A gummy smile can be charming, but if you find yourself avoiding photos or suppressing your grin, you are not alone. Many patients arrive to a consultation holding a phone with a zoomed-in selfie, pointing at more gum than they would like. They are not asking for a frozen mouth. They want their smile to look like them, just with less gum exposure. Botox, used thoughtfully, can achieve that by dialing down the lip elevator muscles so the upper lip does not rise as high. The change is small in millimeters, yet the improvement feels dramatic.
This guide walks you through candidacy, the botox procedure, the injection sites, results, safety, cost, and the trade-offs I discuss affordable botox in Burlington Massachusetts every week in clinic. It is written for anyone considering botox for gummy smile correction, including first-timers who have only heard about botox for forehead lines and want to understand how it works around the mouth.
What creates a gummy smile
A gummy smile often comes from one or a combination of three factors. The upper lip may lift too strongly, the gums may be overgrown or inflamed, or the teeth may be short because of delayed passive eruption. Orthodontic issues like vertical maxillary excess can also play a role. When hyperactive lip elevator muscles drive most of the gum exposure, botox, placed precisely, can soften the upward pull.
The elevator muscles we target are the levator labii superioris alaeque nasi, the levator labii superioris, and occasionally the zygomaticus minor. In practice, we are talking about tiny injections near the sides of the nose to relax the muscles that flare the nostrils and hike the lip. Reducing their activity by even a small percentage diminishes gum show without taking away your ability to smile. The goal is a natural smile, not a slack upper lip.
Who is a good candidate
The best candidates show more than 2 to 3 millimeters of gum when smiling and have a strong lip elevator component. They want a reversible option and are comfortable with maintenance every few months. If your gummy smile comes primarily from skeletal proportions or tooth size, botox can still help, but it may not be sufficient on its own. A thoughtful consultation with an injector who understands dental and facial anatomy is key.
Good candidates usually say things like, “When I grin for real, my lip jumps way up,” or “I like my smile in a soft selfie, but when I laugh, all gum.” If you can press gently on the muscles alongside your nose and see the gum exposure decrease, you are likely to respond well. Patients who seek a one-time permanent fix are better served by surgical solutions after a proper orthodontic and periodontal evaluation.
How botox works for a gummy smile
Botox is a neuromodulator that temporarily blocks the release of acetylcholine at the neuromuscular junction. Think of it as turning down the volume on a muscle, not muting it entirely. In this context, we use low units to reduce the lift while avoiding a flat, heavy look. Technique matters more than the brand name, although brand differences exist. Some patients prefer botox cosmetic, while others respond similar to Dysport or Xeomin. The conversation of botox vs dysport comes up often, and for gummy smile, the decision typically rests on injector familiarity rather than a predictable advantage for one product.
Unlike botox for crow’s feet or botox for frown lines, where higher doses are common, gummy smile correction relies on micro doses in a small area. We layer the effect by starting conservatively, assessing botox results at the two-week mark, and adding a touch up if needed.
The consultation: what to cover and what I look for
A useful botox consultation does not start with the syringe. It starts with observing you speak and smile, then having you smile at different intensities. I measure gum exposure in millimeters, watch nostril flare, and note any asymmetry between the left and right lip elevators. I ask about dental history, periodontal treatments, orthodontics, and any lip flips you may have had. If you are also considering a botox lip flip, we need to coordinate doses so the lip does not become too relaxed to hold shape.
We also discuss expectations. Botox for gummy smile is not a “set it and forget it” treatment. The effect builds over 3 to 14 days, peaks around week two, and typically lasts 8 to 12 weeks around the mouth, sometimes a bit less than forehead or masseter areas. Lifestyle factors like intense exercise and fast metabolism can shorten duration. Patients who do high-intensity training five days a week frequently notice the wear off signs closer to the eight-week point.
I screen for contraindications: pregnancy, breastfeeding, certain neuromuscular disorders, active skin infection, recent dental procedures in the immediate area, and a history of severe allergies to botulinum toxin. Blood thinners are not an absolute deal-breaker, but we plan accordingly to reduce bruising risk. If you are using tretinoin, exfoliants, or had microneedling recently, we adjust timing.
The botox procedure step by step
The appointment is straightforward and quick, usually 10 to 15 minutes. After consent and pre-treatment photos, we clean the area. Numbing cream is rarely necessary, although for very sensitive patients it is an option. I mark injection sites at the “Yonsei point,” a well-described location that influences the key lip elevator muscles. In practice, this translates to two small injections, one on each side of the nose, sometimes with a micro point added if the gummy show extends more laterally.
Units per area vary by face and strength of muscle pull, but the range is often 2 to 4 units per side for botox cosmetic, sometimes a touch more for pronounced cases. If you have mild asymmetry, we adjust one side by a unit or two. The needle is fine, the depth shallow, and the injections are brief. Most patients rate the botox pain level as a 2 or 3 out of 10, describing a quick pinch and mild watering of the eyes.
Right after the injections, you may see tiny blebs that settle within minutes. Makeup can go back on after a couple of hours if the skin looks intact. I ask patients to stay upright for 3 to 4 hours, avoid pressing or massaging the area, and skip vigorous exercise until the next day.
What the first two weeks feel like
The botox timeline is predictable. On day one and two, you may feel nothing beyond slight tenderness or a small bruise. Around day three to five, the upper lip starts to feel “lighter” when you smile. Some patients describe a subtle dampening of nostril flare. By day seven to ten, the effect becomes obvious in selfies. You still smile; you just show less gum. If we were conservative on dose, this is when you decide whether to request a botox touch up at the two-week follow up.
It is worth noting that the mouth is expressive territory. Even small changes can feel strange at first. Within a few days, your brain adapts, and the smile feels natural again. If you had a simultaneous botox lip flip, anticipate a learning curve for sipping from narrow straws or pronouncing certain bilabial sounds. This usually resolves quickly.
How long the results last and how maintenance works
Around the mouth, botox results duration tends to be shorter than in the upper face. Expect 8 to 12 weeks on average. I tell patients to track their selfies and pay attention to wear off signs such as the upper lip rising a bit higher in laughter than it did in week three or four. If you prefer your smile at a specific level, a botox touch up schedule every 10 to 12 weeks works well. Over time, some patients experience a slight training effect, allowing us to maintain with fewer units.
The frequency is personal. If you budget for quarterly treatments, you will keep a steady look. If you let it wear off and return for special occasions, plan the appointment two to three weeks before events so the result peaks when you want it.
Safety, side effects, and what can go wrong
When placed by a trained injector, the botox safety profile is strong, and serious adverse events are rare. The most common temporary effects are redness, tenderness, botox swelling at the injection point, and small bruises. Headaches are less common around the mouth than the forehead, but they can occur. The bigger concern is over-relaxation of the upper lip, which can blunt your smile, or unintended diffusion affecting the levator muscles asymmetrically. If the dose is too high or the product travels too low, the lip may feel heavy. This softens over days to weeks as the effect settles, then resolves as the botox wears off.
Avoid pressing on the sites and keep skincare simple for 24 hours. I ask patients to hold off on facials, steam rooms, or vigorous massage for a couple of days to minimize diffusion risks. If you have bruising, cold compresses the first day help, and arnica can speed resolution.
As for long term effects, we have decades of data for botox cosmetic use. There is no evidence of cumulative toxicity at cosmetic doses, though antibodies can form in rare cases, typically tied to high, frequent dosing. Using the lowest effective dose and spacing sessions reasonably mitigates that risk.
What it looks like: before and after, and how to judge success
Most patients see a 2 to 4 millimeter reduction in gingival show. In photos, this means the pink band above the upper teeth narrows, and the smile looks balanced. A strong “before and after” shows the same intensity of smile, same lighting, and similar head position. This is why we take standardized pictures.
If we miss the mark, it is usually because the baseline gummy smile had a larger dental or skeletal component. In those cases, the smile improves with botox, just not enough for the patient’s aesthetic target. At that point, we discuss botox alternatives like lip repositioning surgery, crown lengthening, or, in more advanced cases, orthognathic surgery coordinated with an orthodontist. Sometimes, pairing botox with a subtle filler plan to support the philtral columns or the upper lip’s vermilion border can balance the proportions. Combination therapy requires experience to avoid overfilling, especially in small lips.
How this fits with other botox uses
People familiar with botox for face wrinkles often assume the lower face behaves the same way. Around the mouth, every millimeter matters. The units per area are far lower than, say, botox for forehead lines or botox for between eyebrows. For context, where a glabellar complex might take 20 units, a gummy smile can respond to as little as 4 to 8 total units. This is why injector expertise is critical. A botox nurse injector or botox dermatologist who treats mouths regularly will adjust the plan based on how you emote, not just an injection map.
If you already do botox for crow’s feet or botox eyebrow lift, gummy smile correction can be added in the same session with careful planning. For bruxism, some patients also receive botox for masseter to slim the jawline or reduce clenching. The combination can subtly reshape the lower face while keeping expressions natural.
Cost, price ranges, and how to evaluate value
Botox cost varies widely by region, injector credentials, and clinic type. Many offices price by unit, others by area. The range for a gummy smile treatment typically sits lower than mid-face or forehead treatments because of the modest dosage. Patients in large cities might see a botox price per unit between the low teens and the low twenties, with total treatment cost commonly in the low hundreds. Clinics that advertise botox near me specials can be excellent or uneven. The lure of a deal is understandable, but you are paying for anatomical judgment more than the milligrams in the vial.
If you are comparing options, ask who will inject you, how many gummy smile corrections they perform each month, and to see their botox before and after photos for this specific indication. Reviews can be helpful, and botox clinic reviews that mention the mouth are especially relevant, but they should supplement, not replace, your consultation impression. A botox certified provider with a track record in perioral work is your best bet.
What to ask at your consultation
A short checklist helps patients leave the consult confident and informed:
- Which muscles contribute most to my gummy smile, and how many units do you plan to use per side? What is your plan if one side lifts higher than the other? How many of these cases do you treat monthly, and can I see before and after photos? If I want a lip flip too, how will you adjust doses so my smile still looks natural? What is the touch up policy if I need a small adjustment at two weeks?
Preparing and recovering like a pro
Simple steps make the experience smoother. Avoid alcohol and high-dose fish oil for 24 to 48 hours before your appointment if your physician approves, as both can increase bruising. If you take prescribed blood thinners, do not stop them without medical guidance. Arrive with clean skin, skip active acids that morning, and plan light activity the day of treatment. Afterward, keep your head elevated for a few hours, avoid heavy sweating until the next day, and do not rub or massage the area. Most patients return to work or dinner plans right away. Makeup can be applied gently after a couple of hours if the skin looks normal.
When botox is not enough
A few real-world examples illustrate limits. A patient with 6 millimeters of gingival display and short clinical crowns improved with botox but still showed 3 to 4 millimeters. Periodontal crown lengthening with a periodontist, followed by subtle botox maintenance, delivered the balanced smile she wanted. Another patient with vertical maxillary excess and lip hyperactivity saw only modest benefit from botox alone. Orthognathic surgery corrected the skeletal relationship, and later, a tiny dose of botox fine-tuned the smile arc.
This is not to discourage. It is to set a realistic framework. Botox excels when the problem is muscular. When bone and tooth proportions drive the issue, it can be part of the plan, not the whole plan.
Botox vs fillers vs other options for the upper lip
Botox reduces muscle pull. Fillers add volume and structure. For gummy smiles, filler can sometimes make the upper lip look heavier, reducing gum show visually, but it can also evert the lip too far if overdone. A micro dose of filler along the vermilion border paired with small botox units often looks more natural than filler alone. If the philtrum is very short, filler may crowd the area and look artificial. A skilled injector will steer you away from that.
Dysport and Xeomin are reasonable alternatives to botox cosmetic, and many practices stock all three. The differences are subtle in this context, and technique outweighs brand. For patients who want to avoid neuromodulators entirely, lip repositioning surgery is a minor oral surgical procedure that limits the upward movement of the lip. Recovery involves swelling and stitches under the lip for a couple of weeks. It is more permanent, but it is also less adjustable than botox.
Results that look like you
Most patients do not want anyone to notice they did something. They want friends to say, “Your smile looks great.” The art lies in restraint. I would rather under-treat and add a unit at the two-week botox follow up than overshoot and wait for it to wear off. This is also where gender expression and personal style matter. Botox for men around the mouth often uses slightly lower doses to maintain a rugged, dynamic smile. Botox for women may aim for a softer arc, but these are preferences, not rules. The shared goal is a natural look and subtle enhancement.
Myths, facts, and practical realities
A few myths persist. Botox will not migrate to your whole face if you laugh after treatment. You can smile and chew normally. You do not need to abstain from sleeping on your side forever, just avoid face-down pressure the first night. The product does not build up in your system; it is metabolized over weeks to months. Preventative botox and baby botox are real strategies, but for gummy smiles, the focus is balancing function today rather than warding off future lines.
The facts are simple and reassuring. The mechanism is temporary, the doses are tiny, and the risk profile is low when handled by experienced hands. The flip side is maintenance. If you love the result, you will be back a few times a year. Plan the botox maintenance in your calendar the way you plan hair appointments or dental cleanings.
Finding the right injector
Search terms like botox near me can help you build a shortlist, but your consultation experience is the decisive factor. A good injector listens to how you describe your smile, measures, photographs, and explains their plan in plain language. They will talk about botox side effects, provide aftercare, and invite a follow up. They will not push you into more areas than you want or jump to filler without explaining trade-offs. If your case is complex, they will suggest a joint evaluation with a dentist or periodontist.
Patients often ask whether a dermatologist or a nurse injector is better. Title matters less than repetition and mentorship. A nurse injector who treats perioral cases daily under a supervising physician can deliver outstanding, consistent results. A dermatologist with procedural focus can do the same. Look for training, case volume, and humility about limits.
A final word on expectations and confidence
Confidence does not come from erasing every quirk. It comes from aligning your features with how you feel inside. A gummy smile is not a flaw; it is a trait. If softening it helps you enjoy photos and laugh without thinking about angles, botox is a light, reversible tool that can make that happen. Expect a small, targeted procedure, a gentle lift in self-assurance, and a maintenance botox near me rhythm that keeps the change steady without shouting that you had work done.
If you are on the fence, schedule a botox consultation, ask the questions listed above, and request a conservative first session. Two weeks later, you will know. Most patients do not need convincing after they see their own before and after photos. They simply smile, a touch less gum and a lot more ease.