Lip lowering periodontal plastic surgery procedure for a gummy smile

The ideal smile shows 90-95% tooth and 5-10% gingiva. Patients with a gummy smile show 25+ % gingiva. People with this condition are often self conscious and typically dont seek treatment because they are unaware of the possibilities of their treatment options. Periodontal plastic surgery has not been promoted to the extent of other plastic surgery procedures.

There are different modalities for treating a gummy smile. Most of them involve removing excessive gum tissue away from the tooth. This is referred to as crown lengthening. There are ideal proportions and visible lengths for the anterior teeth that can be achieved with crown lengthening.

However sometimes the teeth are already at their ideal proportions, yet when the patient smiles they show excessive gingiva. This can be due to a hyper-mobile lip or to a skeletal maxillary discrepancy. Jaw surgery is one way to correct that discrepancy. For patients unwilling to go through with that, the lip lowering procedure is an alternative and much less invasive approach.

The lip lowering procedure reduces the movement of a hyper-mobile lip by reattaching the lip mucosa and musculature lower toward the teeth. A frenectomy is a common procedure performed by a Periodontist, and the lip lowering procedure is essentially the reverse of a frenectomy. The first incision is made at the intersection between the gingiva and lip mucosa called the mucogingivaljunction. The next incision runs parallel toward the teeth in the gingiva. The width of that zone determines how much lowering is desired, the wider the zone the more lowering is achieved. The top incision margin, lip side, is then resutured to gingiva. The results are immediate, though some rebound is expected over the next few weeks. The post operative pictures for this case were taken immediately after the surgery while the patient was still numb and recovered from sedation.

Another application of this procedure is to help mask a dental implant restoration, where there has been substantial ridge resorption prior to implant placement. The restorations often result in longer looking teeth and or exposure of the tooth implant interface. Restricting a hypermobile lip can mask that interface.

About Jack Wasserstein, DDS

I am a Periodontist in Valencia CA and I have been in private practice in since 1990. I am blessed to be able to say that my work is also my play. I hope to share my insights, with you, that I have cultivated over the last 20 years.

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30 Responses to Lip lowering periodontal plastic surgery procedure for a gummy smile

  1. downunder October 19, 2010 at 10:07 am #

    Hi There

    I really hope someone can help, Im searching for a surgeon who knows or has performed a procedure called “Lip Lowering Treatment”. I have a horrible gummy smile, I have very big, red and quite “puffy” gums.
    All my life i had been picked on about it being called gummy etc, I’m so self-conscious that i won’t smile or I’ll cover my smile.
    I’ve been searching for years for procedure that doesn’t require shaving of the gums, Or to re- position my jaw which is very expensive and painful
    I’ve finally found the lip lowering treatment, however apparently this is only done in the US. So now I’m trying to find one in my country.
    If someone could provide me with information regarding it would be much appreciated

    Look forward to a reply,
    Kind Regards

  2. Jack Wasserstein, DDS October 19, 2010 at 10:39 am #

    The lip lowering procedure is essentially a reverse frenectomy which is a very common procedure for a periodontist. “Red puffy gums” is also a sign of Periodontal disease. I recommend that you get a consultation with a local periodontist. I would be happy to share my insights with the lip lowering procedure if they contact me.

    Cheers,

  3. downunder October 20, 2010 at 9:45 am #

    The information you have explained is fantastic, I did a search and found a fair few Periodontist and an organisation – Periodontist Australia – I’ve received an email from a Periodontist Surgeon who specialises in cosmetics also, he basically explained the same as you previous email, including the gingivectomy, I’m assuming this is “gum shaving” which my dentist has mentioned. Best part is most is covered by our Medicare system!!!

    You have been very informative & Kind, thanks again, I will defiantly let you know in the near future how everything turns out

    Kind Regards

  4. Kim February 1, 2011 at 11:41 pm #

    Hi Downunder, I am also from Australia and desperately want this surgery. I saw a periodontist today and he had never heard of this procedure, said there are only 11 oral surgeons in my state (sa) and then told me I needed jaw surgery. I too do not want jaw surgery. At all. Ever. it scares the bejeesus out of me! Please if you have found a surgeon in Australia who does it let me know and please could you share your experiences with me? I am left so downheartened by my appointment today with being told ‘moving the muscle will result in other changes in your face that you may not like etc etc, your only option is jaw surgery.’ You also said something about Medicare covering it?? Can you tell me the cost of the surgery and how much was covered?

    Thankyou so much for your post and thankyou Dr Wasserstein, together you have given me information to make an informed decision and hope that I may finally correct what has been making me insecure my whole life. :)

  5. Alex Nguyen, DDS February 7, 2011 at 10:57 pm #

    Beautifully done, Dr. Wasserstein. This is a very informative website that you have created. Thanks !

    Alex Nguyen, DDS

  6. Jack Wasserstein, DDS February 11, 2011 at 3:15 pm #

    Thanks Dr. Nguyen :)

  7. Jack Wasserstein, DDS February 11, 2011 at 3:18 pm #

    Hi Kim

    To be fair the only downside to the procedure is that the “gummy smile” relapses from the surgery. I have modified my suturing technique and that has been very helpful thus far in preventing relapse.

  8. GH February 19, 2011 at 12:00 pm #

    Great post Dr. Wasserstein, I’m surprised more periodontist are not doing this procedure. I looked and could only find one in Ohio that does.

    periodayton.com/content/gummy_smile_cures.html

  9. Judy April 4, 2011 at 6:48 pm #

    Can someone please help me find a Dr in south Florida. I wasnt born with a gummy smile but I hit myself in the shower when I was little and teared my lip.. Im not sure what the area is called but its the skin that attachs the lip to the gums… Ive had a gummy smile for yrs and hate it I hate smiling. Please help Thank you

    I believe the other surgies are to painful for me..

  10. Kim August 2, 2011 at 7:29 pm #

    Hi Dr Wasserstein,
    can you tell us more about how your modified surturing technique has helped prevent relapse? Does it give you a longer time before relapse or prevent it fully all together? Have you observed you patients a few years after surgery? Basically what are my options? Have the surgery which will last how many years ? relapse, can I have surgery redone? what are my options after relapse and will there be bad visible scarring if I relapse? Sorry I have also left another similar comment on another post on this subject.

    Thanks for your help so far!

  11. Jack Wasserstein, DDS August 13, 2011 at 6:42 pm #

    Hi Kim,

    If you are looking for the most predictable route then Jaw surgery is your best option. There can be relapse with this procedure and most will take place within the first 12 months. Stabilization during healing is very important in minimizing the amount of relapse, and that is where this suturing technique can be very helpful. The type of stitch is called a horizontal mattress suture. It helps by taking a larger section of tissue with each individual stitch.

  12. Joe October 1, 2011 at 10:00 am #

    Im considering haveing lip lowers surgery and venners. My teeth are stright from braces but my lips dont naturally meet. When naturally rest you see my front to teeth and part of the gums above the teeth. I have a very small mouth in width. If I have this surgery would this fix my mouth???

  13. Nesli October 2, 2011 at 12:48 pm #

    Hi Dr Wasserstein,

    I had this lip lowering surgery in LA on 1st of FEB 2011, and I ca not even talk properly, my upper lip before more fuller now is thinner and I have worst gummy smile than ever. I m not happy at all, and cost me 13,000$ I wish I never-ever done. My question is can I go revers surgery? or this is it?! is there other way someone can help me. Thank you.

  14. Jack Wasserstein, DDS October 3, 2011 at 8:15 pm #

    Dear Nesli,

    In my opinion, your first step would be to consult the doctor who did the initial surgery. If you don’t get satisfaction from that you should seek a second opinion. In theory it should be possible to reverse most of the procedure. My practice is in Valencia, if you would like me to do an evaluation. 661 254-8484

  15. Jack Wasserstein, DDS October 3, 2011 at 8:22 pm #

    Dear Joe,

    Not everyone is a candidate for lip lowering surgery. There are certain case types that respond very predictably to this procedure, and others that would be best served by orthognathic (jaw) surgery. Without doing an evaluation it would only be speculative to give you an opinion. If you would like to email me some pictures of your smile I will try to be as specific as I can, but your best bet would be to get a consultation.

  16. Dawn October 11, 2011 at 9:53 pm #

    I have a gummy smile and the middle section of my lips don’t meet and i was considering this procedure but if i’m just gonna end up with a gummy smile again whats the point?

  17. Jack Wasserstein, DDS October 12, 2011 at 6:57 pm #

    Obviously, the expectation is that you will have a result otherwise you would be correct. I continue to stress that not everyone is a good candidate for this procedure. It important to do a thorough preoperative exam to evaluate existing conditions. There is a chance a relapse with this procedure, but it is predictable which pre-existing conditions will lead to relapse and which ones will not.

  18. Canada November 29, 2011 at 7:49 am #

    Hi,

    I have done a lot of research on this procedure and I would love to know how to find a doctor that does this in my area!! Can someone lead me in the right direction please?? =)

  19. Jack Wasserstein, DDS November 29, 2011 at 9:09 am #

    What area are you in? You can use the directory search at perio.org to find a local Periodontist, then contact their office.

  20. Canada December 1, 2011 at 8:25 pm #

    Calgary, Alberta, Canada.

    I have called many periodontists but I can not find any that do this procedure and I really would like to get it done!

  21. Jack Wasserstein, DDS December 1, 2011 at 10:52 pm #

    If its a worth a trip to California, we would be happy to see you here. We have hotel accommodations within walking distance to our facility. Please see our website for more details.

  22. Canada December 8, 2011 at 8:57 am #

    I would like to get some more information please. What is the Website?

  23. Jack Wasserstein, DDS December 8, 2011 at 8:58 am #

    http://www.wasserstein.com

  24. Denmark February 24, 2013 at 3:00 pm #

    hi,
    i realy want to do this surgery, but i cant find any in my country. also i’m a bit afraid now, because you said that it can relaps! i dont want that if i should pay that much mony, i want it to stay the rest of my life.

    by the way sorry for the bad english and just so you know i’m 16 and live in a litle country called Denmark.

  25. Jack Wasserstein, DDS March 4, 2013 at 1:53 pm #

    Being well informed of the risks and complications of any surgical procedure is important. Relapse is a possibility so any ethical doctor would advise you so you can make a decision that you are comfortable with.

  26. BecAussie April 16, 2013 at 4:59 am #

    Hi Downunder, just wondering if you provide an update on how you went with the Periodontist in Australia?

  27. Jack Wasserstein, DDS April 29, 2013 at 2:30 pm #

    I am still not in contact with any Periodontists in Australia.

  28. Dogan December 14, 2013 at 3:54 am #

    Hi,
    I just want to know if this kind of operation is done to me will it effect my speaking?

    Thanks

  29. Jack Wasserstein, DDS March 30, 2014 at 10:41 pm #

    It shouldn’t have an effect on your speaking.

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