum reduced. It is how freely you smile after treatment. Patients tell me they stop editing their expressions in meetings. They laugh without thinking about angles in photos. That mental shift is the real payoff.
If you are curious about whether Botox could restore balance to your smile, start with a precise assessment. Ask about dose ranges, injection points, and expected movement, not just “units.” Bring your photos, describe how you want your smile to look in motion, and insist on conservative first steps. A few careful units can recalibrate your grin from self-conscious to confident, and that is the point.
Quick reference: realistic expectations at a glance
- Effect target: Reduce upper lip elevator overactivity so less gum shows when smiling, without flattening expression Onset and peak: Visible change by day 3 to 5, peak around day 10 to 14 Duration: About 8 to 12 weeks, sometimes a bit longer with repetition Dose style: Microdoses, often 2 to 4 units per side with onabotulinumtoxinA, adjusted for asymmetry Best fit: Muscle-driven gummy smile; partial help in structural causes; complements selective dental or filler treatments
A confident smile is not about hiding. It is about balance. When the lip, teeth, and gums share the frame in the right proportions, the message your face sends matches how you feel inside. Botox, done thoughtfully, can make that alignment possible.