Does Your Smile Detract From Your Appearance?

Many have lovely teeth, but a gummy smile that is unappealing. The New York times recently featured this aesthetic concern that can often be readily treated with Botox. We have been offering this non-surgical treatment for years, and want to put the word out that this is available here. Below is a reprint of the NY Times article:

Bothered by a ‘Gummy Smile’
By ABBY ELLIN
JULY 31, 2014 12:01 AM

Susanna Miller-Pence’s teeth weren’t the problem; her gums were. When she smiled, her upper lip stretched up so high that a ribbon of pinkish gum was exposed, giving her a so-called “gummy smile.” She hated it. “The doctor explained that my gums were longer than my teeth, so the dimensions weren’t right,” said Ms. Miller-Pence, 52, a psychoanalyst living in San Luis Obispo, Calif. Fifteen years ago, she had a gingivectomy, an operation to remove some of the extra gum tissue. A month later, she was grinning broadly. “Now everyone comments on my smile,” she said.

Gummy smiles occur for a variety of reasons, most commonly a short upper lip, excessive gum tissue or small teeth, all of which are genetic. According to Dr. Stan Heifetz, a cosmetic dentist in New York and White Plains whose office treated Ms. Miller-Pence, ideal smiles show up only to about two millimeters of gum. “Anything over three to four millimeters of gum showing starts to look ‘gummy,’ ” he said.

Studies have been done with dentists, plastic surgeons, dermatologists and regular folk to assess smiles. Most everyone agreed that two millimeters or less of gum tissue showing was the level where most participants thought the smile looked normal. Participants started noticing the gum tissue at three to four millimeters, and thinking that too much gum tissue was showing at more than four millimeters, Dr. Heifetz said.

Doctors who specialize in cosmetic procedures estimate that about 14 percent of women and 7 percent of men have excessive gingival exposure when smiling.

“I believe the incidence is probably higher than we think, but we specialists just see and count the ones we treat, which are on the low side since not many people come to the doctor and ask about treatments for this,” said Dr. Jessica Suber, an attending physician in plastic and reconstructive surgery at Southern Ohio Medical Center in Portsmouth. “It’s something a lot of patients aren’t aware of.”

It’s hard to know how many operations are done annually to correct a gummy smile; many patients combine it with other medical and aesthetic treatments. According to data from the American Dental Association Health Policy Institute, 569,160 gingivectomies were performed in 2005-6, the most recent years available.

In the past, surgery was the main treatment option, but that is often costly and painful. Doctors sever the muscles that elevate the upper lip so it can no longer rise as high, or they do a crown lengthening procedure that cuts away gum tissue so the crown appears longer.

In extreme cases, they might perform orthognathic surgery, which repositions the upper jaw if it sticks out too much. But this can be complicated and can take up to two years to complete, Dr. Heifetz said. Laser therapy is also sometimes used.

Now people are going another route: onabotulinumtoxinA, otherwise known as Botox.

For the last few years, Botox has been injected into the upper lip “elevator” muscles. It paralyzes the muscles, inhibiting contraction of the upper lip when smiling to prevent the gummy smile.

In contrast to surgery, Botox is quick and easy, doctors who do the procedure say.

A March 2014 study in Aesthetic Surgery Journal found that off-label use of Botox was a safe and effective procedure for gummy smile, albeit one that lasts only three to four months for the average patient, confirming the findings of an earlier report in the American Journal of Orthodontics and Dentofacial Orthopedics. The price is also more appealing than surgery: Botox costs around $350 (depending on the part of the country you are in and the doctor you see). Ms. Miller-Pence said she paid about $15,000 for surgery and crowns, which was not covered by insurance.

Botox goes directly into the lip tissue, so there’s almost no risk of digesting it, said Dr. Peter Taub, a plastic and reconstructive surgeon at Mount Sinai Hospital in New York.

Stephanie McCarrell, a nurse anesthetist in Tampa, Fla., says she has received Botox three times for her gummy smile, which has always bothered her.

A few days after her injection, her upper lip had dropped and her gums were less visible, she said.

But Botox works only if the problem is in the lips, not the bone. And doctors have to be careful not to overinject the muscles, or they could create an unnatural look.

So if a gummy smile has plagued your appearance, come in for a consultation to determine if Botox cosmetic is a good option for you.