A smile that lifts the upper lip high enough to show a wide band of gum is common and completely normal. Still, many people feel self‑conscious about it, especially in photos or bright lighting. In clinic, I hear the same refrain from patients: they love their teeth, they like their lips, but when they grin, the gums steal the show. Gummy smile Botox is a small, precise tweak that relaxes the muscles lifting the upper lip, softening the upward pull so more attention stays on teeth and eyes. When done thoughtfully, the result looks natural, not frozen. The trick is dose, placement, and judgment.
This guide walks through how gummy smile treatment works, where the injections go, how many units to expect, what it costs, and the safety checks a good provider follows. I will also cover who is and is not a candidate, how the results compare with alternatives, and what makes aftercare straightforward but worth following. Throughout, you will see where this approach overlaps with other areas you might already know, like Botox for frown lines or a lip flip, and where it differs.
What a “gummy smile” actually is
Gummy smile is a descriptive term, not a diagnosis. It refers to excessive gingival display, usually more than 3 to 4 millimeters of visible gum above the upper teeth when smiling. The causes vary:
- Hyperactive elevator muscles of the upper lip, which lift a bit too strongly when you smile. A short upper lip, which unveils more gum line even with normal muscle activity. Vertical maxillary excess, where the midface anatomy presents longer and shows more gum by design. Tooth and gum factors, such as short clinical crowns or altered passive eruption.
That distinction matters, because Botox injections help when the issue is muscular. If bone or tooth proportion drives the show, you may need dental work, gum contouring, or orthognathic surgery for a definitive fix. Many patients have a mixed picture. We often start with small‑dose neurotoxin because it is reversible, low‑risk when done correctly, and gives real‑world feedback about how much softening of the lip elevator you like.
How Botox addresses a gummy smile
Botox, or more precisely botulinum toxin type A (including Botox Cosmetic, Dysport, Xeomin, and others), is a neuromodulator. It reduces the ability of a muscle to contract as strongly by blocking acetylcholine at the neuromuscular junction. For gummy smile, we target the elevator muscles that pull the upper lip upward: levator labii superioris, levator labii superioris alaeque nasi, and zygomaticus minor. A small dose in the right spots dampens the peak lift without changing your resting lip position, speech, or ability to drink from a straw.
You still smile. You still look like you. The lip just does not jump as high, so the gum band narrows. This is not a botox facial for overall anti‑aging or a non‑surgical facelift. It is a focused adjustment, closer to a lip flip in concept than Botox for forehead lines.
Injection sites and technique that actually work
Most providers use one of two patterns.
First, the classic Yonsei point, a triangle landmark where the three main elevator muscles intersect near each nostril. With this method, micro‑doses are placed bilaterally, a few millimeters lateral to the nostril crease. It is efficient and minimizes the number of pokes. A patient with mild to moderate gingival display often top-rated botox in Massachusetts responds beautifully to this single site on each side.
Second, a refined multi‑point approach that spreads even smaller doses across two or three micro‑sites per side. This lets the injector customize lift reduction and preserve your smile’s character. I lean toward botox near me this approach for asymmetry, wider smiles, or when we want the lightest touch.
Either way, the needle is tiny, and the depth is superficial to mid dermal, just enough to reach those elevators. The botox dosage is low compared to the glabellar complex between the eyebrows or the fronal lines across the forehead. Think of it as baby botox for the upper lip elevators rather than heavyweight dosing you might see for masseter contouring or Botox for migraines.
How many units to expect
This is the question everyone asks at the consultation. The range is small compared to other areas, but nuance still matters.
- Typical starting dose per side: 2 to 4 units of Botox Cosmetic. Total starting dose both sides: 4 to 8 units. Touch‑ups after 2 weeks if needed: 1 to 2 units per side.
If you are switching products, dosing equivalence is not 1 to 1 across all brands. Dysport often uses a higher unit number for a similar effect, and Xeomin is more comparable unit for unit with Botox Cosmetic. These are guidelines, not rules.
Patients with a short upper lip or very strong levator pull may need the high end of the range. Those with narrow smiles or subtle gummy display often do well with micro dosing. The injector’s eye counts here. A conservative start, followed by a quick botox follow up, usually produces more natural results than being aggressive on day one.
What it costs, and how price is quoted
Clinics typically price either by unit or by area. Since a gummy smile uses fewer units than, say, Botox for crow’s feet, paying per unit often makes sense.
- Per‑unit price: usually 10 to 20 USD per unit, depending on the market and provider credentials. Total treatment cost: commonly 60 to 200 USD for 6 to 10 units of Botox Cosmetic. Follow‑up tweak at two weeks: 20 to 80 USD if additional units are needed.
Geography drives the spread. A board‑certified dermatologist or a highly experienced nurse injector in a major city charges more than a newer clinic in a smaller market. Beware of deals that sound too good. Rock‑bottom botox price points can indicate diluted product, inconsistent storage, or rushed technique. If you are searching “botox near me specials,” apply the same skepticism you would with dental work. You want a botox certified provider using authentic product, stored and reconstituted properly, with plenty of before and after photos specific to gummy smiles.
What the appointment feels like
The botox procedure is brief. You will check in, review your medical history, and discuss what you want to change and what you want to keep. Your provider will examine your smile at rest, social smile, and full grin. They will map the elevator pull, sometimes marking a dot at each planned point, and may snap clinical photos for botox before and after comparison.
The injections themselves take around two minutes. Most patients describe the pain level as a light pinch with a bit of watering in the eyes, more a reflex than true discomfort. Numbing cream is rarely necessary. You may notice a small raised bump at each site that settles within 20 minutes.
Timeline, results, and how long it lasts
Nothing dramatic happens in the first day. Around day three, you might catch a hint that your top lip is not climbing quite as high. The effect builds to a peak at about 10 to 14 days. That two‑week mark is a good time for a quick check. If your smile still shows more gum than you want, a tiny botox touch up can finish the job.
Expect results to last 8 to 12 weeks in the gummy smile area, sometimes up to 16 weeks if your metabolism is slower. The muscles here are small and active, so duration trends shorter than the 3 to 4 months you might see with Botox for frown lines. Many patients schedule maintenance every 3 months. A few prefer seasonal treatments before busy periods, such as weddings or photo‑heavy travel.
Signs it is wearing off are straightforward. The upper lip begins lifting higher again during big smiles, and your old pattern returns gradually over a couple of weeks. You can extend the smooth, subtle enhancement look with consistent botox maintenance rather than stretching to the last possible week every time.
Safety profile and what to watch for
On the whole, this is a low‑dose, high‑precision treatment with minimal downtime. The most common short‑lived effects are pinpoint redness, slight swelling, or a faint bruise. These settle quickly. Makeup can cover a small mark the next day.
What we work to avoid are unwanted changes in smile dynamics. The upper lip can look heavy or drop at the corners if dosing exceeds what you need, or if product diffuses too far. That is why I keep doses small at the first botox consultation, especially in first‑timers. In my practice, asymmetry is the most frequent adjustment at the two‑week visit, corrected with a unit or two. Over‑relaxation typically softens in several weeks as the toxin fades.
True complications such as allergic reactions are rare. Still, there are clear contraindications: pregnancy or breastfeeding, active skin infection at the injection site, certain neuromuscular disorders, and a known hypersensitivity to botulinum toxin. Share your full medication list at the consult, including blood thinners and supplements like fish oil or ginkgo that can increase bruising.
Who makes a good candidate
If your gummy smile is primarily driven by hyperactive muscle pull and you want a reversible, fast solution, you are likely a strong candidate. Someone with vertical maxillary excess may still benefit from neuromodulator treatment, but expect a partial improvement. Setting goals clearly helps. A patient wanting zero gum to show at any time may prefer combined approaches with dentistry or surgery. Someone hoping for a softened, natural look, where the gum band shrinks a few millimeters, tends to be delighted with Botox results.
Facial harmony matters. If you are also considering a lip flip or filler, plan the sequence. Many patients like a tiny, precise lip flip after their gummy smile is tuned. The flip increases vermilion show without adding volume, while the gummy correction stops the upper lip from vaulting too high. Fillers can look nice in the midface or lips, but add volume thoughtfully. Too much filler in a patient with a short upper lip can exaggerate protrusion when smiling.
Botox vs Dysport and other brands
Botox Cosmetic and Dysport are the two most common brands I use for this area. Both work well. Dysport diffuses a bit more, which some injectors like for broader, softer effects. In a small, high‑precision area like the lip elevators, that characteristic can be a pro or a con depending on your anatomy and the injector’s technique. Xeomin is a cleaner formulation without complexing proteins, useful for patients who prefer a minimalist ingredient profile. In practice, results hinge more on placement and dose than on brand. If you have had great botox reviews from a friend that used a specific product, share that history with your provider.
How it compares with other options
Surgical lip repositioning is a dental‑periodontal procedure that repositions the upper lip to cover more gum. It can be effective for the right patient and offers longer‑term change. Recovery involves stitches and some swelling. Orthognathic surgery addresses skeletal drivers like vertical maxillary excess and changes the facial third proportions, a larger step with substantial downtime and cost, reserved for significant cases.
Gingivectomy or crown lengthening reshapes the gum line and increases tooth show. If your teeth look short because gum covers too much enamel, this can be the cleanest solution. For muscle‑driven gummy smiles, though, gum trimming alone may not last because the lip still lifts high.
Botox sits at the reversible end of the spectrum. It is not a once‑and‑done fix, but it is affordable, quick, and lets you fine tune. For many patients, the balance of low commitment and satisfying cosmetic improvement beats the permanence of surgery.
What to do before and after: a simple, proven routine
The pre‑treatment checklist is short. Avoid blood‑thinning supplements like fish oil, high‑dose vitamin E, or ginkgo for 3 to 5 days if your doctor agrees. Skip alcohol the night before to lower bruising odds. Come with a clean face or be ready to remove makeup around the upper lip and nose.
After treatment, resist the urge to rub the area for the rest of the day. Keep your head upright for a few hours. Light facial movement is fine, heavy exercise can wait until tomorrow. If you see mild botox swelling or a pinpoint bruise, a cool compress for 10 minutes on and off helps. You can resume skincare that night, aside from aggressive rubbing or devices. If your routine includes retinoids or acids, you can use them, just treat the injection points gently for 24 hours.
What a realistic before and after looks like
Imagine a patient who shows 5 millimeters of gingiva on big smiles, more on the right side. We place 3 units per side at refined elevator points, then see them at day 14. Their teeth dominate the smile now, with 1 to 2 millimeters of gum visible at peak grin, symmetrical side to side. The upper lip still animates, just not as high. Friends notice they look great in photos, but often cannot name why. That is a hallmark of a successful botox cosmetic result, whether it is smoothing fine lines or dialing down lip elevation: subtle enhancement, not a new face.
If you want to judge results before committing, ask your injector for gummy smile specific botox before and after photos, ideally with consistent lighting and expressions. Look for smiles similar to yours. A narrow smile behaves differently than a wide grin that exposes molars, and you want evidence your provider has treated both.
Combining treatments without overdoing it
A gummy smile correction pairs well with a tiny lip flip, a touch for vertical lip lines if present, or conservative midface filler for support. Where I see issues is stacking too many changes at once. For example, adding a large volume of lip filler at the same visit can alter how the upper lip curls and lift, complicating the read on your Botox results. If you are new to all of this, stage treatments. Start with the gummy smile botox treatment, review at two weeks, then decide on a lip flip or filler. That stepwise approach keeps the look natural and makes troubleshooting simple.
If you also get Botox for face areas like the glabella or around the eyes, timing can be the same day. The areas are independent in terms of function, and combining can be convenient. Your injector will chart botox injection sites and units per area so maintenance remains consistent.
How to choose the right provider
Credentials matter, but so does experience with perioral injection. A board‑certified dermatologist, facial plastic surgeon, or an advanced practice nurse injector with a strong perioral portfolio are safe bets. During your botox consultation, ask:
- How many gummy smile cases do you treat monthly, and may I see case photos similar to mine? What is your starting dose range and your follow‑up policy for touch‑ups? How do you handle asymmetry or over‑relaxation if it occurs? Which product do you prefer here and why?
Notice whether the provider studies your smile at rest, social, and full grin. They should point out your anatomy with a mirror, discuss realistic botox results and duration, and outline aftercare in plain language. If you feel rushed or sold a package without evaluation, keep looking. Reading botox clinic reviews can help, but nothing replaces a careful in‑person assessment.
Side effects, myths, and facts worth clarifying
A few myths come up often. First, that Botox always makes you look stiff. In this area, stiffness is a sign of too much product. A light dose changes peak lift, not your personality. Second, that the body becomes “dependent.” Muscles do not withdraw when toxin wears off. You simply return to baseline. Third, that Botox for wrinkles in the upper face somehow migrates to the lip. Diffusion is local. Proper spacing and depth contain effect.
Possible side effects include temporary soreness, a small bruise, or mild headache. Rarely, an uneven smile needs a quick balancing touch. If you experience difficulty speaking or drinking, which is uncommon at these doses, call your provider. Most issues are dose related and subside as the product wears in several weeks.
Long‑term use does not appear to cause permanent muscle damage at cosmetic doses. Some patients notice that over many cycles, they need fewer units to get the same result, likely because the muscle learns a lower peak contraction pattern. That is a welcome change, especially in small areas like the lip elevators.
For first‑timers: what to expect without overthinking it
Most first‑time patients are surprised by how quick and precise the process feels. You are in and out in under 20 minutes. You will not see dramatic change in the mirror that day, and that is a good thing. The shift arrives quietly over the first week. By day ten, your smile reads as you, just more tooth and less gum.
Set a simple botox touch up schedule with your provider. Mark your calendar for a two‑week check, then plan maintenance every 3 months. If you later decide to stop, your smile rebounds to its original pattern over several weeks. There is no rebound past baseline. If you track photos, take them in the same light and expression for honest botox results time comparisons.
Where gummy smile fits in the bigger picture of facial aesthetics
Botox for gummy smile sits in a family of small, high‑impact adjustments: Botox for chin wrinkles to soften pebbled texture, a tiny lift at the lateral brow for open eyes, or a conservative dose in the DAO muscles to turn off downward drag at the mouth corners. Each tweak deals with muscle action, not volume. Paired with smart skincare and sun discipline, these changes keep the face dynamic yet rested.
Patients who love a natural look appreciate how these treatments avoid cartoonish fullness. If you are already using preventative botox across the upper face, adding gummy smile correction can complete the expression refresh without advertising that you had work done. For men who worry that lip treatments will feminize features, low‑dose gummy smile botox keeps a masculine smile by respecting natural lip shape, simply reducing gum show.
Final practical notes before you book
If you are price shopping, compare per‑unit rates and expected units honestly. A low per‑area price that quietly uses more units can level out or exceed a fair per‑unit quote. Ask about the reconstitution ratio and whether the clinic uses brand‑name product. Bring a clear photo of your biggest smile for your first visit, ideally one that bothers you, so you and your provider can set a target.
Most importantly, decide on the look you want. A small improvement often feels more believable than perfect concealment of gum. If you prefer a stronger change, say so at the botox consultation, and plan for the two‑week reassessment. That is the beauty of neuromodulators: a few well‑placed units, a careful follow‑up, and your smile lands right where you like it.
By managing dose, respecting anatomy, and choosing a thoughtful injector, gummy smile Botox delivers what patients ask for most, a smile that looks like them on their best day, every day.