Your Questions

Q: Dr. Eppley, I have a question about gummy smile surgery. I’ve always had a long mid-face with significant gum in my smile (5mm with normal smile, 7-8mm with excessive smile). I would be interested in hearing your thoughts about mid-face reduction surgical options.

A: When it comes to gummy smile surgery there are two fundamental treatment approaches. The most common approach is a soft tissue one with a lowering maxillary vestibulopasty and legator myotomies with V-Y upper lip lengthening. This soft tissue approach prevents the lip from retracting upward as much and also drops it down a few millimeters at rest. This is by far the most common gummy smile surgery. The other approach, more historic but still of value in the proper selected patient, is a maxillary impaction surgery. (aka LeFort I impaction) This is the proper gummy smile surgery for those patients that have vertical maxillary excess which is evident by excessive tooth at rest and extreme gum show when smiling. It is not indicated when one does not have excessive tooth at rest. Otherwise a maxillary impaction will bury the upper teeth under the upper lip giving one an aged appearance.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a questions about gummy smile surgery. I am a 25 year-old female. I have an upper jaw prominence as well as a gummy smile. It shows 8 mm of the gum. I went to a dentist to do a lowering lip surgery, however, he said that even if he would do it for me the gummy smile will go back once more time because of the upper jaw prominence. I end up thinking what if  I do a V-Y flap or a W technique for upper lip lengthening?. Are they going to work in my case and last for good? Or there will be a relapse because of the upper jaw prominence. I hope you get my point. Thank you.

A: When it comes to gummy smile surgery, the potential for relapse is related to the surgical technique not how much upper jaw prominence one has. The key to preventing relapse in upper lip lengthening is the vestibuloplasty portion of the procedure. Shortening the depth of the vestibule will serve to keep the upper lip from relapsing back to original position. Going to a dentist is probably not the best doctor to have treat a gummy smile that is so excessive which is probably beyond their comfort zone and experience.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I got the gummy smile by V-shape process in Asia one year ago. It did not work for me. It looks like as before surgery. Can I get the new process for gummy smile in (Lip reposition method) again?

A: Even though you have had an unsuccessful V-Y upper lip mucosal advancement, you can proceed with further efforts at improving the gummy smile. I have found that while the V-Y mucosal procedure is a part of gummy smile surgery, it alone is not enough for a sustained correction. Elevator muscle release and a lowering vestibuloplasty must also be incorporated into the surgery for a sustained improvement. Your other option is to do Botox injections in the paranasal area. With just a few units of Botox, the muscle is relaxed and you will have less lip elevation for the duration of the drug’s effect. (4 months)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a gummy smile procedure done about 3 years ago. I have attached a link so you can see what type of procedure the doctor did. Given that the soft tissue procedure did not work, I am thinking that I need the bone surgery instead. How long is the maxillary impaction osteotomy recovery time and would it require braces after?

A: In looking at the link, I would never have expected that type of ‘gummy smile’ procedure to have ever worked in your case. It was only a very limited anterior maxillary vestibuloplasty procedure. It may work for someone with a small gummy smile problem (maybe 1 or 2mms) but it is a fundamentally flawed procedure. There may have been some temporary restriction of upper lip movement but that would stretch out and relapse back into the full gummy smile in a matter of weeks or a month or two at best.

Maxillary impaction surgery requires orthodontic braces to be in place before (to be used during surgery to help make the bite fit) and then remain in place after surgery to do any adjustment and fitting in of the bite should it be off a little bit. Recovery from such surgery is defined largely by how long does the swelling last until you lok normal. The jaws are not wired together after this kind of surgery so isolated maxillary surgery is quicker to recover from than other types of jaw surgeries. I would say it would take about 3 weeks until you look pretty normal again, although the final bits of swelling takes several months to fully go away.

Give the very limited soft tissue procedure you had done and the more significant commitment of maxillary surgery, a more thorough soft tissue procedure for your gummy smile may be worth considering. One which includes superior labialis muscle release, aV-Y mucosal lip advancement and a more extensive vestibuloplasty procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a gummy smile and spacing. Is it possible for the maxilla to be shaven flatter with the muscle lip lengthening?

A: I am afraid I do not know what you mean by having the ‘maxilla shaven flatter’. There is no such bony operation per se. In gummy smile surgery, there are two basic approaches, either bone-based or soft tissue reconstruction. The bony procedure is a maxillary or LeFort 1 osteotomy. This is where you cut the whole upper above the roots, remove bone above it and then reattach the maxilla up higher. This is known as vertical maxillary shortening or a maxillary impactionk operation. As the maxilla moves up higher, the teeth follow it, moving the excess gum show up under the lip.

You either do the bone operation or all three of the soft tissue procedures. It is all or none one way or the other. You can not intermingle the bone and soft tissue procedures in gummy smile correction.

Dr. Barry Eppley

Indianapolis,Indiana