A gummy smile, where more than about 3 to 4 millimeters of gum tissue shows above your upper teeth when you smile, can be fixed through several approaches ranging from a quick injection to surgery. The right fix depends entirely on what’s causing the excess gum display, and there are four main culprits. Identifying yours is the first step toward choosing a treatment that actually works.
What Causes a Gummy Smile
Not all gummy smiles have the same origin, which is why a one-size-fits-all fix doesn’t exist. The four primary causes are:
- A hyperactive upper lip. Your lip elevator muscles pull your upper lip too high when you smile, exposing gum tissue that would otherwise stay hidden. The lip itself may be a normal length, but it moves too much.
- Excess bone growth in the upper jaw. The upper jawbone grew longer than average in the vertical direction, pushing your teeth and gums downward. This often gives the lower half of the face an elongated appearance.
- Gum tissue that never receded properly. During normal tooth development, gum tissue is supposed to pull back and expose more of the tooth crown. When this process stalls, the gums sit too high on the teeth, making them look short and square.
- Naturally short teeth. Teeth that are worn down, or that simply grew in shorter than average, shift the tooth-to-gum ratio so that gums dominate your smile line.
Many people have a combination of these factors. A dentist or periodontist can determine which ones apply to you through a clinical exam and, in some cases, an X-ray analysis of the jaw. That diagnosis drives everything that follows.
Botox for a Hyperactive Lip
If your gummy smile is caused by lip muscles that pull too hard, Botox is the simplest and least invasive option. A small amount of botulinum toxin is injected into the muscles that elevate the upper lip, weakening their pull so the lip sits slightly lower when you smile. The primary injection site targets the area where the main lip elevator muscles converge near the nose, with additional points near the cheekbone muscles for more complex cases.
Dosing is surprisingly precise. The standard approach uses roughly 1 unit of neurotoxin for every millimeter of gum display you want to reduce. So if you show 4 millimeters of excess gum, you’d receive about 4 units at the primary injection point. If muscles on the sides of the smile also contribute, those points get about half the dose.
Results typically last 4 to 7 months before the muscle activity gradually returns. In a longitudinal study following patients for up to four years, gum exposure began reappearing around 3 to 4 months after injection, and most patients returned for a touch-up by month 4 or 5. By 7 months, the smile had fully returned to its original appearance. This means Botox is a commitment to repeat treatments, not a permanent solution. For many people, though, the speed, low cost, and zero recovery time make it worthwhile while they decide on something longer-lasting.
Gum Contouring and Gingivectomy
When the problem is too much gum tissue covering your teeth rather than too little lip coverage, reshaping the gums themselves is the most direct fix. This procedure, called a gingivectomy, removes excess gum tissue to expose more of the tooth’s natural crown. It’s most effective for people whose gum tissue never fully receded during development.
Modern gum contouring is typically done with a diode laser rather than a scalpel. The laser cuts tissue in thin layers, seals blood vessels as it goes, and allows the periodontist to sculpt precise, even gum lines around each tooth. The procedure is done under local anesthesia, and for purely cosmetic cases, only soft tissue is removed.
Recovery takes about one week. You’ll want to avoid strenuous exercise or heavy lifting for at least 48 hours, since an elevated heart rate can increase bleeding and swelling. If your work is physically demanding, plan for about three days off. You can eat the same day, but stick to soft foods until the numbness fades, and be gentle when cleaning the area.
When Bone Removal Is Needed
Sometimes the issue goes deeper than soft tissue. If the bone underneath sits too close to where the gum line should be, simply trimming the gums won’t produce a stable result. The body maintains a natural zone of about 2 millimeters of tissue attachment between the bone and the base of the gum. If that zone is violated, the bone will remodel unpredictably and gum tissue can regrow.
In these cases, a more involved procedure called crown lengthening is performed. The periodontist lifts the gum tissue, reshapes the underlying bone to create at least 3 millimeters of clearance from the desired gum line, then repositions the tissue at its new, lower level. This is a longer procedure with a more involved recovery than a simple gingivectomy, but it produces permanent results because the bone has been set to the correct position. Your periodontist can determine which approach you need by measuring the depth of the tissue around your teeth and evaluating X-rays.
Lip Repositioning Surgery
Lip repositioning is a middle-ground option for people whose gummy smile comes from excessive lip movement but who want a permanent solution instead of ongoing Botox. The surgery limits how far the upper lip can rise by reducing the depth of the fold between your lip and upper jaw.
The technique involves removing an elliptical strip of tissue from inside the upper lip, extending from roughly one premolar to the other. The remaining tissue is sutured together, effectively shortening the “track” the lip muscles can travel. As a general rule, the strip of tissue removed is twice the width of the reduction you want. So to reduce gum show by 3 millimeters, about 6 millimeters of tissue is removed.
A systematic review of outcomes found that lip repositioning reduces gum display by an average of 3.4 millimeters. The entire procedure is performed inside the mouth, so there are no visible scars. It’s a good option for moderate cases where the jaw structure is normal but the lip simply rises too high.
Orthodontic Intrusion With Mini-Screws
If your upper front teeth sit too low relative to the rest of your face, pushing them upward into the jawbone (called intrusion) can reduce gum display without surgery on the gums or lip. This approach uses tiny titanium screws temporarily placed into the bone above the teeth as anchor points. Orthodontic wires attached to these anchors apply a gentle upward force, typically 80 to 100 grams, that gradually moves the teeth and surrounding gum tissue higher.
Treatment time varies, but studies report the screws staying in place for roughly 5 to 11 months, with average tooth movement of about 2.6 to 2.9 millimeters upward. This is a good option for people who also need orthodontic work for other reasons, such as bite correction, since the gummy smile fix can be integrated into a broader treatment plan. The mini-screws are removed once the teeth reach their target position, and the results are maintained with standard orthodontic retention.
Jaw Surgery for Severe Cases
When the root cause is a jawbone that grew too long vertically, soft tissue procedures and orthodontics can only do so much. Orthognathic surgery is considered the best treatment for moderate to severe vertical excess of the upper jaw. The procedure repositions the entire upper jaw upward, correcting not just the gum display but also the overall facial proportions.
This is the most invasive option and involves general anesthesia, several weeks of recovery, and often a period of orthodontic treatment before and after surgery to align the bite. It’s typically reserved for cases where the elongated jaw also affects chewing function or facial balance, not purely cosmetic concerns. An oral and maxillofacial surgeon works alongside an orthodontist to plan these cases.
Choosing the Right Approach
The best treatment depends on your specific anatomy, how much gum shows, and how permanent you want the results to be. A practical way to think about it:
- Hyperactive lip, mild to moderate display: Start with Botox to see if you like the result. If you do, consider lip repositioning for a permanent fix.
- Excess gum tissue covering normal-length teeth: Gum contouring or crown lengthening, depending on how close the bone sits to the surface.
- Teeth that sit too low: Orthodontic intrusion with mini-screw anchors, often combined with braces or aligners.
- Overgrown upper jaw: Jaw surgery, typically combined with orthodontics.
Many gummy smiles involve more than one contributing factor, and treatments can be combined. Someone might have both excess gum tissue and a hyperactive lip, for instance, and benefit from gum contouring plus Botox or lip repositioning. A consultation with a periodontist or an orthodontist experienced in smile design is the most efficient way to sort out which combination applies to you.