Gummy smile
A gummy smile — clinically known as Excessive Gingival Display — refers to excessive upper gum exposure when smiling.
Our physician’s Real Gummy Smile Cases
Before and after cases for this condition are currently being compiled and will be updated shortly. All cases are drawn from the clinical records of real Luowei Medical Aesthetics Clinic clients who have signed a written Media Release Form. The complete case portfolio is available for review with our physician in person during your consultation.
What is a gummy smile? Why does the gum show when you smile?
A gummy smile — clinically known as Excessive Gingival Display — refers to excessive upper gum exposure when smiling.More than 3 mm Clinically, 1–2 mm of gingival display is considered within the normal aesthetic range. Exposure of 3 mm or more begins to affect the appearance of the smile, while 4 mm or more is classified as a pronounced gummy smile. This is not simply a “dental problem” — it is a condition caused by Muscle activity, bone structure, upper lip length, and gingival height a multifactorial presentation shaped by four contributing factors.
Why is this not simply a “dental issue”?
Only about 30% of gummy smile cases originate from the gums or alveolar bone. The remaining 70% are caused by Overactive upper lip elevator muscles + upper lip length and other soft-tissue factors. This is precisely why orthodontic treatment or gum surgery alone often fails to resolve the issue.
Why is Botox® effective for most cases of gummy smile?
The majority of gummy smile cases in Asian patients fall into Muscular subtype— When the levator labii superioris alaeque nasi (LLSAN) muscle contracts too strongly, it pulls the upper lip too high during a smile. By precisely reducing the activity of this muscle with Botox®, the smile can be restored to a more natural position.
Why can’t treatment begin immediately — why is an assessment required first?
A placement error of just 1–2 mm can cause diffusion into orbicularis oris, resulting in upper lip drooping, difficulty articulating certain sounds, or a stiff smile.
Why Are Asian Faces More Prone to a Gummy Smile?
commonly seen in Asian faces Relatively short upper lip + tendency toward maxillary protrusion + elevated elevator muscle attachment point Three anatomical characteristics make gummy smile significantly more prevalent in Asian women than in Caucasian populations.
Clinical key points:Many clients have been told “your only options are orthodontics or gum surgery.” In fact, 70% of gummy smile cases in Asian patients can be significantly improved with just 4–6 units of Botox®. Our physician’s protocol The first step is always smile type classification and assessment— Muscular / short upper lip / gingival / skeletal subtypes each require a completely different treatment approach.
The 5 Causes of a Gummy Smile — Identifying the Right Cause Leads to the Right Solution
Clinically, a gummy smile is rarely caused by a single factor — it is typically the result of multiple overlapping contributors. Accurate subtype classification is essential for selecting the right treatment plan and setting realistic expectations.
1. Overactive upper lip elevator muscles (most common)
Overactivity of the levator labii superioris alaeque nasi (LLSAN), levator labii superioris (LLS), and zygomaticus minor causes the upper lip to be pulled too high during smiling, exposing the gums. This accounts for approximately 60–70%, Botox the preferred indication.
2. Upper lip length is too short
Static upper lip length < 20mm(Normal upper lip length is 20–22 mm in adult women and 22–24 mm in adult men. When the lip is shorter than this range, gum show during smiling can occur even when muscle activity is normal. Assessment should be combined with Hyaluronic acid lip tubercle enhancement / philtrum contouring visual lengthening.
3. Gingival Hyperplasia (overgrowth of gum tissue)
Excessive gingival tissue covering the tooth crowns can create the appearance of short teeth and prominent gums even when muscle activity and lip length are normal. A periodontal evaluation is recommended to determine whether Crown lengthening procedure.
4. Vertical Maxillary Excess (VME)
Vertical Maxillary Excess, Vertical maxillary excess (VME) refers to overdevelopment of the upper jaw in the vertical dimension, resulting in a higher-positioned dental arch. This is a skeletal issue; severe cases require orthognathic surgery. Botox® can only partially improve the visual appearance.
5. Short clinical crown
Tooth wear or incomplete passive eruption can result in a short clinical crown with an excessive proportion of visible gum tissue. A restorative dental assessment is required; combination treatment with the muscular subtype is possible.
4 Smile concerns commonly mistaken for a gummy smile — key differential diagnosis points
“An” unattractive smile “can stem from several distinct causes, and misidentifying the underlying issue leads to the wrong treatment approach. The table below outlines the 4 most common differential diagnoses our physician encounters in clinical practice.
True Gummy Smile
Excessive Gingival Display
| presentation | Upper gum visible when smiling > 3mm |
|---|---|
| primary cause | Overactive levator muscle / short upper lip / gingival hyperplasia |
| At rest | Normal at rest; becomes visible when smiling |
| First-line treatment | Botox Precision micro-dose injection |
Asymmetric Smile
Cant Smile / Crooked Smile
| presentation | Asymmetry in the height of the corners of the mouth or in gingival exposure |
|---|---|
| primary cause | Unilateral muscle strength asymmetry / mild facial nerve variation |
| At rest | Largely symmetric at rest, asymmetry becomes apparent with movement |
| First-line treatment | Botox Unilateral / asymmetric dosing |
Downturned Mouth
Marionette Lines · DAO excessive
| presentation | Resting downturned corners of the mouth → a persistently sad or tired expression |
|---|---|
| primary cause | Overactive depressor anguli oris (DAO) |
| At rest | Noticeable drooping |
| First-line treatment | Botox DAO Injection + hyaluronic acid filler for mouth corner support |
Marionette lines / deepened smile lines
Nasolabial Folds
| presentation | Pronounced sunken groove from the alar base to the corner of the mouth |
|---|---|
| primary cause | Mid-face volume loss / soft-tissue ptosis |
| At rest | clearly present |
| First-line treatment | Mid-face support and volumization with hyaluronic acid filler |
⚠️ Warning:Clinically, a number of clients present with the concern “Our smile doesn’t look good,” but after assessment by our physician the underlying issue turns out to be a downturned mouth with marionette lines — not a gummy smile. The injection points for these conditions are entirely different. Treating the DAO as though it were the LLSAN leads to treatment failure and can actually worsen facial stiffness.No injection without subtype classification.
Why does treating a gummy smile in Asian faces require an Asia-specific dose?
A common blind spot among mainstream North American clinics
Most gummy smile Botox® protocols used across North America — commonly 4–5 units per side — are based on anatomical data derived from Caucasian patients. Applying these protocols directly to Asian faces can result in:
- ✗ Excessive dosage leading to upper lip ptosis— Asian faces have thinner elevator muscles with a higher attachment point.
- ✗ Stiff, unnatural smile— affecting speech and drinking
- ✗ Injection placed too low, causing diffusion into the orbicularis oris— The already short upper lip is pulled down further
- ✗ Failure to account for short upper lip— Botox® alone cannot correct the visual appearance of gum exposure
Our physician’s Asian-specific adjustments
| parameters | North American standards | Asia-specific adjustment |
|---|---|---|
| Dose per side | 4–5 units | 1.5–2.5 units |
| Injection depth | more pronounced | superficial and precise |
| placement | experience-based estimation | |
| assessment | Assessing gum exposure only | Muscular subtype + lip length + symmetry |
| reassessment | None | 10–14 day reassessment and refinement |
Key differentiating factors:Our physician has focused on Asian facial aesthetics at our Nanjing clinic for over 8 years, with more than 90% of clients having Asian faces. More precise dosing, better risk management, and more natural results.
5 Treatment Options for Gummy Smile — Matched to Your Subtype
There is no one-size-fits-all gummy smile protocol. We combine the following approaches based on your smile type classification and individual anatomy.
Botox(Botox®) precise micro-dose injection
NMPA-registered neurotoxin that acts on Levator labii superioris alaeque nasi (LLSAN), is Gold standard for muscular-subtype gummy smile. As little as 1.5–2.5 units per side can produce a meaningful improvement, with onset in 5–7 days and results lasting 4–5 months.
Dysport(Dysport®)
Another NMPA-registered botulinum toxin with a slightly broader diffusion profile and a faster onset of 3–5 days. It may be a better fit for certain clients. Our physician selects the appropriate product based on your previous treatment history.
Xeomin(Xeomin®)
“A” naked molecule “botulinum toxin that contains no complexing proteins. It is well-suited for clients who have developed resistance to, or a diminished response from, other botulinum toxin products.
Hyaluronic acid lip tubercle enhancement / philtrum contouring
Suitable for Short upper lip gummy smile— A small amount of hyaluronic acid filler placed at the central lip tubercle visually lengthens the upper lip. Combined with Botox®, the result can exceed what either treatment achieves alone —>2 results.
Referral coordination with periodontics / orthodontics / orthognathic surgery
For Gingival hyperplasia subtype and vertical maxillary excess subtype, our physician will proactively refer you to our partner periodontist, orthodontist, or oral and maxillofacial surgeon. In these cases, Botox® serves only as a supplementary measure.
Our physician’s 6-Step Standard Gummy Smile Protocol
Consultation + smile type classification assessment
30 minute free consultation, including static and dynamic smile video analysis, with measurements of upper lip length, gingival exposure in millimeters, elevator muscle activity, and facial symmetry.No injection without subtype classification.
Treatment planning and informed consent
Once your subtype is confirmed, our physician discusses dosage, injection points, expected outcomes, maintenance schedule, and possible side effects. You will then sign the informed consent form — with every detail explained by our physician directly.
This is the gold-standard reference point for gummy smile injections in Asian faces., Most clinics in North America rely on experience-based estimation.
Micro-dose staged injection
1.5–2.5 units per side, administered superficially with a 30G fine needle. The entire injection takes 5–8 minutes with minimal downtime — you can resume your day immediately.
Day 10–14 reassessment
Botox A follow-up assessment is performed once the full effect has been established. If 1–2 mm of residual gum show remains, or if minor asymmetry is present, a small refinement of 0.5–1 unit per side can be added.This step is routinely skipped at most medspas..
Maintenance phase (every 4–5 months)
With consistent maintenance injections and mindful expression habits, some clients are able to extend their interval to every 5–6 months after 2–3 stable sessions. Over time, muscle memory adapts and required doses gradually decrease.
Treatment timeline — how long before you see results?
| stage | time | condition |
|---|---|---|
| on the day of injection | 0 days | No visible change; you can go about your day and apply makeup as normal |
| Initial onset | Day 3–5 | Levator muscle activity begins to diminish; minimal change in smile appearance |
| full effect achieved | Day 10–14 | Gingival exposure steadily decreases, reaching peak effect. |
| Follow-up assessment and refinement | Day 14 | Follow-up assessment by our physician; refinement of 0.5–1 unit per side if needed |
| Stable phase | 2–4 months | Stable results, natural-looking smile |
| Maintenance injection | Month 4–5 | With consistent maintenance, the interval can gradually extend to 5–6 months |
Clinical note:The guiding principle of our gummy smile Botox® protocol is “less is more.” We always start at the lower end of the dose range and reassess at the 10–14 day mark before deciding whether a small refinement is needed. This “staged confirmation” approach is considerably safer than attempting to achieve the final result in one session. For clients in Nanjing who have maintained regular treatments for two or more years, the required dose can often be gradually reduced as the muscle adapts over time.
Are you a candidate for gummy smile Botox® treatment? A 2-minute self-assessment
✅ suitable to begin an assessment
- ✓More than 3 mm of upper gum visible when smiling, perceived as affecting the appearance of the smile
- ✓Lip line is normal at rest; gum show appears only when smiling
- ✓18 years of age or older, with no plans for pregnancy or breastfeeding
- ✓Has previously tried to hide their smile (pursing lips / covering mouth with hand)
- ✓Comfortable with maintenance injections every 4–5 months
- ✓Willing to return for a follow-up assessment at 10–14 days
❌ Treatment should be deferred or other concerns addressed first
- ✗Currently pregnant, breastfeeding, or trying to conceive
- ✗Neuromuscular disorders (myasthenia gravis / ALS, etc.)
- ✗Known allergy to botulinum toxin or a history of serious adverse reactions
- ✗Active infection or rash in the treatment area
- ✗Severe vertical maxillary excess (VME) requiring orthognathic surgery
- ✗Expecting “immediate results” or a “permanent cure”
Luowei Medical Aesthetic Gummy Smile Protocol vs. a Typical MedSpa
- ✗Injecting after a quick look, with no subtype assessment
- ✗Dosing based on Caucasian norms (4–5 units per side)
- ✗Dynamic assessment only, without measuring static upper lip length
- ✗Procedures are often performed independently by nurses with no physician assessment.
- ✗Upper lip drooping occurred and was told to “wait for it to wear off” with no further follow-up
- ✗No day 10–14 reassessment protocol in place
- ✓Subtype classification is mandatory (muscular / short upper lip / gingival / skeletal)
- ✓Asian face specialist dosing (1.5–2.5 units per side)
- ✓Multi-dimensional assessment: static and dynamic smile, upper lip length, and symmetry
- ✓Personally assessed and injected by our physician
- ✓Risk identification + corrective plan + long-term follow-up
- ✓10–14 day follow-up assessment with refinement if needed
Why Is Luowei Medical Aesthetics Clinic’s Gummy Smile Content Trustworthy?
Experience experience
Expertise specialty
Authoritativeness expertise
Published author · All injections personally performed by the physician
Trustworthiness trustworthy
All cases on this page are covered by a signed Media Release Form · Clinical records available for review
About the cost of gummy smile treatment
Pricing for gummy smile Botox® varies considerably between clinics, but the real difference is not in the cost of the product itself — it lies in Who performs the assessment, determines the injection points, and personally administers the injections. Treating a gummy smile requires only 4–6 units of Botox®, yet a 1 mm placement error can cause upper lip drooping or a stiff smile. That risk is managed through experience alone — no device can eliminate it. At Luowei Medical Aesthetics Clinic, all injectable treatments are performed by our physician personally, and our pricing reflects that level of medical commitment. For established clients on a stable maintenance dose, follow-up injections are carried out efficiently under our physician’s protocol. Laser and energy-based treatments are performed by our physician or our trained medical team based on complexity — this distinction does not apply to injectables. The right approach for you depends on your muscle type, upper lip length, and symmetryyour muscle characteristics, and your previous treatment history — not by price. Your personalized plan will be discussed in detail during the consultation, based on smile type classification and anatomical assessment.
- Payment is made at the clinic, after the consultation and before treatment begins
- Nothing is paid in advance, and no deposit is required to hold an appointment
- Cosmetic treatment is a self-pay item and is not covered by public medical insurance in China
- All new clients receive a complimentary 30-minute complimentary Consultation and assessment
Risks and contraindications — what you need to know
What are the main risks?
1. Upper lip drooping / stiff smile(Excessive dosing or misplacement causing diffusion of the LLSAN effect into the orbicularis oris muscle — resolves naturally within 3–10 weeks; 2. Temporary swelling and bruising at the injection site (typically resolves within 1–5 days); 3. Asymmetry (can be assessed and refined at the 10–14 day follow-up); 4. Rare allergic reaction (< 0.1%);5. Insufficient effect (a small touch-up may be performed); 6. Return of muscle activity as the maintenance period ends (not a side effect — this is a normal part of the drug's metabolic cycle).
Who should absolutely not have this treatment?
Pregnancy, breastfeeding, or actively trying to conceive; neuromuscular disorders (myasthenia gravis / Lambert-Eaton syndrome / ALS); a known allergy or history of serious adverse reactions to botulinum toxin; active infection at the intended injection site; significant keloid or hypertrophic scarring that has not been assessed; unrealistic expectations (believing the result will be permanent); or severe vertical maxillary excess (VME) requiring orthognathic surgery — in any of these situations, our physician will recommend deferring treatment or providing an appropriate referral.
How can the risk of upper lip ptosis be minimized?
What does the informed consent form include?
Every client signs an informed consent form before their first treatment. It covers: how Botox® works, possible adverse reactions and their likelihood, alternative options, the reassessment and touch-up schedule, maintenance intervals, and an optional media release. All details are explained by our physician personally — not delegated to administrative staff.
Where the medical claims on this page come from
Everything above about Gummy smile rests on published evidence rather than on our own word. The sources below are the ones behind those statements: peer-reviewed papers indexed in PubMed, and guidance written for patients by dermatology academies and national health services. Read them before you decide — and bring any of them to your consultation.
- Peer-reviewedBotulinum toxin type A for facial wrinkles
- Patient guidanceBotulinum toxin: Overview
What these references can and cannot tell you. They describe what is known about the treatment itself — how well it tends to work, how long results last, and what can go wrong. They are not an assessment of this clinic, and no published study can tell you whether it suits your skin type, anatomy, or medical history. That judgement comes from the physician who examines you in person, and it may well be “not this one”.