Management of gummy smile using botulinum toxin: a case series

A "gummy smile," considered to be exposure of more than 3.0 mm of gingival tissue during a forced smile, negatively affects smile esthetics. The present case series describes the clinical indications and technique for applying botulinum neurotoxin type A (BoNTA) to correct a gummy smile and assesses the outcomes and satisfaction levels of 3 patients. The patients were told about the risks and benefits of the procedure and advised that their gummy smile was likely to recur within 6 months posttreatment. After the exposed gingival tissue of the patients was measured with a ruler, photographs were taken, and the patients recorded their pretreatment level of satisfaction with their smile on a visual analog scale (VAS), the patients were treated with BoNTA. The BoNTA was diluted in 1 mL of sterile saline according to the manufacturer's instructions, and an extraoral point of application was marked 1 mm lateral to each of the patient's nasal wings, close to the insertion of the elevator muscles of the upper lip and the nasal wings. At each location, 4 U was injected by tilting the syringe 45° in relation to the skin. Fourteen days after treatment, the gingival tissue exposed during a smile was again measured with a ruler, new photographic records were taken, and the patients' level of satisfaction with the treatment and the esthetic result was determined. Repositioning of the upper lip was observed in all patients. No adverse effects or complaints were reported. All 3 patients reported that they were satisfied with the outcome and wanted to continue therapy with BoNTA as needed. The results of the reported cases suggest that the application of BoNTA constitutes a safe, effective treatment for the correction of gummy smile and is well accepted by patients. However, for the treatment to be successful, it is essential that clinicians master the facial topographic anatomy and the technique to be employed.