neithernorwood
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Excessive gummy smile is a universally unattractive feature on both men and women. Fortunately, it is usually possible to fix. Orthognathic surgery is typically suggested as the “proper” fix for most patients, but it may not always be the best option. There are many causes of gummy smile, and many different fixes. This post surveys the current research and highlights a few relatively unknown but promising permanent fixes for situations where the root cause is upper lip hypermobility.
Attribution: much of this post is inspired by these two slideshares:
POSSIBLE ROOT CAUSES FOR A GUMMY SMILE
IDENTIFYING ROOT CAUSES FOR A PATIENT
Factors to evaluate:
Notable: When interlabial space at rest is normal (1-3mm), gummy smile is considered to have a predominantly muscular origin. Hyperactive muscles are indicated when lip length is normal and the lower third of the face is proportional to the other thirds.
SOLUTIONS
For jawbone
DISCUSSION
Jaw surgery is the best long-term fix for many patients. For patients without jaw issues, Botox and lip repositioning are the most commonly known options. But each of these have downsides (short fix duration and fatter lips in repose, respectively). Silicone impact, fat transplantation, and muscle amputation may be worth considering in these cases as well.
Anything I missed? Would appreciate clarification on any of these if you know about them. Hope this helps some gummycels.
Attribution: much of this post is inspired by these two slideshares:
Code:
https://www.slideshare.net/Yasmine_M_Hammad/gummy-smile-75638777
https://www.slideshare.net/marwanmouakeh/diagnosis-and-treatment-of-gummy-smile-30724980POSSIBLE ROOT CAUSES FOR A GUMMY SMILE
- Hard tissue
- Excess downward vertical growth of the upper jawbone (VME)
- Excess forward protrusion of the upper jawbone
- Soft tissue
- Hyperactive upper lip muscles (muscles move too much when smiling)
- Short philtrum (distance between top of upper lip and bottom of nose)
- Might be both
- Short teeth crowns (vertical height of individual teeth is low)
IDENTIFYING ROOT CAUSES FOR A PATIENT
Factors to evaluate:
- Horizontal extent of gum show within the smile arch during full smile
- Height of bottom third of face compared to the rest at rest with jaw/lips sealed
- Interlabial distance at rest (vertical distance between lips)
- Exposure of upper incisors at rest and speech
- Shape of smile arc itself
- Width and length of maxillary incisors
- Philtrum length (average 24mm for men, 20mm for women)
- Upper lip thickness
- Movement of upper lip from rest to full smile
Code:
See the decision tree on slide 43 here:
https://www.slideshare.net/Yasmine_M_Hammad/gummy-smile-75638777
See the decision tree on slide 58 here:
https://www.slideshare.net/marwanmouakeh/diagnosis-and-treatment-of-gummy-smile-30724980Notable: When interlabial space at rest is normal (1-3mm), gummy smile is considered to have a predominantly muscular origin. Hyperactive muscles are indicated when lip length is normal and the lower third of the face is proportional to the other thirds.
SOLUTIONS
For jawbone
- Le Fort 1 osteotomy (remove part of upper jaw bone) video
- Le Fort 1 osteotomy with BSSO (double jaw surgery, aka “bimax”) video
- Pros: permanent, fixes VME, also can get more forward growth
- Cons: expensive ($10k+), invasive, 4-6 week recovery time
- Intrusion of the upper incisors (braces to pull teeth up into jaw)
- Pros: permanent, less invasive than jaw surgery, can be combined with other ortho
- Cons: somewhat expensive ($5k+), takes many months, requires braces, doesn’t work for cases with >3mm
- Crown lengthening (recontouring of both gum and supporting bone) video video
- Pros: permanent, less invasive than jaw surgery, proper fix for overgrown gums
- Cons: somewhat expensive ($1k to $10k)
- Gum contouring (recontouring the gum only) link
- Pros: permanent, super fast recovery
- Cons: only removes gum, which might not make that big of a difference. mild soreness, somewhat expensive ($300 - $3k)
- Flossing [speculative]
- Over the years flossing may reduce gum size
- Botox in smile muscles
- Pros: individual sessions are cheap, easy, no down time, effective
- Cons: only lasts 3-4 months, risk of toxicity, only certain places offer this
- Lip repositioning procedure (cut inside the vestibule of mouth and reattach)
- Pros: semi-permanent (seems like years at least)
- Cons: makes the lip appear fuller at rest. Not a good option if your lips are already full
- Levator labii superioris (one or two) amputated at the junction with the orbicularis oris (link, link)
- Cons: cause upper lip to hang down too far in repose (?)
- Fat transplantation (link)
- Pros: permanent or at least semi-permanent
- Cons: not aware of any practices that offer this, adds to facial bloat (?)
- Silicone implant below nose (link, link)
- Pros: permanent
- Cons: implant rejection (link); affects only the “up” muscles, not the “out” muscles (?)
- Age
- Muscles become less active as you age
- V-Y plasty link
- Pros: Can lengthen philtrum
- Cons: Makes you look older earlier. Generally short philtrum is better
- Taping mouth shut at night [speculative]
- Taping may pull down the philtrum
- Age
- Short philtrum is sign of youth
- Philtrum drops as you age
DISCUSSION
Jaw surgery is the best long-term fix for many patients. For patients without jaw issues, Botox and lip repositioning are the most commonly known options. But each of these have downsides (short fix duration and fatter lips in repose, respectively). Silicone impact, fat transplantation, and muscle amputation may be worth considering in these cases as well.
Anything I missed? Would appreciate clarification on any of these if you know about them. Hope this helps some gummycels.
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