For individuals self-conscious about showing too much gum when they smile, a common cosmetic concern known as 'excessive gingival display,' a treatment involving botulinum toxin injections has emerged as a viable solution. This procedure, often referred to by the brand name Botox, targets the overactivity of a specific facial muscle responsible for lifting the upper lip too high.
Sally White, a 53-year-old office manager, described her lifelong struggle with a self-perceived 'gummy smile.' She frequently avoided photos and suppressed laughter due to discomfort with her appearance. "I absolutely hated having my picture taken or seeing photos of myself – I felt uncomfortable and self-conscious because of my horrible, gummy smile," White stated. "If I started smiling or laughing in public, I would either cover my mouth – or else force myself to stop."
Excessive gingival display is characterized by showing more than three to four millimeters of gum above the upper teeth when smiling. While not precisely defined clinically, it is estimated to affect approximately 14 percent of women and 7 percent of men in the UK. The primary cause is often an overactive muscle called the 'levator labii superioris alaeque nasi' (LLSAN), which runs alongside the nose and elevates the upper lip. When this muscle is particularly strong, it pulls the lip higher than normal, revealing more gum.
Dr. Kate Carr, a former GP and founder of Dr. Kate Aesthetics, explained that this condition can significantly impact self-esteem, often stemming from childhood experiences. "Kids can be cruel – and if someone has been bullied or called names because of their smile, it can have a really profound and lasting impact," Dr. Carr noted. "Some patients could never relax when smiling and even altered the way they smiled in public or when having a photo taken."
The treatment involves carefully injecting a small dose of botulinum toxin into the LLSAN muscle. This temporarily weakens the muscle, preventing it from pulling the upper lip as high. "It doesn’t paralyze the muscle, just weakens it slightly, so when someone smiles the lip isn’t pulled as strongly and doesn’t lift as much," Dr. Carr said. She emphasized the importance of precise dosage, warning that over-injection could lead to the lip dropping too low, obscuring teeth instead of revealing too much gum.
The effects of the injections develop over about three weeks and typically last between six to eight weeks, requiring repeat treatments every three to four months. The procedure, costing around £180 per session, has been described by patients like White as a "game-changer."
White discovered the treatment through a conversation with her dentist and, despite initial reservations about cosmetic procedures, found the minimal dose to be transformative. "When Botox first came out, you’d see celebrities with stiff-looking faces. I swore I’d never touch it – that I’d just grow old gracefully. But then I discovered that just a tiny bit could completely change the way I feel," she shared. While the treatment does not affect eating, drinking, or talking, it can slightly limit the ability to purse lips tightly. Nonetheless, White expressed immense satisfaction, stating, "It’s fantastic to finally be able to smile again." Dr. Carr highlighted that while the treatment is quick and straightforward, many individuals remain unaware that this common concern is treatable.
