Can Botox fix a gummy smile? 2025 data on success rates, dosage charts, combination strategies, costs and risks all in one evidence-based guide.
Table of Contents
- Gummy Smile Types & Why Botox Entered the Chat
- Anatomy & Injection Points — 2025 Protocols
- Evidence Review: RCTs & Meta-analyses 2023-2025
- Dosage & Longevity Table (2–8 U)
- Combination Approaches: Intrusion, Laser, Fillers
- Risks, Contra-indications & Management
- Cost Breakdown vs Surgical/Laser Options
- Decision Flowchart: Who’s a Good Candidate?
- FAQ
- Conclusion & Next Steps
(≈ 2 500 words, 4 minutes read time)
1 | Gummy Smile Types & Why Botox Entered the Chat
“Gummy smile” (excessive gingival display ≥ 3 mm) affects ~10 % of adults, but only 20 % seek surgical correction due to cost, fear and downtime. Botulinum toxin type A emerged in 2005 as a quick, reversible fix; high-quality trials in 2024 finally quantified its predictability. pubmed.ncbi.nlm.nih.gov
Four Etiology Buckets
| Type | Etiology | Botox Usefulness | Alt. Mainstay |
|---|---|---|---|
| Hyperactive Upper-Lip | Elevator muscles over-contract | ★★★★★ | Botox first-line |
| Dento-Alveolar Extrusion | Incisors erupt too far | ★★☆☆☆ | Orthodontic intrusion |
| Vertical Maxillary Excess (VME) | Skeletal overgrowth | ★☆☆☆☆ | Le Fort I impaction |
| Short Upper Lip (< 20 mm) | Anatomic deficit | ★☆☆☆☆ | Lip-lengthening surgery |
2 | Anatomy & Injection Points — 2025 Protocols
Modern practice targets the “Yonsei point”—an anatomical sweet-spot where fibers of the levator labii superioris (LLS) and levator labii superioris alaeque nasi (LLSAN) overlap. One 3 U injection per side routinely replaces the earlier 2-site method. journals.lww.com
Standard Dosage: 4-8 U total (women) • 6-10 U total (men)
Onset: 3-5 days • Peak: 14 days • Duration: 14-24 weeks
3 | Evidence Review 2023-2025
| Study | Design | N | Outcome (GD↓) | Duration | Notes |
|---|---|---|---|---|---|
| Gong 2024 pubmed.ncbi.nlm.nih.gov | RCT | 64 | –3.2 mm | 24 wk | Yonsei vs LLSAN sites; Yonsei superior |
| Rojo-Sanchis 2023 pubmed.ncbi.nlm.nih.gov | Meta-analysis | 18 studies | –2.8 mm pooled | 12-24 wk | 78 % satisfaction |
| Case-series 2024 scielo.sa.cr | 1 | –4.1 mm | 20 wk | High initial GD (5 mm) |
Mean gingival-display reduction across robust RCTs: 2.7–3.3 mm, comfortably covering most mild-to-moderate gummy smiles.
4 | Dosage & Longevity Table
| Total Units | Average GD Reduction | Longevity (weeks) | Retouch Interval |
|---|---|---|---|
| 2 U | –1.5 mm | 10–12 | 3 mo |
| 4 U | –2.5 mm | 14–18 | 4–5 mo |
| 6 U | –3.0 mm | 16–22 | 5 mo |
| 8 U | –3.4 mm | 18–24 | 5–6 mo |
Higher doses plateau after 8 U; risk of lip droop rises > 10 U. mdpi.com
5 | Combination Approaches in 2025
- Orthodontic Intrusion + Botox — miniscrew intrusion (–2 mm) then 4 U Botox trims residual display; synergistic relapse control. pmc.ncbi.nlm.nih.gov
- Laser Gingivectomy + Botox — remove 1 mm gingiva, finish with 2 U Botox for muscle hyperactivity.
- Fillers at G-Point — 0.3 mL HA filler prolongs Botox by resisting upper-lip eversion, extending results to 8 months.
6 | Risks, Contra-indications & Management
| Risk | Incidence | Mitigation |
|---|---|---|
| Transient upper-lip weakness | 8–12 % | Stay ≤ 8 U, inject intramuscular not subdermal |
| Asymmetry | 5 % | Precise anatomic landmarks, micro-adjust at 2-week check |
| Antibody resistance | < 1 % | Rotate to daxibotulinumA in repeat patients |
| Needle bruising | 7 % | 31G needle, ice 2 min pre-/post-shot |
Contra-indications: pregnancy, myasthenia gravis, aminoglycoside use.
7 | Cost Breakdown vs Surgical & Laser Options (U.S. 2025)
| Treatment | Upfront Cost | Re-do Cycle | 5-Year Cumulative* | Downtime |
|---|---|---|---|---|
| Botox 6 U | $300 | 2× / yr | $3 000 | 0 days |
| Laser Gum Lift | $1 200 | none | $1 200 | 2–3 days soft diet |
| Lip-Reposition Surgery | $3 500 | rare touch-up | $3 500 | 7 days |
| Le Fort I Impaction | $25 000 | none | $25 000 | 2–4 wks |
*Assumes typical Botox retreatment every 24 weeks at $300/session.
8 | Decision Flowchart (Simplified)
- Hyperactive lip? (Smile exposure drops when saying “mmm”)
▶ Yes → Botox 4–8 U trial. - GD > 4 mm despite lip test?
▶ Yes → Add intrusion or laser; assess VME. - Profile convex & VME > 4 mm?
▶ Yes → Orthognathic consult; Botox as interim.
9 | FAQ
Will Botox make my smile look fake?
When dosed ≤ 8 U and placed at the Yonsei point, lip function remains natural; average reduction ~3 mm.
How long before I can eat/drink?
Immediately; avoid massaging area or lying flat for 4 hours.
Can I combine with aligners?
Yes—Botox can be injected mid-aligner treatment; wait 24 h before next scan.
Is it painful?
Minor sting; topical lidocaine optional.
What if it wears off unevenly?
A 2-U “tweak” at week 4 fixes asymmetry; rarely needed.
10 | Conclusion & Next Steps
Botox offers a rapid, reversible path to taming mild-to-moderate gummy smiles, especially when skeletal surgery feels extreme. Success hinges on correct patient selection, Yonsei-point precision and realistic repeat-visit budgeting.
Thinking about Botox for your gummy smile?
– Book a 10-minute virtual eligibility consult.
– Download our printable “Gummy Smile Matrix” to discuss all options with your orthodontist.
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