Read this part first: there are four common reasons a smile shows a lot of gum, and toxin only solves one of them. Getting the category right is the whole treatment.
Gum showing beyond about three millimetres on a wide smile has four possible causes. Only one answers to botulinum toxin. Which category you fall into decides everything that follows, so it gets settled at assessment rather than after a needle has already been used.
| Cause | What is driving it | Who treats it |
|---|---|---|
| Hyperactive lip elevators | Lip length, teeth and bone are all normal. The muscles that raise the upper lip are simply strong and carry it higher than average | This is the type that responds to toxin, and it responds well. It is the case we treat |
| A short upper lip | The lip itself is anatomically short, so even normal movement exposes gum. You are working against resting anatomy rather than movement | Toxin buys a little. Results are modest and you should be told so in advance |
| Vertical maxillary excess | The upper jaw is longer than average, so the gum sits lower before any muscle moves at all | Orthodontic or surgical. Toxin does not change bone, and a clinic promising to inject it away is selling you something |
| Altered passive eruption | The gum never fully receded off the teeth during development, so teeth look short and gum looks abundant | A periodontist or dentist. It is a dental situation rather than a muscular one |
We measure how far the lip travels between rest and a full smile, the length of the lip itself, and the proportion of tooth to gum on show. High travel with normal lip length and normal tooth proportion points at the first type. Doses into the lip elevator complex are deliberately low and added to at two weeks, because an overtreated upper lip can look stiff or asymmetric and takes months to resolve on its own.
Toxin fixes one type of gummy smile. Here are the four.
A gummy smile is usually defined as showing more than about three millimetres of gum when you smile fully. That single description covers several completely different anatomical situations, and they do not respond to the same treatment. Before anyone injects anything, the question to answer is which of these you actually have.
1. Hyperactive lip elevators
The muscles that raise your upper lip are simply strong and pull it higher than average. Your lip length is normal, your teeth and bone are normal, the lip just travels too far. This is the type that responds to toxin, and it responds well.
2. A short upper lip
The lip itself is anatomically short, so even normal movement exposes gum. Relaxing the elevators buys you a little, but you are working against resting anatomy rather than movement. Results are modest and you should be told that in advance.
3. Vertical maxillary excess
The upper jaw is longer than average, so the gum sits lower before any muscle moves. This is a skeletal pattern. Toxin does not change bone. This is orthodontic or surgical territory, and any clinic promising to inject it away is selling you something.
4. Altered passive eruption
The gum never fully receded off the teeth during development, so teeth look short and gum looks abundant. That is a dental situation, not a muscular one, and a periodontist or dentist handles it.
How we tell them apart in the room
We measure how far your lip travels between rest and a full smile, look at the length of the lip itself, and look at the proportion of tooth to gum on show. High lip travel with normal lip length and normal tooth proportion points at type one. That is the case we treat. If the picture points at type three or four, we say so and refer, because injecting it would waste your money and your time.
From our injection team: the honest conversation here saves people a lot. Someone with vertical maxillary excess can get injected every four months forever and never get the result they came in for.
What treatment looks like for the type that works
Very small doses into the lip elevator complex near the base of the nose. This is one of the most dose-sensitive areas on the face, because the difference between a softened smile and a heavy, uneven or flattened upper lip is a small number of units in the wrong spot. We deliberately start low. You can add at two weeks. That is not us being cautious for the sake of it, it is that an overtreated upper lip is genuinely difficult to live with for three months.
Onset around two weeks, and it wears off a little faster here than in the forehead because the area is so mobile. Most people find they get three to four months rather than four to five.
Questions people ask before booking
Will my smile look fake?
Not if it is dosed properly. Done well, the lip simply stops travelling quite so far, and most people around you register that you look different without identifying why.
What happens if it is overdone?
The upper lip can look stiff, long, or asymmetric, and it can affect how you pronounce certain sounds. It resolves on its own, but it takes months. This is the single strongest argument for starting conservatively and for asking who is doing the injecting.
Can it be combined with filler?
Sometimes. If part of the issue is a thin upper lip that disappears when you smile, a small amount of lip flip or filler can share the work. That is assessed together, not booked blind.
Cost?
Per unit, and the unit count is low. See the Toronto price index for current pricing, and you get an exact quote before anything is injected.
Consultations are free and include the assessment above, so you will leave knowing which of the four categories you are in even if the answer is that we are not the right people to treat it. Book online or call 416-923-1200.
Ready to look into it properly?
Our consultation is free. We will look at your skin, give you an honest recommendation, and say so if a different treatment would suit you better.
Or call 416 923 1200 · 46 Fort York Blvd, CityPlace, Toronto
Questions about this treatment?
Ask us anything before you book. Consultations are free, and we will tell you honestly if a treatment is not right for you.