Gummy smile treatment is a common procedure at our Sydney clinic.
Gummy smile is a very common problem where on smiling, a large area of gum can be seen above the upper teeth. Sometimes gummy smiles are genetic, and will run in a family.
Small injections with a very fine needle are used to relax the muscles to bring the upper lip down to resolve the excessive gum display.
The consultation for muscle relaxing injections for gummy smiles
History-taking is very important in the treatment of gummy smile. The following should be explored:
Is there a genetic component? ie are there others in the family who have a gummy smile?
Has the patient had treatment before? Were they happy every time?
Did the effect of the muscle relaxing injections last well?
Which area came back first?
How is the patient’s metabolism? Do they exercise? Are they very muscular? Do they have trouble putting on or losing weight?
How many mm of gum display would the patient like resolved..
Have they every had any complications with muscle relaxing injections before, including difficult with speaking, “the camel” ie the reverse of the gummy smile where there is too little tooth show during smile because of excessive treatment
Does the patient want a more natural appearance, or do they want the maximal effect possible?
Have they used or are they going to use filler in the lips
The doctor will examine the face and gummy smile. In particular, she will look at many features, such as:
How is the appearance at rest, ie with no smile. How is the smile through the whole range of smiling, from the start of a smile to maximal smile
Whether there is an asymmetry, measuring the length of the philtrum.
Choosing the dose for gummy smile
The doctor will assess the gummy smile and decide on the best dose after taking a history and examining the patient. In particular discussing with the patient how many mm of reduction of excessive gum display would the patient want. If there is excess of 6 mm, then that level of treatment can cause a speech impediment.
If the patient has a history of poor longevity, or needing high doses or wanting maximal effect, then a higher dose may be suggested
If a patient has a history of complications with muscle relaxing injections, or if their budget is small or if they want a more subtle result, then a smaller dose might be chosen.
It is very important to assess the philtrum, as some patients may look older with treatment for gummy smile, so may be unsuitable. Your doctor can discuss this with you after your assessment.
Pain relief during treatment
A numbing cream (eg EMLA or LMX ) may be applied to the area prior to the treatment (45 minutes prior is ideal) Glad wrap may be used over the numbing cream to increase its effect.
Most patients do not bother with numbing cream because the gummy smile treatment is very quick and they don’t want to wait so long with the numbing cream for such a treatment that is so quick,
Ice maybe used to decrease pain and to reduce the risk of bruising.
Nitrous oxide (Happy Gas) is available for use with injectables
Very rare patients will use Penthrox for gummy smile treatments
What happens during the gummy smile treatment itself?
The mouth, upper lip and nose area will be cleaned with alcohol.
Ice will be applied to the area briefly before treatment
The doctor will inject approximately 3 sites. Then pressure with gauze will be applied.
The procedure itself takes less than 5 minutes.
Side effects and risks
In general, treatment of the gummy smile is low risk.
Headache happens in around 10% of new users.
Bruising occurs in a significant number of cases.
Asymmetry: One side may be better treated than the other, this is usually because the patient is asymmetrical to start with. In some patients they have a stronger muscle on one side compared to the other.
Infection is a very rare complication, but always a possibility when the needle goes into the skin.
There is a low risk of the speech being affected, also the patient may have difficulty with smoking, drinking through a straw or eating if too high a dose is used.
Also if too high a dose is used then the area can be overtreated, causing “the camel” where on smiling, tooth show is reduced and at rest, the cutaneous lip appears long
Who is unsuitable for treatment of gummy smile with muscle relaxing injections?
Most people with a gummy smile are suitable for this treatment.If a patient has a long distance between their nose and upper lip ie a long cutaneous lip, then gummy smile treatment may not be suitable for them aesthetically, as the appearance may become less attractive due to the area lengthening.
After Gummy Smile Treatment
Instructions for care afterward
No makeup for 4 hours
No massage that day
No heavy exercise that day
No lying down for 4 hours
Lay off the acid face products for 24 hours
What to expect after gummy smile treatment?
Sometimes there is nothing to see. Sometimes there can be redness, small lumps, which can look like mild acne and usually resolve quite quickly.
Most people could come during their lunch break during work and go back without their coworkers noticing anything
The effect of the injections will not start to occur for 2-8 days.
The maximal effect of the drug will be at 3-4 weeks, so a review should be booked for 3 weeks. If at that time, further treatment is necessary, it should be performed.
What if I get asymmetry at some time before the 3 week point? Do I call the doctor?
No. No need to call the doctor. Sometimes asymmetry will occur because one side just comes on quicker than the other. Usually it will right itself by the time of the review appointment. If it doesn’t, then it can be treated at the review appointment. There is no point in coming in early for treatment of asymmetry.
What do I do if at 4 weeks post treatment one side is better treated than the other?
This is not uncommon, at your 4 week review appointment, further treatment may be administered.
How long will the treatment last?
The answer to this is very individual and depends on the patient’s metabolism, the dose, the placement etc.
Typically this is what happens:
At 6-8 weeks, there is a maximal effect
at 8 weeks, movement starts to return
at 12 weeks, 50% of movement should be back
at 16 weeks 80% of movement should be back.
For most patients, this is very close to what occurs.
When should I have my next treatment for muscle relaxing injections in gummy smile?
At 3-4 months is typical. Some patients prefer to have treatment again at 8 weeks
Cost of gummy smile treatment?
Cost starts from $320, it will cost less if combining with treatment of other areas. Please see our current antiwrinkle injection pricing.