Lip Flip for Gummy Smiles: Benefits and Results

A gummy smile—clinically termed excessive gingival display—occurs when an overactive muscle pulls the upper lip high above the teeth during a smile [2], [3].

In a standard lip flip, a medical practitioner injects botulinum toxin into the orbicularis oris, the circular muscle around the mouth, specifically near the vermilion border and corners of the mouth [1], [2], [3]. This relaxes the superficial muscle fibers that pull the lip inward and downward, allowing the vermilion to evert (roll outward) [3].

When addressing a gummy smile caused by hyperactive elevation, practitioners may also target the levator labii superioris alaeque nasi (LLSAN) muscle in the cheek area [3]. Relaxing these hyperactive muscles produces two specific benefits:

• Reduces gum visibility: Because the muscles cannot contract as aggressively upward, the upper lip elevates less, concealing excess gum tissue [4], [5].

• Prevents smile thinning: The upper lip maintains its height and shape rather than curling inward or disappearing when you smile or laugh [1], [4].

While both treatments alter the appearance of the mouth, their mechanisms and results differ fundamentally:

Dosage and Formulation

The procedure uses botulinum toxin type A brands such as Botox, Dysport, Xeomin, or Jeuveau [1], [2].

• Standard Lip Flip: Involves approximately 2 to 4 units of Botox in the upper lip (sometimes 2 units in the lower lip), or roughly 4 to 6 units along the upper vermilion border [2], [3].

• Gummy Smile Injection: When targeting the LLSAN muscle, typical starting doses are 2 to 4 units per side (often 2 to 3 units per side) [3]. Doses of 5 units or higher per side increase adverse effects without added benefit [3].

What Happens During the Visit

The procedure takes between 2 and 20 minutes [1], [2], [5]: 1. Preparation: Skin is cleaned with an antiseptic; a topical numbing cream may be applied if requested [1], [2]. 2. Injection: The provider uses a fine needle to make small, superficial pinches along the upper lip border [1], [2]. 3. Monitoring: Providers observe patients for 15 to 20 minutes post-treatment to check for unexpected reactions before discharging them to drive home [1], [2].

Aftercare Protocol

• Apply an ice pack for up to 10 minutes to manage local swelling or bruising [2].

• Avoid alcohol, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs) for at least 24 hours to prevent bruising [1], [2].

• Avoid drinking through a straw, smoking, or puckering lips for at least three days to keep toxin from migrating [2].

• Do not sleep facedown on the first night [2], [5].

• Postpone facials and facial massage for up to two weeks [1].

Ideal Candidates

A lip flip works best for individuals whose gummy smile stems from hyperactive facial muscles pulling the lip upward, or whose upper lip naturally disappears or curls inward upon smiling [1], [4].

When to Avoid or Seek Alternatives

• Skeletal or Dental Causes: If excessive gingival display is caused by jaw structure or tooth length rather than muscular movement, botulinum toxin will not correct it; surgical or orthodontic options are required instead [3].

• Very Thin Lips: Patients seeking significant volume increase will see minimal benefit, as a lip flip only everts existing tissue [3]. Dermal fillers are better suited for volume deficits [1], [3].

• Contraindications: Avoid the procedure if you are pregnant, breastfeeding, allergic to botulinum toxin (or cow’s milk albumin in formulations containing it), or have neuromuscular disorders like myasthenia gravis [1], [2], [3]. Active cold sores or oral infections must resolve before treatment [1], [2].

Potential Risks

Because the orbicularis oris controls the mouth seal, over-relaxation or improper placement can cause:

• Difficulty pronouncing sounds like “p,” “b,” or “m” [3].

• Impaired ability to drink through a straw, spit, whistle, or eat with a spoon [1], [3].

• Drooling or minor smile asymmetry [2], [3], [4].

• Minor injection site swelling, tenderness, or bruising [1], [2].

No botulinum toxin brand is FDA-approved specifically for a lip flip or gummy-smile correction; this application is off-label and carries the standard boxed warning regarding the rare risk of distant toxin spread [3]. Seek immediate medical care if you experience vision problems, difficulty swallowing, or shortness of breath [1], [2].