Your Questions
Your Questions
Q: Dr. Eppley, I have a gummy smile. I would like to see what options are out there to correct this issue. I have attached pictures of me smiling and not smiling for you to see how much gummy smile I have.
A: Thank you for sending your pictures. The first thing I can say is that you are not a candidate for any bone surgery (maxillary impaction) for your gummy smile (thank heavens) as one has to have lip incompetence at rest…which you do not. Therefore, any effort for improvement in your gummy smile has to be directed towards soft tissue management. While there are internal soft tissue lengthening procedures which will have long-term benefits, your long upper lip (skin between your nose and upper lip) poses some concerns. One has to be careful that you don’t fix the gummy smile but then also lengthen the upper lip. (may not be a good trade-off) The good news is that there is a test before doing the procedure to see how the result of the surgery might work. That is Botox. A few units of Botox (generally 2 – 4 units per side) on each side of the nose will simulate the effects of a muscle release and mucosal lengthening. if you like the result of the Botox injections, you can just continue with the Botox (much less units and cost than the typical injection sessions done in the forehead which are usually 20 to 30 units) or then proceed for the surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would love to show less gum when I smile. I have tried Botox and it has slightly improved the amount of gum shown, however I would like a more permanent solution. I have had repositioning which involved sewing the lip down, and although it looked nice for a while, it appeared to stretch out and go back to normal. I am terribly afraid of the procedure which involves cutting the bone, so I’m hoping that a soft tissue correction will fix my smile.
A: Based on your pictures and the magnitude of your gummy smile, I would not be optimistic about any soft tissue procedure significantly improving your gummy smile. As you know, the best procedure for you is a maxillary impaction osteotomy. (vertical upper jaw shortening) Since I do not know exactly what soft tissue procedure you had done, I can not tell whether my soft tissue approach to the gummy smile will provide benefit to you. I am not sure what was exactly done in the ‘sewing the lip down’ procedure and whether it involved labii superioris muscle release and a mucosal v-y lip advancement. I would need to read the operative note from the procedure you had done to tell if a different soft tissue approach to your gummy smile would be more effective.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a gummy smile that I don’t like. I would like to achieve four things: 1) straighten gum line 2) reduce amount of gums shown when smiling 3) improve lip seal at rest and 4) reduce horizontal protrusion of upper lip area in profile. (least important) I have attached some pictures. Do you think my gummy smile is caused by vertical maxillary excess, or short upper lip, or hyperactive upper lip muscle or some combination? Will jaw surgery for vertical maxillary excess reduce my face length too much?
A: In looking at your pictures, I do think your gummy smile is a result of a combination of a short upper lip and some degree of vertical maxillary excess. The short upper lip is the bigger component of the problem however. The first step you need to do is consult with an orthodontist to find out if you are even a candidate for a maxillary shortening. This is going to require a model and x-ray analysis. It is impossible to anyone to say, based on these pictures alone, that you have a significant VME and whether it merits surgical shortening. If it is determined that a maxillary osteotomy is not an option, then you may consider soft tissue management of the gummy smile through various upper lip techniques such as levator muscle release and mucosal V-Y lengthening.
Dr. Barry Eppley
Indianapolis, Indiana