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What you need to know about the effects of botulinum injections in Gummy Smile treatment and not ...



Laughing woman

Gummy smiles, which make your gums look unnecessarily when you laugh, have multiple causes, such as tooth alignment and skeleton, one of which is muscle overdevelopment .

Injecting botulinum, which suppresses muscle function, into overdeveloped muscles causes muscle paralysis, which can be expected to improve gummy smile .

However, botulinum injections may pose risks and side effects, and the effects are temporary, so botulinum injections should be continued.

Also, if you have a gummy smile other than muscle overdevelopment, you will need another procedure, so it is a satisfying gummy to know not only the cause of the gummy smile but also other treatments. It can be said that you can receive smile treatment.

Gummy Smile Symptoms and Causes

Features of Gummy Smile

Gummy smile is derived from "gum", which generally refers to the gums, and refers to the symptom that the gums are visible more than necessary when laughing .

It is said that 10% of people in their 20s and 30s are suffering from Gummy Smile in Japan because it is a serious symptom that may cause mental problems because they cannot laugh in public due to Gummy Smile. I will.

Gummy smile is strongly influenced by heredity , and it is more likely to develop when the skeleton and dentition are prone to gummy smile, or when the muscles are originally strong. It can also be caused by habits and habits in daily life, such as sucking fingers in childhood, cheeks, and leaving missing teeth.

Also, in children, gummy smiles may improve during the period of deciduous and permanent teeth growth, but they rarely heal spontaneously and often require treatment. For children who have room for bone and tooth growth, radical treatments such as orthodontics are recommended .

Causes of Gummy Smile

The causes of gummy smiles are as follows, but gummy smiles tend to occur due to a combination of several causes rather than one cause.

The levator labii muscle works strongly

If the levator labii superioris (the levator labii superioris) and the levator labii superioris, which are involved in the opening and closing of the lips, are overdeveloped, the upper lip will be lifted more than necessary and the gums will be easier to see.

Since it is caused by muscle development, improvement can be expected with botulinum injection, which relaxes muscles and suppresses work .

Large oral vestibule

When you smile, your upper lip is lifted to the boundary between your gums, so if you have a large oral vestibule, which is the space between your upper lip and gums, or if you have long gums, your gums will be easily exposed. It tends to be a gummy smile.

Also, people with thin lips have difficulty hiding their gums, which can lead to a gummy smile.

By performing "upper lip mucosal resection" that sutures the upper lip mucosa and the gingival mucosa, it is possible to prevent excessive lifting of the upper lip .

Skeleton and dentition

Maxilla bone protruding forward

Asians, including Japanese, tend to become gummy smiles because the bones around the mouth, such as the maxilla, are protruding and the gums are lengthened accordingly.

In the case of a gummy smile due to the protrusion of the maxilla, the protrusion can be made less noticeable by lowering the maxilla to the back, and the exposure of the gums can be suppressed.

In addition, if the maxilla is protruding, not only the gummy smile but also the protruding teeth, the open bite with a gap between the upper and lower anterior teeth, and the overcapped occlusion in which the upper tooth covers the lower tooth will occur. It is easy and may not be cured by just cutting the bone.

It is necessary to treat each symptom, such as "orthodontic treatment" for protruding teeth and open bite, and "installation of a multi-bracket device" for shallow tooth engagement for overcapsular occlusion .

How to grow teeth

If your teeth are smaller than usual, or if your teeth are growing diagonally, the area of your gums will increase accordingly, which may result in a gummy smile.

Gummy by performing "orthodontics" to correct the alignment and position of teeth and "crown extension" to raise the gum line to expose the teeth that should be visible. Your smile may improve .

The gums are well developed

When the gums cover the teeth due to the development of the gums and the area of the gums is larger than that of the teeth, the gums are more likely to be exposed when laughing. By performing "gingival surgery" to remove the gums that cover the teeth , the gums will be less noticeable .

Botulinum injection to improve gummy smile due to abnormal muscle development

Abnormal development of the levator labii superioris and levator labii superioris, which is one of the causes of gummy smile, is caused not only by heredity but also by excessive use of muscles around the mouth such as strong biting and excessive use of the tongue .

In this case, botulinum injection, which has the effect of relaxing the muscles, is effective because it can prevent excessive lifting of the upper lip by suppressing the contraction force due to muscle development.

Also, in the case of Gummy Smile due to multiple causes such as skeleton and dentition as well as muscle, complete improvement by botulinum injection is difficult, but partial improvement can be expected.

Ingredients for botulinum injection

The ingredients of Clostridium botulinum injection do not contain Clostridium botulinum, which is also the cause of food poisoning, but use a type of protein called botulinum toxin produced by Clostridium botulinum .

In the botulinum preparation obtained by decomposing and purifying Clostridium botulinum, which is harmful to the body, the amount of botulinum toxin contained in one bottle is about 1/1000 of the risk of poisoning, so it is said that there is no harm to the body. However, injecting too high a concentration of botulinum preparations can lead to poisoning .

Action of botulinum injection

Botulinum injection acts on the joint between muscles and nerves to suppress the neurotransmitter acetylcholine, which is produced when commands are sent from the brain to the muscles. This suppresses muscle activity and can cause temporary muscle paralysis .

Since it has a function of suppressing neurotransmitters, it is also used in cosmetology to improve gill tension and calf swelling, and to improve hyperhidrosis and armpits .

In addition, botulinum toxin, which is used in medicine, rarely causes allergic reactions, so an allergy test is not required.

However, if you experience any allergic side effects such as rash, itchiness, abdominal pain, or stunned consciousness, please consult a medical institution.

A "unit" that represents the amount of botulinum toxin

The botulinum preparation is powdered in a bottle called a vial, and when used in the procedure, it is diluted with saline and injected.

The amount is expressed in "units" rather than ㏄ or ml , and is adjusted with saline so that the required units are included in 0.1 ml . The higher the amount of saline, the lower the concentration of the botulinum preparation used in the procedure.

Since the type and amount of botulinum preparation used and the unit required per 0.1 ml differ depending on the injection site and application, it is necessary to adjust the amount of physiological saline to be diluted according to the site and application.

When treating Gummy Smile with botulinum injection, use 5 to 20 units, depending on the patient's Gummy Smile condition and desired shape.

Generally, the amount of botulinum toxin that becomes addictive is said to be 30,000 units, so use a high-quality, nationally recognized botulinum preparation, and at an appropriate dilution concentration, contraindicated people or should use it. It is said that poisoning is less likely to occur with injections of 50 to 100 units, if treatment is avoided for those who do not.

Botox is the name of the product

Botulinum toxin is also called Botox injection, but Botox is the name of Allergan's product, not the name of the procedure.

Allergan's Botox is the only botulinum preparation approved by the Ministry of Health, Labor and Welfare, and the only product that can be officially purchased for beauty purposes, but it is approved by the US FDA, which is the Japanese Ministry of Health, Labor and Welfare, and the KFDA in South Korea. Botulinum preparations are also used in many medical institutions because they can be imported individually.

product name Pharmaceutical company National approval
Dysport Ipsen FDA (Food and Drug Administration)
Zeomin Merz FDA (Food and Drug Administration)
Regenox Hans biomed MFDS (Korean Ministry of Food and Drug Safety: Former KFDA)
Neuronox Medy-Tox MFDS (Korean Ministry of Food and Drug Safety: Former KFDA)

Where to hit the botulinum injection

By injecting botulinum into the levator labii superioris muscle and the levator labii superioris muscle next to the nose, it is possible to suppress the excessive work of muscles and prevent the excessive lifting of the upper lip.

Depending on the condition of the gummy smile, 5 to 20 units of botulinum preparation is injected into the left and right muscles where overdevelopment is observed, divided into 1 to 3 points.

It is necessary to adjust the amount of botulinum preparation and the number of injections so that there is no difference between left and right when laughing.

Gummy smile symptoms may occur on only one side depending on how the teeth grow, the distortion of the maxilla, and the laterality of the muscles .

If the cause is the dentition or maxilla, perform treatment such as orthodontics and osteotomy in consideration of the laterality, and if it is caused by muscles, inject a botulinum preparation so that the laterality is even. To do.

Pain from botulinum injection

Some medical institutions may apply an anesthetic cream before the procedure to reduce pain.

Not all medical institutions handle this, so please check with your medical institution in advance.

Extra-fine needle used for pain relief

The general needle thickness used for botulinum injection is 30G to 32G, but some medical institutions use a needle as thin as 34G to reduce the pain felt during injection.

The fineness of the injection needle is represented by "G (gauge)", and the larger the number, the thinner the needle and the less pain.

Depending on the medical institution, there may be an additional charge for using the 34G needle, so please check with the medical institution about the handling of the 34G needle and whether there is an additional charge before the procedure.

Duration of effect of botulinum injection in Gummy Smile treatment

The effect of botulinum injection in Gummy Smile treatment appears 2 to 3 days after the treatment, and the effect lasts for 4 to 6 months .

When the botulinum injection is effective, the amount of muscle activity is suppressed and the muscle itself shrinks, so the second and subsequent botulinum injections tend to have a longer duration of effect.

Botulinum injection is not a cure for Gummy Smile, so regular treatment is required to maintain its effectiveness. However, care must be taken when injecting 100 units or more in a short period of time, as neutralizing antibodies may be produced and the effects may be less likely to appear .

What to do if a botulinum injection fails in Gummy Smile treatment

Failure in Gummy Smile Treatment

The sites where the botulinum preparation is injected are the levator labii superioris and the levator labii superioris, which are one of the facial muscles, so if the effect is too effective, the lips may not rise and an unnatural smile may occur .

Also, because the lips do not lift , the vertical groove between the tip of the nose and the upper lip of the philtrum may appear to stretch .

Therefore, it is important to understand the shape you are looking for in the counseling before the procedure , convey it to the doctor, and perform a careful simulation .

Corrective injection if you want to weaken the effect of botulinum injection

If you want to reduce the effect of botulinum injection, such as an unnatural smile or facial expression , left-right difference , or inability to eat after botulinum injection, there is a modified injection of botulinum toxin called acetylcholine chloride.

The purpose of the modified injection is not to remove the botulinum preparation, but to temporarily weaken the action and widen the range of motion of the muscles, so a single injection will be less effective in about 3 to 4 days and will return to normal.

Therefore, for those who want to continuously weaken the effect, paralyzed muscles can move and return to a natural facial expression by giving 2-3 correction injections at intervals of 1 to 2 weeks . ..

Since modified injections are a last resort, it is important to perform a simulation before the procedure to convey the shape of the lips that you are looking for .

What you need to know in advance when treating Gummy Smile with botulinum injection

The price of Gummy Smile treatment by botulinum injection varies depending on the medical institution because it is a self-financed medical treatment. The amount of injection varies depending on the symptoms, but it is about 5 to 20 units.

Formulation name price
Botox 15,000 yen to 41,800 yen
Disport 25,000-46,200 yen
Zeomin 17,300 yen-40,000 yen
Regenox 10,000 yen to 32,780 yen
Neuronox 15,000-40,000 yen

Those who need consultation with a doctor when receiving treatment

  • Those who are not contraceptive
  • Those suffering from spinal cord / peripheral nerve diseases
  • People with respiratory diseases and glaucoma
  • Those who have had food poisoning due to Clostridium botulinum
  • Those with urinary tract infections

Those who cannot receive botulinum injection

  • Pregnant / lactating women
  • Those with systemic neuromuscular junction disease
  • Those who have had an abnormal reaction to botulinum toxin before

Flow of treatment

(1) Counseling

Check with your doctor about your ideal shape and ask about any concerns during counseling.

(2) Treatment

If you need anesthesia, use anesthesia cream.
The treatment time is 2 to 5 minutes.

(3) Cooling

After the treatment, cool the affected area for about 10 minutes to reduce swelling and pain.

Course and side effects of botulinum injection in Gummy Smile treatment

In rare cases, the following side effects may occur after the procedure.

Days to heal Possible side effects
Same day to 2 days Swelling, pain
2 days to 1 week Scars on needles
~ 2 weeks Internal bleeding
~ 1 month Difficult to eat and drink

About one month after the treatment, the muscles of the upper lip are paralyzed, which makes it difficult to use straws and noodles, but the effect of botulinum injection diminishes and disappears at the same time.

Things to watch out for after botulinum injection

By refraining from promoting blood circulation, swelling and pain can be prevented or symptoms can be suppressed.

Therefore, please be aware of the following after the botulinum injection.

Estimated time to do action
From the day Shower, makeup, face wash
From the next day Bathing, light exercise
After the swelling subsides Vigorous exercise, drinking
From one month later Facial massage

Treatment methods other than botulinum injection in Gummy Smile treatment

Upper lip mucosal resection

Upper lip mucosal resection is a method of removing and suturing the upper lip mucosa and gingival mucosa to prevent excessive lifting of the upper lip.

This surgery is suitable for those who have a wide oral vestibule with a wide space between the upper lip and gums, and those who have a long distance from the boundary between the upper lip and gums to the hairline .

Upper lip mucosal resection may be performed in combination with crown extension to reshape the alveolar, which is the hole in the mandible where the teeth are buried.

Unlike botulinum injection, the mucous membrane is excised and sutured, so swelling and internal bleeding occur, and downtime is required . However, strong swelling and internal bleeding subside in about a week, and one operation is a long-term gummy smile. You can expect improvement .

However, if the levator labii superioris and levator labii superioris develop after surgery, you may feel a sense of discomfort when you laugh, so choose a doctor who can make appropriate decisions before surgery. Is important .


Osteotomy is a surgery that is suitable for people who have a gummy smile due to the protrusion of the maxilla . By scraping the maxilla and lowering the bone backwards, the protrusion of the bone can be improved and the gum length is relatively shortened, which improves the gummy smile.

For surgical surgery to shave the bone, about 2 weeks a large swelling and pain, the surgical site for about a month for the fixation of bone long down time such as fixed by the rubber, but is the hospital is required surgery, once the surgery This will reduce the chance of a recurrence of Gummy Smile .


Orthodontics is a method of improving the alignment and position of teeth, so it is an effective treatment for those who become gummy smiles due to alignment of teeth .

Unlike botulinum injection and osteotomy, the effect is not obtained immediately after the procedure, and since the position of the teeth is changed over a long period of time using a wire or mouthpiece, those who are seeking the effect immediately after the procedure. It is an unsuitable treatment for.

However, you can prevent tooth decay and periodontal disease by orthodontic treatment to cure the alignment and occlusion of teeth .

Gingival shaping

Gingival surgery is a method of removing the gums that cover the teeth to increase the exposure of the teeth, and is suitable for those who have a gummy smile due to the development of the gums and the covering of the teeth . As the gums regenerate over time, they tend to go back .

Advantages and disadvantages of Gummy Smile treatment by botulinum injection

Botulinum injection is not a permanent procedure, so it is necessary to continue injection, but for those who want to cure temporarily or who want to try out what kind of finish it will be as a simulation before surgery. This is the recommended method.

In addition, botulinum injections are injected into the muscles above the nasolabial fold, which may cause the nasolabial fold to become thinner as a side effect .

If you have a gummy smile due to something other than muscles , such as small teeth, orthodontics, or long gums, you can't expect improvement with botulinum injection, so treat it according to your own cause. Is recommended .

Medical institutions to choose for improving Gummy Smile with botulinum injection

Many medical institutions handle botulinum injection because it can improve various cases.

However, some botulinum preparations are of poor quality and cause allergic reactions and granulomas, so side effects can be caused by performing the procedure at a medical institution that uses a drug approved by the government, such as the Ministry of Health, Labor and Welfare or the FDA. You can mitigate the risk .

In addition, each pharmaceutical company has a certified doctor and instructor system in which a certificate is given after training and practical seminars are held, so those who are worried about botulinum injection are doctors who hold the certificate. One way is to choose a medical institution that has a medical institution.