What is gummy smile botulinum toxin?
Gummy smile botulinum toxin is a procedure based on temporarily reducing the movement of the muscles that pull the upper lip upwards during smiling. Whether any change can occur in how much of the gums shows when smiling is assessed at the examination.
The substance used in this procedure, which is popularly known by a brand name, is botulinum toxin. Botulinum toxin is a prescription-only medicinal product for human use (opens in a new tab) that temporarily reduces the contraction of the muscle to which it is applied. The procedure is carried out with an authorised product, within the terms of use in its authorisation, and by a physician.
There may be more than one reason why the gums are visible during smiling: the movement of the muscles that pull the upper lip, the height of the lip, the length and position of the teeth, the structure of the gums, or the structure of the jawbone.
This procedure addresses only the presentation related to muscle movement. With the other causes, no contribution is expected, and a dental assessment is required. Which of these is present is determined at the examination.
The procedure is performed at the practice (opens in a new tab) by Dr. Suzan Alp, Specialist in Internal Medicine.
Which factors determine whether the procedure is suitable?
The decision on suitability is made at the end of the examination. The following factors are decisive in the assessment of this area:
- How far the upper lip is pulled up during smiling
- The distance between the nose and the upper lip, and the height of the upper lip
- The contribution of tooth length, gum structure and the bite to the presentation
- Whether the smile is symmetrical on both sides
- Any previous procedures in the area
If there is an issue relating to gum health, tooth length or the bite, a dental assessment is required first.
In which patients is the procedure not performed?
- In patients with a disease affecting the neuromuscular junction (myasthenia gravis, Lambert-Eaton syndrome, amyotrophic lateral sclerosis and similar conditions)
- In pregnant and breastfeeding patients
- In patients under 18 years of age
- In patients with a history of allergy to the product to be used or to its components
Situations that require separate assessment
- Muscle disease (an assessment by the relevant specialist physician is required)
- Use of medicines that affect neuromuscular transmission (aminoglycoside antibiotics, muscle relaxants and similar)
- Bleeding or clotting disorder, or use of blood-thinning or anticoagulant medicines
- Active infection or febrile illness (the procedure is postponed)
- A recent procedure in the same area (the timing is adjusted accordingly)
Additional conditions specific to this area
The procedure is not performed if the following are present in the area to be treated:
- Difficulty swallowing
- An active cold sore, infection or open wound around the mouth
In these situations, the procedure is planned subject to the physician’s assessment:
- Existing asymmetry in upper lip movement (the risk of it becoming pronounced is high in this area)
- A history of facial palsy (the opinion of the relevant specialist is sought)
- A speech disorder (the opinion of the relevant specialist is sought)
- Active gum disease or a dental infection (a dental assessment is needed first)
- A short distance between the nose and the upper lip (the result may differ from what is expected)
- Previously applied dermal filler in the area (timing and planning are adjusted accordingly)
If the visibility of the gums is not related to muscle movement, this procedure does not address it.
How is the procedure performed?
- Assessment. Whether the visibility of the gums is related to muscle movement is determined. The movement of the upper lip during smiling, the distance between the nose and the upper lip, and the symmetry of the smile are assessed. The contribution of tooth length, gum structure and the bite to the presentation is taken into account; if necessary, a referral to dentistry is made. Any history of cold sores or neuromuscular disease, current medication, allergies and previous procedures are recorded. Blood pressure and pulse are measured.
- Product check. The marketing authorisation status of the product to be used and its compliance with storage conditions are checked.
- Information and consent. The procedure, the limit of the expected change, the temporary nature of the effect, the high likelihood of smile asymmetry in this area and the possible side effects are explained in writing and verbally; the form is signed.
- Preparation. There must be no make-up on the area. Antisepsis is ensured.
- Application. The product is applied to the predetermined points with a fine needle.
- Observation and follow-up. Vital signs and any observed findings are recorded in the file. A follow-up appointment is given at which the result will be assessed.
When does the effect begin, and how long does it last?
The time it takes for the effect to appear varies from person to person; the full result is assessed between a few days and two weeks. The effect is temporary, and how long it will last cannot be stated in advance. The timing of any repeat is determined at the follow-up.
What should you do before and after the procedure?
Before the procedure, report:
- A list of all the medicines and supplements you use (in particular blood thinners, painkillers and antibiotics)
- Your known allergies
- Any history of nerve or muscle disease
- Your pregnancy and breastfeeding status
Please state if you have a history of cold sores, or a complaint relating to your gums or teeth.
Come with no make-up on the area.
After:
- The area must not be massaged or rubbed on the day of the procedure
- In the first few days there may be a temporary change in smiling and in speech
- You will be asked to avoid bending forward, staying head-down for long periods and lying face down for the period specified
- Avoid hot environments, saunas, sunbeds and vigorous exercise for a time
- Temporary raised bumps, redness and mild bruising may occur at the injection sites
Recommendations and time periods specific to you are given in writing at the end of the procedure.
Risks and side effects
The risk of smile asymmetry is higher in this area than in the other areas of the face.
Risks specific to this area
- Smile asymmetry (an unwanted outcome frequently reported in gummy smile botulinum toxin)
- The upper lip coming down further than expected and the smile being restricted
- Lengthening or an uneven appearance of the upper lip
- A temporary change in speech
- A feeling of heaviness or numbness in the upper lip
- The expected change not being seen (if the presentation does not arise from the muscles, no result is obtained)
- Triggering of a cold sore in the area
General risks that may occur with any minor procedure
- Pain, redness, swelling and bruising
- Infection at the site of the procedure
- Headache
- Allergic reaction
- Flu-like symptoms
- Vasovagal syncope (fainting)
These side effects are temporary; however, the time they take to resolve varies from person to person and may take weeks. It is not possible to reverse the effect of the botulinum toxin.
Results vary from person to person.
When should you see a physician without delay?
If you experience these symptoms during treatment, contact your physician without delay:
- Marked asymmetry in smiling
- Continuous leakage of liquid from the mouth
- Increasing redness, increased warmth, swelling or discharge at the site of the procedure
- A high fever
- Widespread rash, itching
In the event of difficulty swallowing, disturbance of speech, double vision, shortness of breath, widespread muscle weakness, or swelling of the lips or eyelids, go directly to the emergency department.
Frequently asked questions
Why might my gums show when I smile?
There may be more than one reason: the movement of the muscles that pull the upper lip, the height of the lip, the length and position of the teeth, the structure of the gums, or the structure of the jawbone. Which of these is present is determined at the examination; this procedure addresses only the presentation related to muscle movement.
Can botulinum toxin be used for every gummy smile?
No. If the visibility of the gums is not related to muscle movement, this procedure does not apply and a dental assessment is required. Tooth length, gum structure and the bite are a matter for dentistry.
Will this procedure spoil my smile?
Smile asymmetry is the most frequent and most noticeable unwanted outcome in this area; the risk is higher than in the other areas of the face. The upper lip coming down further than expected and the smile being restricted are also among the situations reported. These possibilities are discussed in detail before the procedure.
I have gum disease; can I still have the procedure?
In those with active gum disease or a dental infection, a dental assessment is required first. Please state your complaint at the consultation.
I am prone to cold sores; is that a problem with gummy smile botulinum toxin?
Triggering of a cold sore in the area is among the situations reported. If there is an active cold sore around the mouth, the procedure is not carried out. Please state your history of cold sores at the consultation.
How long does the effect of gummy smile botulinum toxin last?
The effect is temporary and its duration cannot be stated in advance. It varies according to the person, muscle strength and the pattern of application. The timing of any repeat is determined at the follow-up consultation.
Is gummy smile botulinum toxin carried out during pregnancy?
No. The procedure is not carried out during pregnancy or breastfeeding.
Sources
- Ministry of Health of the Republic of Türkiye, Turkish Medicines and Medical Devices Agency, Beşeri Tıbbi Ürünler Ruhsatlandırma Yönetmeliği, Official Gazette 11 December 2021 / 31686. https://www.resmigazete.gov.tr/eskiler/2021/12/20211211-5.htm (opens in a new tab)
- Ministry of Health of the Republic of Türkiye, Ayakta Teşhis ve Tedavi Yapılan Özel Sağlık Kuruluşları Hakkında Yönetmelikte Değişiklik Yapılmasına Dair Yönetmelik, Official Gazette 7 January 2025 / 32775. https://www.resmigazete.gov.tr/eskiler/2025/01/20250107-3.htm (opens in a new tab)
