Gummy Smile Correction: What Botox Can and Can’t Fix

Gummy smile Botox can reduce how much gum shows when you smile, but only when the cause is a lip that lifts higher than average. In this guide I explain the different causes of a gummy smile, which one Botox treats, what the research shows about how much it helps and for how long, and how it is assessed.

A gummy smile has more than one cause

Only one cause of a gummy smile responds to Botox: an upper lip that lifts too far when you smile. The others are about bone, teeth and gum tissue, and no injection changes those. A 2023 systematic review in the Journal of Clinical Medicine (Rojo-Sanchis and colleagues, University of Valencia) defines a gummy smile as more than 2 mm of gum showing at a smile, and lists these causes:

Cause	What is happening	Who usually treats it
Upper lip hyperactivity	The lip-lifting muscles pull the lip higher than average	Botox, by an injector
Vertical maxillary excess	The upper jaw is longer than average	Orthodontist or oral surgeon
Altered passive eruption	Gum tissue still covers part of the teeth, so they look short	Dentist or periodontist
Gum enlargement	The gum tissue itself has thickened	Dentist or periodontist
Short upper lip or over-erupted teeth	Lip length or tooth position	Dental assessment

Many people have more than one of these at once. That is why a result can’t be promised from a photo, and why a dental opinion before or alongside Botox is sometimes the right step.

Is gummy smile Botox FDA-approved?

No. Using Botox to treat a gummy smile is off-label. Botox Cosmetic is FDA-approved for frown lines, crow’s feet, forehead lines and platysma bands in the neck, according to its prescribing information. The upper lip is not one of those areas. Off-label use of an approved product is legal and is described in many published studies, and it is explained before treatment.

What the research shows

How much less gum shows

The 2023 review pooled 11 studies. Two weeks after treatment, gum show fell by an average of 3.22 mm across 9 studies and 213 patients. At three months the average reduction was still 2.70 mm, across 5 studies and 182 patients. Before treatment, the average gum show in those studies ranged from 3.5 to 7.2 mm, so for many people that reduction is the difference between a gummy smile and a typical one.

The results varied a lot between studies, and the authors call the evidence heterogeneous. An earlier meta-analysis in Brazilian Oral Research (Chagas and colleagues, 2018) found a reduction of about 4.4 mm at two weeks and a stable effect to at least eight weeks, but only three studies qualified, and the authors asked for trials with at least six months of follow-up.

How many units

The doses are small: about 1.25 to 7.5 units per side across the studies in the 2023 review, with about 2.5 units per side used often. Interestingly, the review found that a higher dose did not predict a bigger reduction. Placement and the pattern of the smile mattered more than the number.

How long it lasts

Expect a shorter effect than on the forehead. The 2023 review reports that gum show creeps back gradually after the first few weeks, and in studies that followed patients for 8 to 9 months, gum show had returned to about where it started. It can wear off sooner for some people than for others, so the timing of repeat treatment should be planned around how your own result holds.

How a gummy smile is assessed and treated

1. Smile assessment. Your smile is looked at at rest, at a social smile and at a full smile, to see how much gum shows and where.
2. Sorting out the cause. If your teeth look short or the gum line looks uneven, see a dentist or periodontist as well, because Botox won’t change that part.
3. A small first dose. The dose is set at the consultation, starting low, and placed into the muscles that lift the upper lip.
4. Judge it at about two weeks. If anything looks uneven at two weeks, contact us; that is when small adjustments are judged.

Gummy smile Botox vs a lip flip

A gummy smile treatment and a lip flip both use small doses near the upper lip, but they do different things. Gummy smile treatment targets the muscles that lift the lip, so less gum shows when you smile. A lip flip relaxes the edge of the lip itself, so more of the pink lip shows. The two are sometimes combined; ask at your consultation which one fits your smile. Our guide to lip flip vs lip filler covers the lip flip in more detail.

What gummy smile Botox costs at KORA

Prices come from our current price list. Your plan and total are confirmed at a complimentary consultation before anything begins.

Next steps

Read more about Botox at KORA and what to expect week by week in our Botox timeline. Smile assessments take place at our clinic on the Scottsdale and Paradise Valley border.