Lip Repositioning Surgery for a Gummy Smile. How It Works and the Pros and Cons

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Lip Repositioning Surgery for a Gummy Smile. How It Works and the Pros and Cons

A gummy smile can make your teeth look smaller than they really are, even when your teeth have normal length. Dentists call it excessive gingival display when you show more than about 3 mm of upper gum tissue during a full smile.

Lip repositioning surgery targets one specific cause of a gummy smile. It helps most when your upper lip lifts too high when you smile, which people often describe as a hyperactive or hypermobile upper lip.

This article by Dr. S. Kashani shares general education. A dentist or periodontist should evaluate your bite, gum levels, and facial proportions before you choose any treatment.

Part 1: What lip repositioning actually changes

Lip repositioning does not reshape your teeth or cut bone. It changes the resting position and movement range of your upper lip during a smile.

During the procedure, a clinician removes a narrow strip of tissue from inside the upper lip area. Then they suture the lip lining closer to the gumline. That move creates a shallower vestibule, which limits how far the lip can lift when you smile.

Think of it like setting a new “upper limit” for lip elevation. You still smile naturally, but you stop at a lower point, so you show less gum.

Researchers and clinicians have described the technique for decades. Rubinstein and Kostianovsky first described it in the 1970s, and dentistry later adopted and modified it.

Part 2: Who usually makes a good candidate

Lip repositioning works best when the gummy smile comes mainly from lip movement. Many people have more than one cause, so your dentist should diagnose the “mix” first.

A clinician often considers lip repositioning when you have mild to moderate gum display, and the lip lifts aggressively during smiling.

The procedure fits better when you do not have a major skeletal problem driving the gummy smile. When a severe vertical maxillary excess causes the gum show, jaw surgery often makes more sense. One review notes a contraindication in severe cases, such as vertical maxillary excess greater than 8 mm.

Your dentist should also look at your gum type and where a scar might land. A reduced width of attached gingiva can make scar visibility more likely, so your provider should discuss that risk upfront.

Part 3: What happens during the procedure, step by step

Most clinicians perform lip repositioning with local anesthesia in an office setting.

First, they mark an elliptical shape inside the upper lip vestibule. Then they make partial thickness incisions and remove the epithelial strip inside that outline.

Next, they pull the lip mucosa downward and suture it to the mucogingival line. That closure creates the new, shallower vestibule and limits elevator muscle pull during smiling.

Older clinical descriptions in periodontics lay out this same core idea. Ari Rosenblatt and Ziv Simon describe removing a strip of mucosa and suturing the lip mucosa to the mucogingival line to restrict muscle pull and reduce gingival display.

Some clinicians use modifications to reduce relapse risk. A randomized clinical trial describes the standard approach and discusses technique changes designed to keep the lip from drifting back toward its original position.

Part 4: Recovery timeline and what people usually feel

Expect tightness. The surgery changes how your lip moves, so talking and smiling can feel awkward at first.

Swelling often peaks around the first 48 hours and can last about 5 to 7 days, according to postoperative instruction sheets used in specialty practices.

Most patients manage discomfort with prescribed or recommended pain control, plus a soft diet and careful oral hygiene around the surgical area.

Many dentists also tell patients to reduce excessive lip movement early on. That advice aims to protect sutures and support stable healing. A review on lip repositioning techniques emphasizes the role of proper case selection and postoperative stability in outcomes.

Part 5: Results and how long they tend to last

Lip repositioning aims for a noticeable reduction in gum show when you smile.

You should also know about relapse. Studies and reviews report relapse in a meaningful number of cases, often within 6 to 12 months in some reports. A randomized controlled clinical trial explicitly notes relapse in some cases during that window.

Technique modifications can reduce relapse, and some studies report more stable outcomes with specific suturing and muscle management approaches. At the same time, published results vary, so your provider should frame the outcome honestly and explain what drives stability in your specific case.

If you want the most predictable “forever” solution for severe skeletal causes, lip repositioning will not compete with orthognathic options. Lip repositioning shines when you need a less invasive option for the right anatomy.

Part 6: Pros in real life

Lip repositioning can deliver a great cosmetic change without jaw surgery.

It targets lip elevation directly, so it can help when gum show comes from a hyperactive upper lip.

It also avoids the “maintenance cycle” that comes with temporary approaches such as Botox, although relapse can still occur and sometimes leads patients to consider a touch-up procedure.

Many clinicians view the procedure as less invasive than orthognathic surgery and associate it with faster recovery and fewer major postoperative burdens in properly selected cases.

Part 7: Cons and tradeoffs you should take seriously

You cannot treat every gummy smile with one tool.

If the gummy smile comes mainly from jaw position, tooth eruption, or gum overgrowth, lip repositioning alone may disappoint you. Many cases include multiple causes, and that reality forces combination planning.

Relapse can happen. Some studies report partial or complete relapse in certain groups, which can blunt the long-term payoff if your anatomy pushes the lip back upward.

You can also run into side effects. Reviews describe mostly minor complications such as swelling, bruising, and early tightness when speaking or smiling. They also mention rarer issues such as mucocele formation, transient numbness, paresthesia, and other uncommon nerve or muscle effects.

Scarring can show in some patients, especially when the tissue conditions make the mucogingival area more visible during a smile. Your dentist should walk you through that risk with photos and measurements.

Part 8: How lip repositioning compares with other gummy smile treatments

You can group gummy smile solutions by the cause they target.

If you have excess gum tissue covering tooth structure, gum contouring or crown lengthening can expose more tooth and reduce the gummy look.

If you have a bite or tooth position problem, orthodontic approaches can intrude teeth or correct the relationship that drives gingival display.

If your upper lip lifts too aggressively, Botox can reduce elevator muscle activity for a few months, while lip repositioning aims for a longer-lasting mechanical limit on that lift.

If you have severe vertical maxillary excess, jaw surgery often provides the most definitive change, and reviews point to that direction when the skeletal discrepancy rises into severe ranges.

A good treatment plan matches the tool to the cause. Dentists often combine treatments when multiple causes stack together.

Part 9: Questions that protect you from a bad outcome

Ask your provider to measure your gingival display in millimeters and explain what causes it in your case. That step matters because the literature ties success to correct diagnosis and proper case selection.

Ask where they expect the incision line and scar to sit when you smile. Ask what your gum type suggests about visibility.

Ask how they manage relapse risk and what revision looks like if the gum shows returns.

Ask for their own before and after cases that match your anatomy, not just the best-case photos.

Closing thoughts

Lip repositioning can deliver a dramatic change for the right gummy smile, especially when your lip lifts too high and your gums and bone sit in a favorable range. The procedure works by removing a strip of mucosa and suturing the lip lining lower, which limits how far the upper lip retracts during a smile.

It can also relapse, and it can carry tradeoffs like tightness, scar risk, and rare complications. A skilled provider should diagnose the cause, set realistic expectations, and map a plan that fits your anatomy.

Source: https://hollywood-dentist.com/gummy-smile-treatment/