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Where to Inject Botox for Gummy Smile – Precision Injection Points

Medically Reviewed
Medically Reviewed by Dr. Aurora Kalmanson on
Written by Fillers Editorial Team, plastic surgery specialists.

Botox injections for gummy smile treatment typically target the muscles responsible for excessive upper lip elevation. The primary injection site is the Yonsei point, located at the intersection of three key muscles: the levator labii superioris, the levator labii superioris alaeque nasi, and the zygomaticus minor.

This point is found approximately 1 cm lateral to the ala of the nose and 3 cm above the lip line. Additional injection sites may include areas lateral to the nasal alae, adapted to the individual’s anatomy. Typically, 2-4 units of botox are injected on each side, with the total dosage ranging from 4-8 units. The procedure is minimally invasive, quick, and requires no downtime, making it an attractive option for those seeking to reduce excessive gum display when smiling.

Botox as a Treatment for Gummy Smile

Botox has emerged as an effective, non-surgical solution for treating gummy smiles. This neurotoxin temporarily relaxes the hyperactive muscles responsible for excessive gum exposure, providing patients with a more balanced and aesthetically pleasing smile.

Mechanism of Action

Relaxation of Hyperactive Muscles: Botox works by blocking nerve signals in the muscles where it is injected. When used for gummy smile correction, it targets the muscles responsible for upper lip elevation, primarily the levator labii superioris alaeque nasi (LLSAN) and the levator labii superioris (LLS). These muscles, when hyperactive, cause the upper lip to rise excessively during smiling, revealing a disproportionate amount of gum tissue. By inhibiting the release of acetylcholine at the neuromuscular junction, botox effectively weakens these muscles, reducing their ability to contract forcefully. This controlled weakening results in a more moderate lip elevation when smiling, effectively minimizing gum exposure without completely immobilizing the muscles or compromising natural facial expressions.

Temporary Reduction in Upper Lip Elevation: The injection of botox into the targeted muscles leads to a temporary reduction in the upward movement of the upper lip during smiling. This effect is achieved through the selective weakening of the muscles responsible for lip elevation, particularly the LLSAN and LLS. As these muscles become less active, the upper lip’s range of motion is slightly limited, preventing it from rising as high as it previously did when smiling. This reduction in lip elevation is carefully calibrated to ensure that the patient can still smile naturally and expressively, but with less gum exposure. The temporary nature of botox allows for adjustments in subsequent treatments, ensuring optimal results adapted to each patient’s unique facial anatomy and desired outcome. Typically, the effects of botox for gummy smile correction last between 3 to 6 months, after which the treatment can be repeated to maintain the aesthetic improvement.

Advantages of Botox Treatment

Minimally Invasive Procedure: Botox treatment for gummy smiles offers a significant advantage as a minimally invasive procedure. Unlike surgical alternatives, such as lip repositioning or crown lengthening, botox injections require no incisions, sutures, or extensive recovery time. The treatment is performed using ultra-fine needles, which cause minimal discomfort and leave no visible scarring. The entire procedure typically takes only 10-15 minutes, allowing patients to return to their normal activities immediately after treatment. This minimal invasiveness not only reduces the risk of complications but also makes it an attractive option for those who are hesitant about more extensive surgical interventions. Additionally, the lack of downtime associated with botox injections means that patients can see improvements in their smile without disrupting their daily lives or work schedules, making it a convenient and practical solution for many individuals seeking to address their gummy smile concerns.

Quick and Painless: The botox treatment for gummy smile is renowned for its speed and minimal discomfort. The procedure typically takes only 10-15 minutes, making it convenient for those with busy schedules. Patients experience little to no pain during the injections, thanks to the use of ultra-fine needles and the skill of experienced practitioners. Some providers may apply a topical numbing cream before the treatment to further enhance comfort. The sensation is often described as a slight pinch or pressure, which subsides almost immediately. This quick and relatively painless process contrasts sharply with more invasive surgical options for gummy smile correction, making botox an attractive choice for many patients seeking a more comfortable solution.

No Downtime: One of the most significant advantages of botox treatment for gummy smile is the absence of recovery time. Unlike surgical procedures that may require days or weeks of healing, patients can resume their normal activities immediately after receiving botox injections. There are no incisions, sutures, or bandages to contend with, allowing individuals to return to work, social engagements, or daily routines without interruption. Some patients may experience minor redness or swelling at the injection sites, but these effects typically subside within a few hours. The lack of downtime not only minimizes disruption to one’s life but also contributes to the discreet nature of the treatment, as there are no visible signs of having undergone a cosmetic procedure.

Reversible Effects: The reversible nature of botox treatment for gummy smile is a key benefit that appeals to many patients. Unlike permanent surgical alterations, the effects of botox are temporary, typically lasting between 3 to 6 months. This temporary duration allows patients to “test drive” their new smile without committing to a permanent change. If a patient is unsatisfied with the results or decides they prefer their original smile, they can simply wait for the effects to wear off naturally. On the other hand, if they are pleased with the outcome, they can maintain the results with periodic touch-up treatments. This reversibility also provides flexibility for adjusting the treatment over time, allowing for fine-tuning of the dosage or injection sites to achieve optimal results as the patient’s facial structure changes with age.

Injection Techniques for Gummy Smile

Precise injection techniques are crucial for successful gummy smile treatment with botox. These methods involve identifying specific target muscles, locating optimal injection points, and administering the correct dosage to achieve natural-looking results.

Identifying the Target Muscles

Levator Labii Superioris Alaeque Nasi (LLSAN): This muscle plays a crucial role in elevating the upper lip and is often the primary target for botox injections in gummy smile treatment. The LLSAN originates from the upper part of the frontal process of the maxilla and inserts into the upper lip and ala of the nose. When hyperactive, it contributes significantly to excessive gum display during smiling. Proper identification of this muscle is essential for effective treatment. Practitioners typically locate it by asking the patient to smile and observing the muscle’s movement. The LLSAN is usually injected at a point approximately 1 cm lateral to the ala of the nose and about 3 cm above the lip line, known as the Yonsei point. Accurate targeting of this muscle can significantly reduce upper lip elevation without affecting other facial expressions.

Levator Labii Superioris (LLS): The Levator Labii Superioris is another key muscle targeted in gummy smile treatment. It originates from the infraorbital margin of the maxilla and inserts into the upper lip. This muscle works in conjunction with the LLSAN to elevate the upper lip during smiling. When injecting botox into the LLS, practitioners typically aim for a point slightly lateral and inferior to the LLSAN injection site. The precise location may vary depending on the individual’s facial anatomy and the severity of their gummy smile. Careful injection into this muscle helps to further reduce excessive upper lip elevation while maintaining natural facial movements. Balancing the treatment between the LLSAN and LLS is crucial for achieving a harmonious and aesthetically pleasing smile without compromising facial expressiveness.

Zygomaticus Minor: The Zygomaticus Minor muscle plays a secondary but important role in gummy smile treatment. This muscle originates from the zygomatic bone and inserts into the upper lip, working alongside the Levator Labii Superioris Alaeque Nasi and Levator Labii Superioris to elevate the upper lip during smiling. While it is not always the primary target for botox injections, addressing the Zygomaticus Minor can be crucial in cases where a more comprehensive approach is needed to achieve optimal results. Injections into this muscle are typically made at a point lateral to the Yonsei point, approximately 2-3 cm from the corner of the mouth. Proper targeting of the Zygomaticus Minor can help create a more balanced and natural-looking smile reduction, especially in patients with complex gummy smile presentations or those who have not achieved satisfactory results from targeting only the main elevator muscles.

Injection Points

Yonsei Point

Location and Landmarks: The Yonsei Point is a crucial anatomical landmark for botox injections in gummy smile treatment. It is located at the intersection of three key muscles: the Levator Labii Superioris Alaeque Nasi, the Levator Labii Superioris, and the Zygomaticus Minor. To precisely identify this point, practitioners typically measure approximately 1 cm lateral to the ala of the nose and 3 cm superior to the lip line. This location can be further confirmed by palpating the area while the patient smiles, feeling for the most prominent muscle contraction. The Yonsei Point’s proximity to these three muscles makes it an ideal injection site for achieving maximum effect with minimal dosage.

Significance in Gummy Smile Treatment: The Yonsei Point holds crucial importance in the treatment of gummy smiles due to its strategic location. Injecting botox at this point allows practitioners to simultaneously target multiple muscles responsible for upper lip elevation with a single injection. This approach not only increases the efficiency of the treatment but also reduces the total amount of botox needed, minimizing the risk of over-treatment and unnatural results. The Yonsei Point injection typically provides a balanced reduction in gum show across the entire smile, rather than just in specific areas. Its effectiveness in treating gummy smiles has made it a standard technique in aesthetic medicine, offering predictable and satisfactory outcomes for patients seeking a less invasive solution to excessive gingival display.

Lateral to the Nasal Alae: While the Yonsei Point is the primary injection site for gummy smile treatment, additional injections lateral to the nasal alae can enhance the overall result in some cases. These injection points are typically located 0.5 to 1 cm lateral to each ala of the nose. Targeting this area helps to further relax the Levator Labii Superioris Alaeque Nasi muscle, which is a key contributor to excessive gum show, especially in the central portion of the smile. Injections at these sites can be particularly beneficial for patients with a more pronounced gummy smile in the central incisors region or those who require a more complex approach to achieve their desired smile aesthetics. The practitioner must carefully assess each patient’s unique muscle dynamics to determine if these additional injection sites are necessary to complement the Yonsei Point treatment.

Adapted to Individual Anatomy: The effectiveness of botox treatment for gummy smiles largely depends on adapting the injection sites to each patient’s unique facial anatomy. While standard injection points like the Yonsei Point serve as crucial guidelines, skilled practitioners understand the importance of customizing the treatment plan. This personalization involves carefully assessing the patient’s smile dynamics, muscle strength, and the specific areas of gum exposure. For instance, some patients may require additional injections in the Zygomaticus Minor or Risorius muscles to achieve optimal results. Others might benefit from asymmetrical injections if their gummy smile is more pronounced on one side. By adapting the injection sites to individual facial structures and smile patterns, practitioners can ensure more natural-looking results and higher patient satisfaction.

Dosage and Dilution

Typical Units per Injection Site: The dosage of botox used for gummy smile treatment typically ranges from 2 to 5 units per injection site. At the Yonsei Point, which is the primary injection site, practitioners usually administer 2 to 4 units on each side. For additional injection sites, such as those lateral to the nasal alae, a lower dose of 1 to 2 units per side is often sufficient. The total dosage for a complete gummy smile treatment generally falls between 4 and 8 units, depending on the severity of the condition and the number of injection sites used. It’s crucial to note that these are average doses, and the exact amount can vary based on individual factors. Practitioners often start with conservative doses and may adjust in follow-up treatments to achieve optimal results while minimizing the risk of over-correction.

Severity of Gummy Smile: The extent of gum exposure significantly influences the botox dosage required for effective treatment. Patients with mild gummy smiles, typically showing 2-4 mm of gum tissue, may only need minimal doses, often around 2 units per side at the Yonsei Point. Moderate cases, with 4-6 mm of gum exposure, usually require a slightly higher dosage, typically 3-4 units per side. Severe cases, where more than 6 mm of gum is visible, may require the maximum recommended dose of 4-5 units per side, and might also require additional injection sites. The practitioner must carefully assess the degree of gum show in various smile positions to determine the appropriate dosage that will achieve a natural-looking reduction without over-correcting and compromising the patient’s ability to smile fully.

Muscle Strength and Activity: The strength and activity level of the upper lip elevator muscles play a crucial role in determining the appropriate botox dosage for gummy smile treatment. Patients with stronger, more active muscles typically require higher doses to achieve the desired effect. This is because more units of botox are needed to adequately relax these powerful muscles. On the other hand, individuals with less muscular activity may require lower doses to avoid over-correction. Practitioners often assess muscle strength by observing the patient’s smile dynamics and palpating the muscles during various facial expressions. They may also consider factors such as the patient’s age, as younger individuals tend to have more muscle tone and may require slightly higher doses. Adapting the dosage to the specific muscle characteristics of each patient ensures a more precise and effective treatment outcome.

Frequently Asked Questions

How long does botox for gummy smile last?

The effects of botox for gummy smile typically last between 3 to 6 months. After this period, you will need follow-up treatments to maintain the desired results.

Is botox treatment for gummy smile painful?

Most patients report minimal discomfort during botox treatment for gummy smile. The injections are quick, and a fine needle is used, often making the procedure relatively painless.

When will I see the results of botox injection for gummy smile?

You can expect to see initial results within 3 to 7 days after the injection, with full effects typically visible within 2 weeks post-treatment.

Are there any long-term side effects of botox for gummy smile?

Long-term side effects are rare. Common side effects such as bruising and swelling are usually temporary. Always consult your healthcare provider for a thorough risk assessment.

Can botox treatment for gummy smile be reversed?

The effects of botox are temporary and will gradually wear off over 3 to 6 months. If you are unhappy with the results, they are reversible as the botox effects diminish over time.

How often do I need to get botox injections for gummy smile?

To maintain the results, you will generally need botox injections every 3 to 6 months. The frequency may vary depending on individual response and treatment goals.

Is botox the only treatment option for gummy smile?

No, there are other treatment options such as lip fillers, laser gum contouring, and orthodontic procedures. Your provider can help determine the best approach based on your specific needs.

How much does botox treatment for gummy smile cost?

The cost of botox treatment for a gummy smile varies but typically ranges between $200 to $500 per session. The exact cost depends on the number of units used and geographic location.

Can I get botox for gummy smile during pregnancy or while breastfeeding?

Botox is not recommended during pregnancy or while breastfeeding due to the lack of sufficient safety data. Always consult your healthcare provider for personalized advice in these situations.

Conclusion

Botox treatment for gummy smiles offers a minimally invasive and effective solution for those looking to reduce excessive gum show. With effects lasting 3 to 6 months, periodic touch-ups are required to maintain results. Combined with other treatments like lip fillers or laser gum contouring, botox can provide a complete approach to achieving a balanced, aesthetically pleasing smile. Always consult a qualified healthcare provider to discuss your specific needs and ensure the best possible outcome.

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References:

Rojo-Sanchis, C., Montiel-Company, J. M., Tarazona-Álvarez, B., Haas-Junior, O. L., Peiró-Guijarro, M. A., Paredes-Gallardo, V., & Guijarro-Martínez, R. (2023). Non-Surgical Management of the Gingival Smile with Botulinum Toxin A-A Systematic Review and Meta-Analysis.

https://www.mdpi.com/2077-0383/12/4/1433

Fatani B. (2023). An Approach for Gummy Smile Treatment Using Botulinum Toxin A: A Narrative Review of the Literature.

https://www.cureus.com/articles/134579-an-approach-for-gummy-smile-treatment-using-botulinum-toxin-a-a-narrative-review-of-the-literature#!/

Dr. Aurora Kalmanson

Always Consult a Medical Specialist

The information provided in this blog is for informational and educational purposes only and should not be interpreted as personalized medical advice. It's crucial to understand that while we are medical professionals, the insights and advice we provide are based on general research and studies. They are not tailored to individual health needs or conditions. Thus, it is essential to consult directly with a healthcare provider who can offer personalized medical advice relevant to your specific situation.