Gummy Smile: Causes, Treatment Options and Costs

A gummy smile describes a smile where an excessive amount of gum tissue is visible — treatable with Botox injections into the levator labii superioris alaeque nasi muscle. Clinically, a gummy smile is defined as more than three millimetres of visible gum when smiling. The imbalance between teeth, gums and lips makes the teeth appear smaller and the smile look less harmonious. While it causes no health problems, many people experience a significant reduction in self-confidence. With the right treatment, a gummy smile can be corrected effectively and often permanently.

Causes of a Gummy Smile

The underlying cause determines the most appropriate treatment. A gummy smile can result from:

Vertically prominent upper jaw: The jaw is too long — when smiling, the face elongates and the gum becomes visible
Small teeth: Relatively small tooth crowns create the impression of excessive gum tissue
Hyperactive upper lip elevator muscle: The muscle pulls the upper lip too far upward when smiling, exposing a large area of gum
Short upper lip: An anatomically short lip does not adequately cover the gums when smiling
Excess gum tissue (gingival hyperplasia): The gums grow too far over the teeth, making them appear smaller

Gummy Smile Correction: Treatment Methods

1. Muscle Relaxant Injection (Botox)

When an overactive elevator muscle is the cause, an injection of botulinum toxin directly into the affected muscle can be highly effective. The active ingredient relaxes the muscle so that the upper lip is lifted less when smiling, keeping the gum covered. The treatment is outpatient, takes only a few minutes and takes effect within 3 to 7 days. The effect lasts six to nine months and must then be repeated.

2. Myotomy (Permanent Muscle Correction)

As a permanent alternative to injections, a myotomy can be performed under local anaesthesia. The elevator muscle is selectively weakened so that the upper lip is permanently lifted less when smiling.

3. Gingivectomy (Laser Gum Correction)

In cases of excess gum tissue, the dentist or oral surgeon removes the excess gum with a laser. The procedure is usually painless and can be performed on an outpatient basis. The removed tissue generally does not grow back; in specific cases a flap technique is used to ensure a lasting aesthetic result.

4. Veneers or Crowns

When small teeth are the cause, thin porcelain veneers or crowns can visually increase the tooth surface. The ratio of tooth to gum improves without surgical intervention on the jaw.

5. Orthodontic Treatment

When a vertically prominent upper jaw is the cause, surgical jaw correction (Le Fort I osteotomy) may be necessary. This extensive method is only used in severe cases.

Aftercare and Results

Aftercare depends on the chosen method:

Botox injection: No special aftercare required; avoid sport and intense facial massage for 24 hours
Gingivectomy: Good oral hygiene is essential; dental check-ups after 2 and 6 weeks
Veneers/Crowns: Regular dental visits and professional cleaning recommended

Most patients report significantly greater confidence when smiling after treatment. Results are either temporary (Botox) or permanent (myotomy, laser, veneers) depending on the method chosen.

Costs of Gummy Smile Treatment

Botox injection: from approx. 150 to 350 EUR per treatment (every 6 to 9 months)
Gingivectomy (laser correction): approx. 500 to 1,500 EUR depending on extent
Myotomy: approx. 1,500 to 3,000 EUR
Veneers: approx. 600 to 1,200 EUR per tooth

Costs are generally not covered by health insurance as this is an aesthetic treatment.

Frequently Asked Questions

Is Gummy Smile Treatment Painful?

The Botox injection is barely painful and takes only a few minutes. The gingivectomy is performed under local anaesthesia and is also well tolerated. Post-treatment discomfort is minimal.

How Quickly Does Botox Work for a Gummy Smile?

The effect becomes noticeable within three to seven days. The full result is visible after approximately two weeks. The smile looks more natural and the gum remains covered when smiling.

Is the Result Permanent?

This depends on the method: Botox injections must be repeated every six to nine months. Myotomy, laser correction and veneers provide a permanent result.

How Does Botox Treatment for Gummy Smile Work?

Two to four units of botulinum toxin are injected bilaterally into the levator labii superioris alaeque nasi muscle (LLSAN). This muscle excessively lifts the upper lip when smiling, exposing too much gum tissue. Botox relaxes it so the lip stays lower when smiling — keeping the gum covered.

How Much Gum Is Normal When Smiling?

Up to 2 to 3 mm of visible gum is considered aesthetically normal. From 4 mm onwards a gummy smile is diagnosed. At 8 to 10 mm or more, surgical correction (lip repositioning, orthognathic surgery) should be considered if Botox is insufficient.

Can a Gummy Smile Be Treated Without Botox?

For a muscular cause, Botox is the first-line treatment. For a dental cause (short tooth crowns): crown lengthening by a dentist. For a skeletal cause (too-long upper jaw): orthognathic surgery (Le Fort I impaction). For lip hyperplasia: lip repositioning (mucosectomy).