A gummy smile is not a diagnosis, it is a description. When you smile, the lip lifts high enough that a wide band of gum shows above the upper teeth. Many people find it charming on others and distracting on themselves. If you have ever tilted your head down in photos or learned to smile with your lips closed, you know the feeling. The good news is that for a substantial number of cases, a precise botox treatment can gently soften the lip lift and create a balanced, natural smile without surgery.
I have treated gummy smiles in a range of faces, from petite lips that leap skyward to athletic mouths with a strong levator pull, and the same principle holds: subtlety wins. The goal is to refine your smile, not erase it. Below is how that happens in practice, what to expect, and how to weigh the pros and cons alongside other options.
Why gums show in the first place
Several anatomic players control how the upper lip moves when you smile. The most important elevators are the levator labii superioris alaeque nasi, levator labii superioris, zygomaticus minor, and sometimes the orbicularis oris acts as a brake or accelerator depending on patterning. If these muscles pull strongly or if your upper lip is short, the lip rises higher than average. Tooth size and gum display also vary by skeletal structure. A slightly vertical maxilla or a thin gingival phenotype can make the gums more visible.
Botox, technically a neuromodulator, works by relaxing targeted muscle fibers. In the case of a gummy smile, we inject tiny amounts into the muscles that elevate the upper lip so the lip still lifts, just not quite as far. It is a finesse move. Done well, you keep your expression and laugh lines and gain balance between teeth, gums, and lip.
What “natural” looks like with gummy smile botox
Natural results are defined less by a number of millimeters and more by how your smile lands on your face. When we review botox before and after photos together, what convinces people is not the freeze but the flow. Before, the upper lip may spring up and roll under, exposing a continuous pink band. After, the lip lifts in a softer arc, exposing more tooth than gum. The philtrum looks settled rather than stretched. Your cheeks still rise, your eyes still crinkle, the change sits quietly in the middle third of your face.
I tell first time botox patients to expect a 1 to 3 millimeter reduction in gum show with a conservative plan, sometimes 4 millimeters in stronger patterns. Those numbers sound small until you see them on your own smile. A 2 millimeter change often converts “gummy” to “balanced.”
Where the injections go and how much is used
The classic points sit beside the nostril flare at the junction where the levator labii superioris alaeque nasi originates alongside the nose. In lean faces with high pull, an additional drop over the levator labii superioris may be helpful. In some smile patterns, we add a fractional dose laterally near the zygomaticus minor. The trick is to avoid heavy dosing that drags the lip. The dose is measured in units, and for gummy smile correction it is modest.
In my hands, most women start with 2 to 4 units per side, men often 3 to 5 per side, adjusted for muscle mass and smile strength. Baby botox or micro botox approaches simply mean dividing that total into more sites with smaller aliquots, which gives even spread and reduces peaks. Mini botox is another term you will hear, and it usually implies minimal dosing to test your response. None of these marketing phrases changes the mechanism, they just reflect your practitioner’s philosophy on subtle results.
The appointment, from consultation to injection
A thorough botox consultation matters more with smile work than with forehead lines. I watch you speak and laugh, then I ask for a full smile and a half smile. I look at tooth size, lip length at rest, and the amount of gum show on both sides. If your left smile pulls higher, we plan asymmetrical dosing. If you also want a botox lip flip for a slightly fuller upper lip, we discuss how the two treatments interact, because relaxing the elevator and relaxing the lip border together can be a touch heavy if you are not careful.
On the day of the botox procedure, the injection step is quick. The skin is cleaned, a fine needle delivers a few tiny deposits, and we apply gentle pressure. Most patients describe a brief sting that fades in seconds. You can drive yourself afterward. Appointments for this area typically run 15 to 25 minutes including mapping and photos.
The first week: what changes and when
You will not walk out of the office with a new smile. Botox effects usually begin around day 3, reach a first peak at day 7, and feel fully settled by day 10 to 14. Early on, you may sense that your upper lip feels less “springy.” By week two, the gum-to-tooth ratio looks different in the mirror and especially in photos. If we planned a staged approach, we might add a small touch up around week two for refined symmetry.
Expect minimal downtime. Tiny injection marks last an hour or two, and occasional pinpoint bruising can linger a few days. Makeup can be applied after several hours. As aftercare, avoid heavy rubbing, facials, or hot yoga the same day. You do not need to ice unless you feel puffy, and you can return to work immediately.
How long it lasts and what maintenance looks like
For gummy smile botox, durability tends to sit at 8 to 12 weeks for initial treatments and sometimes 10 to 14 weeks once you have had several cycles. You will see references to botox longevity of three to four months for many areas, but smiles involve small elevator muscles that recover a bit faster. Lifestyle matters as well. High-metabolism individuals and endurance athletes often metabolize neuromodulators quicker.
Botox maintenance becomes predictable after your second or third round. If your ideal botox duration is 10 weeks, we schedule at 9 to 10 weeks to maintain consistent botox results. A botox touch up between visits can help if one side wakes up early. Over time, some patients find they can reduce units as the lip elevators learn a milder pattern, though this is not universal.
Results you can expect: subtle is the sweet spot
People often bring in botox before and after photos from friends or social media. These are helpful to discuss goals, but your face is your blueprint. The best gummy smile results look unremarkable to strangers and delightful to you. Teeth show, gums peek just at the papilla, the upper lip looks calm. You still have your smile lines, and if you also treated crow’s feet or frown lines in the same visit, the upper face reads smoother. Pairing botox for forehead lines or botox for glabella with smile work is common, but it is not required.
If you are seeking a very dramatic change, consider that botox is not a substitute for surgery in severe cases. Orthognathic surgery or lip lengthening procedures remain the gold standard for large skeletal gummy displays. Fillers can occasionally help by adding weight to a thin upper lip, but they are not a primary fix for strong elevator pull.
Cost, value, and how to think about price
Botox price varies by market, injector expertise, and brand. In the United States, per-unit botox cost commonly ranges from 10 to 20 dollars. A typical gummy smile treatment uses 4 to 10 units total depending on your anatomy, so the botox price for this area often sits between 80 and 200 dollars before tax, with outliers higher at boutique practices. Some clinics price per area rather than per unit. When comparing botox cost, ask two questions: how many units will be used, and what is the plan if a touch up is needed? An honest answer tells you more than the headline price.
Cheapest is not always best, but most expensive does not automatically mean better. Review botox consultation notes, ask to see cases similar to your face, and make sure your injector explains risks and alternatives. A transparent approach beats a slick package deal.
Safety, side effects, and how to avoid a “stiff” smile
Botox is widely used and well studied in both medical and cosmetic settings. For gummy smile, the main risks come from inaccurate placement or overdosing. If too much product relaxes the elevator muscles, the upper lip can feel heavy or look lengthened when you smile. In extreme cases, speech sounds that rely on lip movement, like “p” and “b,” can feel odd for a couple of weeks. This is rare at conservative doses.
Common minor side effects include brief soreness, small bruises, or a headache. Allergic reactions are very uncommon. Systemic effects are exceedingly rare at aesthetic doses and typically relate to off-label use in higher volumes. If you have a neuromuscular disorder, are pregnant or breastfeeding, or have had prior adverse reactions to botox cosmetic, you should not be treated without medical clearance.
Choosing the right injector is the best safety measure. Look for clinicians who treat the lower face and smile often, not only the upper face. Ask how they decide dosing, how they manage asymmetry, and what they consider early aging prevention in smiles. If you have had prior filler in the philtrum or lip, mention it, as it can change the way the lip lifts.
How gummy smile botox interacts with other popular treatments
Many people combine botox for gummy smile with a botox lip flip. The lip flip uses tiny units along the lip border to relax the orbicularis oris so the lip everts slightly at rest. It can give a soft “fuller” shape without volume, but it also reduces the lip’s ability to purse. If we pair the two, we scale doses down and stage them, often placing the gummy smile units first, reassessing at day 10, then deciding if the flip still makes sense. The goal is a balanced lip, not a limp one.
If you routinely get botox for crow’s feet, the smile dynamics change slightly as well. Over-relaxation around the lateral canthus can make a smile appear flatter through the eyes, which draws attention to the central face. Subtle dosing at the crow’s feet plus a conservative gummy smile plan tends to look best.
Jawline slimming with botox for masseter reduction does not directly affect the smile muscles, but it can make the face appear narrower. A narrower lower face makes gum show more noticeable in some people, so think of these as related design choices. Again, plan dosage and timing thoughtfully.
Who is a good candidate, and who should consider alternatives
You are likely a good candidate if your gums show about 2 to 6 millimeters above the teeth at full smile and your upper lip length at rest is average. You should also have good dental health and stable bite mechanics. If you have a very short upper lip at rest, hyperactive smile elevators, and more than 6 to 8 millimeters of gingival display, botox can still help, but you may need a staged plan and a frank discussion about limits.
If your gummy smile comes primarily from altered passive eruption or short teeth, a periodontal approach such as crown lengthening may be more appropriate than botox. If the cause is skeletal, and your goal is a permanent, comprehensive change, orthognathic surgery is the definitive path. Fillers in the upper lip can modestly reduce gum show by adding weight, but the effect is small compared with targeted neuromodulation. Some people prefer botox alternatives like lip repositioning surgery, which reattaches the lip at a lower point. That can work well in selected patients, though it carries surgical downtime and its own risks.
A realistic timeline from first idea to stable routine
Most people take one or two months from the first appointment to feeling at home with their new smile. The consultation clarifies your goals, the first treatment shows your response, and a touch up dials in symmetry. By your second or third cycle, you will know your precise botox duration, ideal units, and touch-up timing. Many schedule around life events, like weddings or professional photos. If you want peak effect for a date, plan your botox appointment two weeks beforehand.
If you also treat other areas, synchronize your calendar. Forehead and glabella lines tend to last three to four months, crow’s feet two and a half to three and a half months, and gummy smile eight to twelve weeks. Some patients accept a slight mismatch rather than multiple visits. Others prefer shorter, coordinated cycles.
Expectations, trade-offs, and what experience teaches
I have learned to respect two truths with gummy smile correction. First, tiny amounts can do a lot. The difference between a natural look and a flat smile is often a single unit per side. Second, symmetry is a moving target. Humans do not smile the same way every day. Fatigue, hydration, and mood shift patterns subtly. That is why I like staged, light dosing initially and why I take standardized photos at rest, soft smile, and full smile for each visit. Data helps.
There are trade-offs. If you enjoy pronounced top-lip movement for certain performances or singing, heavy dosing can feel limiting. If you speak for a living, tell your injector so they can adjust. If you clench or grind and already plan botox for jaw clenching in the masseters, start that first and let the lower face settle before you change the upper lip. When you combine treatments, less is more until you see how they interact.
Comparing botox to fillers, lasers, and surgery for gummy smiles
Botox vs fillers is not a head-to-head contest here. Botox reduces muscle pull. Fillers add structure or volume. For a gummy smile, they can complement each other but do different jobs. A thin, retracted upper lip may benefit from a whisper of filler plus a very small botox dose. If your lip is full and mobile, filler adds little.
Lasers and skin tightening devices have almost no role in gummy smile correction unless you are addressing texture or pigment around the mouth as part of broader facial rejuvenation. They will not influence how far the lip lifts.
Surgery addresses either the skeleton or the attachment of the lip. It is a bigger step with longer recovery and higher upfront botox cost equivalent, but it can be permanent. If you are on the fence, a trial with botox provides a reversible preview of Soluma Aesthetics a more balanced smile.
What the appointment feels like, and what patients report after
Patients describe the injection discomfort as a pinprick and a brief watery-eye reflex near the nostrils. The treated area can feel tender to the touch for a day. By day 3 to 5, early botox effects are noticeable. The most common comment at follow up is that photos feel easier and more consistent. Some say they feel less self-conscious laughing, which is the whole point.
People who come in for botox around eyes or a botox eyebrow lift often add a gummy smile treatment at a subsequent visit after they see how subtle botox can look elsewhere. They appreciate that the downtime is minimal and that the face still moves. The phrase botox natural look gets used a lot in marketing, but it is not a myth when dosing and placement are careful.
Practical aftercare and small choices that improve outcomes
You do not need a lengthy routine after treatment. Skip vigorous exercise and saunas the day of. Avoid massaging the area. Stay upright for four hours. If you bruise easily, a cool compress for ten minutes a few times on day one helps. Arnica can reduce visible bruising for some, though results vary. Keep your usual skincare. If you are starting retinoids or acids, wait a day.
For the first week, notice how your smile feels. If you sense too much heaviness or an uneven lift, note when and take a quick video for your injector. It can guide micro adjustments at the touch-up visit. Do not chase perfection day by day. Give the muscles a full two weeks to settle.
Frequently asked questions, answered from real cases
- How many units do I need? Most need 4 to 10 total. Petite faces with mild gummy show might need 2 per side, strong pullers might need 4 per side. We individualize. Will it make me talk funny? At conservative doses, speech changes are rare. If you use your lips intensively for work, tell your injector so they can dose accordingly. Can I combine with a botox lip flip? Yes, but stage it. We often treat the gummy smile first, then decide on a micro lip flip after 10 days. How often will I need it? Expect 8 to 12 weeks between visits. Some stretch longer with maintenance. What if I do not like it? The effect is temporary. If the smile feels too subdued, we lower the dose next time or skip a cycle.
What a balanced treatment plan might look like
A first-time patient, mid-thirties, shows about 4 millimeters of gum on a full smile, with the left side higher. We agree on 3 units near the alar base on the left and 2 units on the right. She returns at day 12 with 2 millimeters of gum show and symmetrical arc. We add a 0.5 unit tweak on the right for fine tuning. She reports a comfortable smile with no speech change. At week 10 she notices the old lift returning, and we repeat at the same dosing. By the third cycle, we are consistent at 10-week intervals.
Another patient in his late twenties, strong levator pull and thin upper lip, wants both less gum and a slightly fuller vermilion. We stage: first visit 4 units per side for gummy smile, second visit at day 14 a tiny 1 unit per side lip flip. He likes the shape but prefers a touch more movement for brass instrument practice, so at the next cycle we reduce the lip flip to 0.5 units per side and keep the gummy smile dose steady.
These small calibrations add up to results that look natural because they are built on your habits and needs, not a template.
The bigger picture: aging, prevention, and harmony
Faces age as systems. Teeth wear, gums recede, lips thin, and muscles adapt. Some use botox anti aging strategies across the upper and lower face, including preventative botox for fine lines in the forehead and 11 lines. For gummy smile correction, starting early is not about freezing youth, it is about setting a comfortable range of movement. If your elevators are hyperactive in your twenties, light botox can encourage a softer smile pattern that carries forward.
Combine this with sensible dental care, thoughtful filler only where it serves structure, and restraint around trend-driven treatments. You will see terms like botox facelift alternative or botox skin tightening online, but those do not apply to gummy smiles. What does apply is craft: steady hands, precise mapping, and a conversation that respects how you express joy.
When it is not the right time
If you are mid-course in orthodontics with active bite changes, wait. If you are pregnant or breastfeeding, defer until cleared. If you have an upcoming performance demanding maximal lip strength, schedule botox well after, not before. If you are considering major dental work or gum surgery, stage botox after healing so you can judge changes clearly.
Final thoughts from the treatment chair
A gummy smile is often the last thing people bring up in a consultation. They point to frown lines and crow’s feet first, then pause and lift their lip as a side note, almost apologetic. It is not a side note in your life if it makes you self-conscious daily. When botox is used with a light touch, the fix is quiet, quick, and reversible, and the payoff is disproportionate to the effort. You do not need a completely new face, just a little breathing room between lip and gum.
If you are curious, schedule a botox consultation and ask to see botox before and after cases that match your anatomy. Discuss botox risks, downtime, dosage, and touch-up timing. If the plan makes sense, start conservatively. Your future selfies will thank you, and more importantly, so will the unguarded laughs that are hard to stage and easy to enjoy.