When a gummy smile is due to a skeletal discrepancy and not excessive gum tissue covering the teeth, orthognathic, jaw, surgery is the most predictable way to treat this condition. Under the right circumstances, lip lowering plastic surgery can achieve dramatic results with a much less invasive surgery.
The procedure itself is a variation of a common periodontal surgery called a frenectomy. The lip lowering procedure is essentially a reverse frenectomy. The goal of the procedure is to reduce the vestibuluar lenghth or shorten the fold between the lip and gum thereby reducing the amount of movement of the lip.
Relapse of this procedure is common if good initial stability is not achieved and maintained during that first week. The lip musculature will override the surgery, drawing the flaps apart. The resulting space will granulate in very quickly but that results in increased vestibule which is counter productive to the goal of surgery.
Suturing is important to the success of the procedure. While this case shows the use of vertical interrupted sutures, I now favor the use of horizontal mattress sutures. With this technique the sutures and approximated flaps stay in position for the entire week. This contributes to a more stable adherence of the lip in its new position. A periodontist has a wide arsenal of suturing techniques and materials given the array of intra-oral plastic surgery procedures they perform. I also favor leaving the sutures for 10 days as opposed to one week.
Post surgical swelling can also be problematic for for wound stability. As the tissues swell this can cause tension against the flaps resulting in the same separation and granulation. I typically do this procedure with IV sedation and administer Dexamethasone upon completion to keep the swelling down during that first week. Dexamethasone can be given intra orally if IV sedation is not used during the procedure. I also prescribe Ibuprofen to be used during the first week to help control swelling.
Post operative discomfort from this procedure is controlled well with the ibuprofen, but I also prescribe Hydrocodone. Most patients will not need the Hydrocodone. Bleeding and infection is very uncommon but post surgical ecchymosis (black and blue) is common and can extend from the lip to the lower eyelids and can persist during the first week.
Patients with a gummy smile due to a hypermobile lip can be very self conscious about their smile. Lip lowering periodontal plastic surgery is a very cost effective and minimally invasive procedure to treat this condition. Careful patient selection is important, not everyone with hypermobile lip is a candidate for this procedure.