Botox for Gummy Smile: How It Works, Results, and Aftercare

A gummy smile — where more than 3–4mm of gum tissue is visible above the upper teeth during a full smile — affects an estimated 10–15% of the population. In most cases it is caused by a hyperactive levator labii superioris alaeque nasi (LLSAN) muscle that pulls the upper lip too high when smiling. Botox targets this specific muscle with 2–4 units, reducing the peak elevation of the lip during a smile without affecting normal mouth function.

The treatment is one of the most technically demanding in facial aesthetics — not because of complexity, but because the margin for error is small. Too little and there is no visible effect; too much and the smile looks flat or asymmetric. Here is how it works and what the aftercare requires.

The Anatomy of a Gummy Smile

A gummy smile can have several causes, and Botox only addresses one of them. Understanding which cause applies to you determines whether Botox is the right treatment.

Hyperactive upper lip elevator (most common): The LLSAN muscle contracts excessively during smiling, pulling the upper lip 4–8mm above the gum line. This is the primary indication for Botox. The muscle is working normally — it is simply doing too much.

Short upper lip: The resting position of the upper lip is higher than average, exposing gum even at rest or during minimal smiling. Botox can help but the structural component limits how much correction is achievable.

Vertical maxillary excess: The upper jaw (maxilla) is longer than average, pushing the gum downward relative to the lip. This is a skeletal cause and cannot be fully corrected with Botox — orthognathic surgery is the definitive treatment. Botox provides partial, temporary improvement.

Anterior teeth eruption: The upper front teeth have erupted more than normal, pushing the gum line down. Orthodontic or surgical treatment addresses the underlying cause.

For the majority of patients seeking Botox for gummy smile — those with a hyperactive lip elevator and normal jaw anatomy — the treatment produces excellent, reliable results.

The Injection: Where and How Much

The LLSAN muscle runs from the lateral nasal cartilage downward and inserts into the upper lip. On smiling, it contracts upward, pulling the lip with it. The injection point is typically 1–2mm below the junction of the nostril base and the upper lip (the alar base), on both sides.

Standard dosing:

• 1–2 units per side (2–4 units total) for mild to moderate gummy smiles
• 2 units per side (4 units total) for more pronounced cases
• Optional: 1 unit to the procerus (between the brows, at the nose bridge) if nose-tip depression on smiling contributes to the gummy appearance

The LLSAN sits in close proximity to several other muscles that affect lip expression — the levator labii superioris, the zygomaticus minor, and the orbicularis oris. Injection depth and precise placement matter significantly. An experienced injector will mark the injection point carefully and ask you to smile to confirm the target muscle is correctly identified before injecting.

Why conservative dosing is essential: Over-treating the LLSAN produces a flat, unnatural smile where the upper lip does not lift freely. This is more aesthetically disruptive than the gummy smile it was intended to correct. Most providers start at 1 unit per side, assess at 2 weeks, and add more only if insufficient correction was achieved.

What the Result Looks and Feels Like

After the Botox takes full effect at 10–14 days, the change is specific and subtle in most cases. Normal day-to-day lip function — speaking, eating, kissing — is unaffected. The difference is visible in a full, open smile where previously the upper lip would have risen high enough to expose gum tissue.

Most patients describe the result as: the smile looks the same but the gum is no longer as visible. The change is more obvious in photos than in conversation.

What does not change: Resting lip position. Upper lip fullness. Ability to speak or eat normally. The smile does not disappear — it is simply limited in its upward travel.

Edge cases: Patients who smile very broadly or who have professions requiring exaggerated expression (performers, public speakers, teachers who use exaggerated facial expression) sometimes find even conservative dosing affects their expressiveness. This is worth discussing with your injector before treatment. The dose can be titrated very precisely — even 0.5-unit increments make a difference at this dose level.

Aftercare: Same as Botox, With Extra Precision Importance

The aftercare for gummy smile Botox follows the same protocol as all facial Botox. The critical rules apply with particular emphasis given the precision required at this injection site.

First 4 hours — no touch, no movement: The injection sites are at the alar base — close to the nose and upper lip. Any manipulation, rubbing, or facial massage in the first 4 hours risks migrating the small toxin dose to adjacent muscles. The consequences of migration here are more visible than in larger muscle groups — even 1 unit migrating into the wrong muscle can affect smile symmetry for weeks.

• Do not touch the injection area
• Do not blow your nose forcefully (the alar injection is very close to the nasal muscles)
• No facial treatments or massage
• Stay upright

Exercise restriction: As with all Botox, avoid vigorous exercise for 24 hours — see our Botox exercise guide.

No alcohol: Avoid alcohol for 24 hours post-injection — it worsens any bruising and causes vasodilation. Full guidance in our Botox and alcohol guide.

Assess at 14 days, not before: The partial relaxation of the LLSAN takes the full 10–14 day timeline to manifest. Smile photos taken at day 3–5 are not representative of the final result.

What a Touch-Up Involves

If the 2-week result shows insufficient correction — gum tissue still visible at peak smile despite Botox being fully active — a touch-up with 1 additional unit per side is appropriate. This is common in first-time gummy smile patients where the provider has taken a conservative approach.

If the result shows over-correction — the smile looks flat or there is asymmetry — the appropriate response is waiting. Touch-up injections cannot reverse existing Botox. The effect will wear off in 6–10 weeks, and the dose can be adjusted at the next appointment.

Gummy Smile Botox vs. Other Treatments

Botox is not the only option for a gummy smile, and it is not always the best:

For patients with a purely muscular cause and mild to moderate presentation, Botox is the lowest-risk, fastest, most reversible option and should be tried before any surgical approach.

Combining Gummy Smile Botox With Other Treatments

Gummy smile Botox is often combined with a Botox lip flip in the same session. The two treatments address different aspects of upper lip aesthetics:

• Lip flip: Relaxes the orbicularis oris muscle above the upper lip border, causing the lip to roll outward and appear fuller — improves visible lip show
• Gummy smile: Relaxes the LLSAN, limiting how high the lip travels on smiling — reduces gum exposure

Together, they produce a more comprehensive upper lip improvement: better lip show at rest (flip) and a more balanced smile (gummy smile correction).

If combining both, the injector will plan the total dose carefully — both treatments affect upper lip mobility, and the cumulative effect of full doses of both simultaneously can over-restrict lip movement. A conservative combined approach — lower doses of each — with a 2-week review and touch-up as needed is the safest protocol.

Related guides: Botox lip flip aftercare · Botox swelling and recovery timeline · Botox forehead vs glabella

AftercareGen generates professional aftercare sheets for gummy smile Botox and all major aesthetic procedures — including the dose-specific instructions and the 14-day assessment timeline your patients need.