Gummy Smile Treatment: Proposal for a Novel Corrective Technique and a Review of the Literature

Alberto Diaspro, MD, MSc Maurizio Cavallini, MD Giuseppe Sito, MD Patrizia Piersini, MD

Aesthetic Surgery Journal, sjy174,

Published: 13 July 2018


A perfect smile is dictated by the balance between three parameters: the white (teeth), the pink (gum), and the lips: excessive gingival display while smiling has been a cause of esthetic embarrassment for many patients, thus affecting their psychosocial behavior.

With respect to different etiologies, treatment of gummy smile must be properly planned: treatment options include facial surgery, oral surgery or laser.

Given the growing demand for less invasive techniques and observed complications secondary to botulinum toxin injection, we present a novel treatment option aimed at correcting gummy smile using hyaluronic acid injection and review the published techniques and the anatomy of the involved facial muscles.

The treatment was performed by infiltration in the paranasal area, in the location of the most cranial portion of the nasojugal fold, about 3 mm lateral to the alar cartilage wing, according to a vector perpendicular to the cutaneous plane, to gently compress the lateral fibers of the levator labii superioris alaeque nasi without invading it. A Vycross® technology filler was used for all the treatments.

All patients had an immediate improvement, with a maximum duration ranging from 186-240 days (mean, 213 days) days, according to parameters of the Global Aesthetic Improvement Scale (GAIS 4.06).

This new, less invasive and safer technique to correct dynamic excessive gingival display was shown to be feasible and safe with a long-lasting result. This treatment could be a novel effective option for experienced injectors to treat aesthetic facial flaws.

Topic: botulinum toxins cartilage esthetics face facial muscles gingiva hyaluronic acid lasers oral surgical procedures cranium smiling surgery, oral surgical procedures, operative teeth lip surgery specialty levator labii superioris muscle
Subject Cosmetic Medicine