Sally White once avoided photos and stifled laughter due to her "gummy smile," a condition where too much gum is visible when smiling. Now, thanks to a simple course of anti-wrinkle injections, the 53-year-old office manager can beam with confidence.
A gummy smile, formally known as excessive gingival display, is generally defined as showing more than three to four millimeters of gum above the upper teeth. This condition affects an estimated 14 percent of women and 7 percent of men in the UK. The most common cause is the overactivity of a muscle called the levator labii superioris alaeque nasi (LLSAN), which lifts the upper lip too high during a smile.
"A significant number of people have excess gum tissue on show and feel very self-conscious about it," said Dr. Kate Carr, a former GP and owner of Dr. Kate Aesthetics. "Often it has been a problem from a young age. 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."
Treatment involves injecting a small dose of botulinum toxin, commonly known as Botox, into the LLSAN muscle. This blocks nerve signals, causing temporary muscle relaxation and reducing the extent to which the upper lip is pulled upwards. "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 explained.
Dr. Carr emphasized the importance of precise dosage. "It's a fine balance," she stated. "A larger dose might last longer. But if you overdo it, the lip drops too far. Instead of showing too much gum when they smiled, they would end up not showing enough of their teeth. It's better erring on the side of caution."
The effects of the injections gradually increase over three weeks and typically last for six to eight weeks. The treatment, costing around £180 per session, usually requires repeat appointments every three to four months. While the botulinum toxin may slightly limit the ability to tighten the lips, it does not interfere with eating, drinking, or talking.
"For many people with a gummy smile, this treatment works really well and gives them a smile they feel happy and confident with," Dr. Carr noted. "It's quick and relatively straightforward but can be life-changing."
White discovered the treatment through a conversation with her dentist, overcoming initial reservations about cosmetic procedures. "When Botox first came out, you'd see celebrities with stiff-looking faces," she recalled. "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."
White expressed regret only for not seeking treatment sooner. "I'm just gutted it took me so long to find out about the treatment. I wouldn't ever want to be without it. It's fantastic to finally be able to smile again."