Gummy smile: cosmetic surgery as a permanent solution

Some people find it difficult to smile in public when that smile exposes too much of their gums. We call this a gummy smile when the upper lip appears to ride up too high relative to the teeth, giving the smile a « toothy » look. Plastic surgery offers an effective, permanent solution to correct and refine this facial feature so you can feel more at ease in social interactions. A range of procedures, more or less invasive, with varying pain and scarring, can help those affected say goodbye to their self-consciousness with a more natural smile and without fear of how others see them. Here is an overview of the different procedures available to overcome a gummy smile.

What defines a gummy smile?

A gummy smile is the term used to describe a type of smile that opens too wide and reveals the gums and upper teeth, often partially but sometimes fully. It shows up as lips that draw back to expose the teeth and gum tissue more and more clearly as the smile widens. The gums of the upper incisor-canine group are then overly exposed, sometimes with significant psychological and social consequences for those affected.

In practice, clinicians speak of a gummy smile when the height of gum visible during a smile exceeds roughly 3 mm: below that, the amount of exposed gum is still considered a harmonious smile. This benchmark, widely accepted in the dental and orthodontic literature, helps distinguish a simple cosmetic feature from a gummy smile that may warrant correction.

The smile indeed plays a very important social role through its ability to convey positive emotions and expressions to the people we talk to. An unattractive smile can therefore create a relational barrier for those affected, both professionally and personally in social or family relationships. Correcting a gummy smile is consequently an increasingly common request, which can be carried out using different procedures depending on the cause (sometimes multiple) identified beforehand.

The possible causes of a gummy smile

Smiling involves engaging different parts of the face, namely the facial muscles that raise the corners of the lower and upper lips, whose movements expose the gums, the maxilla and the teeth.

The causes of a gummy smile can therefore be varied and sometimes overlapping, and notably include:

• a physical or muscular abnormality of the various components of the facial anatomy, including an overdeveloped gum that rides too high on the upper jaw, or an upper or lower lip that is too thin and covers the gums insufficiently;
• a dento-maxillary abnormality with an abnormal protrusion of the alveolar bone (proalveolia) or of the lower jawbone (prognathism);
• excessive muscle activity raising the upper lip or, conversely, an excessive weakness of the orbicularis oris muscle that relaxes too much. Overactivity of the muscles that raise the upper lip is generally the main cause of a gummy smile;
• a dental positioning that pulls too far up toward the nose, or an incomplete tooth eruption that leaves the crowns partly covered by the gum;
• an abnormal shape or position of the jaw with an insufficiently pronounced frenulum between the lip and the upper gum (the muscle attachment being too short).

The different treatments to correct a gummy smile

Because the causes of a gummy smile can be multiple and varied, they call for different solutions tailored to each situation. A gummy smile may sometimes be the result of a loss of lip volume, and other times that of an overcontracted upper-lip muscle. These two situations, for example, require a different and tailored medical treatment: a hyaluronic acid injection in the first case, or Botox injections in the second.

If the cause of the gummy smile is a bony deformity of the maxilla, then the standard surgical treatment known as « maxillary impaction » must be considered. A less invasive alternative is the upper-lip repositioning technique, which can be performed under local anaesthesia and without hospitalisation. Finally, other solutions focused mainly on periodontics and dental aesthetics can also be considered.

Choosing the right procedure depends on the height of exposed gum, the identified cause and the patient’s expectations regarding whether or not the result should be permanent. A consultation with a surgeon makes it possible to establish this diagnosis and prioritise the options.

Plastic surgery to correct a gummy smile permanently

Several plastic surgery procedures exist to correct an overly pronounced gummy smile. These may involve the jaw or the lips depending on the patient’s anatomy responsible for this « cosmetic flaw ».

Maxillofacial surgery

The maxillary impaction osteotomy is a relatively invasive surgical procedure that consists in reducing the height of the maxillary bones by reshaping the upper part of the jaw. This maxillofacial surgery therefore requires anaesthesia and a stay of at least one night in the clinic, as well as a long recovery period. It is regularly accompanied by pain in the maxillary area during the first few days, as well as a bruise that usually fades after two weeks.

Despite its drawbacks related to the heaviness of the procedure, this surgery has the advantage of being very effective, with long-lasting results and without leaving any visible scars. It will, however, require a certain amount of social downtime (at least ten days or so) as well as a soft diet for about a month. When the bony imbalance is marked, this procedure is akin to a form of chin and jaw reshaping surgery and often fits into a treatment plan combining orthodontics and surgery.

Maxillofacial surgery may give entitlement to a partial reimbursement from the French national health insurance with no age limit, when it meets a purely functional objective (to correct a dental occlusion, i.e. teeth that fit together poorly) or a mixed objective (functional + cosmetic). Reimbursement is not possible, however, when the goal is purely cosmetic.

Upper-lip repositioning

Less heavy than maxillary impaction, the upper-lip repositioning technique (or lip repositioning) consists in removing a thin strip of mucosa from the inner surface of the lip in order to limit how far it rides up when smiling and to better cover the gum. Performed under local anaesthesia, without hospitalisation and without acting on the bone, it is suited to gummy smiles linked to muscular overactivity or to a lip that is too short. The recovery is mild (swelling and bruising for a few days). It should be noted, however, that some dental studies report a risk of partial recurrence of the gummy smile in the months or years that follow, as the muscle may regain part of its mobility: the result is long-lasting but not always strictly permanent.

Frenectomy

The surgical frenectomy procedure consists in removing the frenulum of the upper lip in order to reduce the distance between the upper central incisors when these are too far apart. It is a common procedure that can be performed quickly and with little post-operative recovery. Using a laser as a complement allows minimal bleeding and faster scar healing thanks to a vaporisation of the fibres that make up the frenulum.

Turning to aesthetic medicine to correct the gums without surgery

For patients who wish to avoid surgery, or when the situation at rest is satisfactory, less invasive aesthetic medicine solutions exist to reduce the appearance of the gums. These are not permanent, however.

Botox injections for a gummy smile

A gummy smile can be treated with botulinum toxin injections into the lip-elevator muscles. In practice, two or a few micro-injections placed on either side of the nostrils prevent the excessive contraction of the muscles that draw the upper lip up, thanks to a relaxation of the lip-elevator muscle; the lip then drops slightly and covers more of the gum. Botox injections for a gummy smile produce results visible within just a few days (about 4 to 7 days, once any bruising has cleared) and last around six months. They therefore need to be repeated for a lasting result. For a more subtle and gradual effect, some people turn to Baby Botox, a micro-dosed technique. Botulinum toxin is often enough to treat most gummy smiles; in some cases, however, used in excess, it plumps the lip too much and partly hides the teeth, hence the importance of precise dosing.

Hyaluronic acid injections

When the upper lip is too thin, hyaluronic acid injections to plump the lip performed in the office make it possible to increase its thickness harmoniously to better cover the gums and correct their abnormal exposure when smiling. It is the same principle as for lip-volumising techniques such as Russian lips, but applied here to correcting the smile. The effects again last around six months depending on how strongly the muscles contract.

Other solutions to treat visible gums

Beyond surgical or aesthetic medicine solutions, other options that most often call on dental specialists can be used, with varying effectiveness depending on the technique.

When the gummy smile comes from an excess of visible gum (a gum that is too thick or an incomplete tooth eruption), the dental surgeon can offer a gingivectomy or a gingivoplasty. These procedures, most often performed with a laser, consist in removing or reshaping the excess gum on the visible surface of the teeth in order to rebalance the gum line and restore a harmonious height to the crowns. The recovery is generally mild and scar healing fast.

To treat a very mild gummy smile in adults, it is for example possible to limit oneself to a purely orthodontic method, through a process of intrusion of the upper incisors. This type of movement remains very limited in terms of impact, however, as it only results in about 2 mm of coverage at most, which does not always meet patients’ demands, particularly those with severe cases. It also does not give entitlement to reimbursement from the French national health insurance for adults.