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.
Do you know where I can get a treatment like this in the Philadelphia area?
Hi Ashley, I think your best bet is to call a Periodontist in PA. I know of a couple I will see if I can shoot them an email to find out if they can help you out.
Hi Dr. Wasserstein,
I am a RDH in the northern VA (Washington DC Metro) area. I am interested in the lip lowering procedure for myself. Can you tell me how effective (if it all) it is for someone with incompetent lips? My lips do not close in the natural resting position but I also have a very gummy smile. Does this procedure help with incompetent lips? Do you have experience with treatment for this issue? Any advice/information would be greatly appreciated!
Thank you,
Emily Smith
Hi Emily,
Thank you for your comment. In my experience there is relapse with the lip lowering procedure. However, this is predictable, with experience, which cases will experience more relapse then others. Most patients who seek this procedure have a skeletal discrepancy with their jaw relationship. These patients can be treated more predictably with orthognathic surgery to correct the gummy smile. Orthognathic surgery is very invasive and expensive Most patients wont opt for that just to correct a gummy smile, but when their bite is also affected there is more incentive and benefit to the orthognathic surgery. Incoment lips is a sign of a skeletal discrepancy. Your maxilla is lower from an imaginary plane at the base of your eyes, which is why you have to force your lips together to close yet at the same time when you smile your natural musculature allows your maxillary lip to travel to its natural position thus exposing more of the oral cavity creating the gummy smile. So to be clear, and I haven’t done an exam to verify this, from what you are describing your maxillary lip is probably where it should be but your maxilla is lower than where it should be. Orthognathic surgery corrects this condition by relocating the maxilla higher if you will toward the plane of your eyes.
As an alternative, the lip lowering procedure can have a result but long term not as dramatic as the orthognathic surgery for that group of paitints. There are variations on the technique that will make it more predictable. There are also other techniques that can be employed at the same time such as botox and or crown lengthening if there is excessive gingiva contributing to the gummy smile.
I hope that helps!
Hi Dr.Wasserstein
Do you know who might perform this in the New York City area? I have checked with a couple of periodontist but none seem to know what im talking about, they all say removing some gum & exposing more teeth is the only option they know of…. which i dont think i need being that my tooth to gum ratio is fine! Please help!!!!!!!!!!!! I’m even considering traveling to CA, just because from my research more dds out there have/ can give options. BUT I dont want to travel due to the extra expenses- flight, hotel, car rental, etc… it will take, but might have to. Will it be possible to send you some pics & get your thoughts of my situation?
Also, what do you think Botox, to correct a gummy smile, any cons to this?
Hello, does anyone know of someone in the dallas texas area that does the lip lowering procedure?
I would check in with your local Periodontist. They would be a good referral source if they don’t perform the procedure them self.
I worried about relapse. As you spoke about earlier there is a high chance of relapse. My main concern is that will it go back to exactly how it was before or is there a possibility that it can be even worse (more gummy) Also I am worried that if I have this surgery and relapse I will have disfiguring scars on my gums and will never be able to just go back to normal but will have to continue having surgery/botox/other methods for the rest of my life. What can you tell me about this?
Dear dr.Wasserstein
I’m very interesting to see your cases in two or three years follow up.
Bet regards
Laura
I will post pictures of these cases as the patients return. However, unless there is a problem, these patients do not need to be under a recall so I typically don’t get long term follow up.
I think it is important to keep patients informed that this maybe a temp solution, as it wears off with time! Many people reported that, so its worth keeping an eye on potential consequences.
I think people with hyperactive lips are likely to pull back, in which case people will end up with scarred gum.
Thanks
Hi Sarah, I have been notorious in my warnings that case selection is important to predict a successful outcome for these procedures. Not everyone with a “gummy” smile is a candidate for this procedure, because you can and will have some rebound. However, with clinical experience, this procedure is much more predictable. There can be scarring but it is predictably minimal with the lip lowering procedure and clinical experience.
hi doctor.. I`m laura a student in first year orthodontics master program in the middle east area
im very interested in this procedure which is rarely done in our area.
im doing a literature review about it to know more about all its aspects from both ortho & perio points of veiw ..
i couldnt find much doctors doing this procedure untill i find this website
so im wondering if you can provide me with some resources to know more about this procedure .. i would be so gratefull for you
thank you so much 🙂
Do you know where I can get a treatment with gummy smile I have a problem I hab been told that I have nice teeth but for many years I cover my smile due that I show alot of gums I have had bad experances were I go to Dentist and nobody can help all they do is take money I don’t hab inuranse so for me it taks alot of me to go to the dentists and nobady can help me I try looking for places I try asking friends simply can’t fine a place that can help me here I live in the state of oregon in portland if anybody can help it will be very Appreciated..
Where are you located, perhaps I can help you find a Periodontist in your area?
Hello,
Ive just found your case stydies and finaly is mentioned procedure prety clear for me.
But Im from Czech Republic and looking for some doctor which will be able to do this procedure, unfortunately, in Europe, its still something unknown for most of doctors.
I have 8mm gumm tissue between my teeth and lip when I smile, and thats not “normal” and pretty smile, so I really want to fix it, but I still cant find someone who is able to do it.
Now I will try to present them your images to explain them what I mean by fixing my gummy smile and will see if some will be able to help me and will want to do surgery.
If you have some advises, or know about someone in central Europe, I’ll be grateful.
Unfortunately, I dont have a contact for you in the Czech Republic. But I’m sure there are probably dentists that specialize in Periodontics that you should be able to consult with.
Hi Dr, it a very nice surgery i wonder about the effect of the facial muscles ability to pull up the sit of resection specially during the action of the upper lip ?if there any additional precotion during the healing period?
Hi Dr Jack,
I think I might be a good candidate for one of the more invasive surgeries you mentioned but also for the treatment of the gummy smile. I have a very gummy smile and I hate it. I have difficulty closing my mouth and I have frequent headaches and fatique – was told by my dentist that it is probably caused by my jaw positioning.
I am trying to find someone in Chicago who performs both procedures and I was unable to find anyone who would do lip repositioning so far. Do you have anyone to recommend?
Thanks!
S.
Hi there,
Do you know if anyone in the Southwestern Ontario region would do this procedure? Near London/Toronto? Thanks
Do you know of a good perio in the Chicagoland area?
thank you!
Hi, that is a possibility, but I have found that it can be minimized by using horizontal mattress sutures.
Unfortunately I dont have a recommendation for you, but if you go the Academy of Periodontology’s website http://www.perio.org you can search for Periodontists in a given zip code and call from there. Hope that helps!
Unfortunately I dont but you can check the Academy’s website for a listing of Peridontists in you zip code. http://www.perio.org.