A "gummy smile" — when more than 2–3 mm of gum shows above the upper teeth on smiling — is a common concern that has multiple anatomic causes and matching treatments. Korean dermatology, plastic surgery, and dental aesthetics offer a tiered approach from temporary botox to permanent bone work. Picking the right intervention depends on what is actually causing the excess gum display.
The four causes of gummy smile
- Hyperactive upper lip muscle — the levator labii superioris pulls the upper lip too high. Most common cause; responds well to botox.
- Excess gum tissue (altered passive eruption) — teeth appear short because gum covers more enamel than typical. Treated with gum contouring.
- Vertical maxillary excess — the upper jaw is too long; the teeth and gums sit lower than ideal. Requires orthognathic surgery for full correction.
- Short upper lip — congenital or age-related; may be addressed with lip lowering or lip lift adjustments.
The right treatment requires accurate diagnosis. Botox helps cause #1; surgery helps causes #3 and #4. Treating cause #1 with surgery — or trying to fix cause #3 with botox — produces minimal benefit at best.
Tier 1: Botulinum toxin for hyperactive lip muscle
The least invasive option; first-line for the most common cause:
- Mechanism: small dose injected into the levator labii superioris reduces the upper lip\'s elevation during smile.
- Procedure: 5–10 minutes; quick injection.
- Effect: visible at 5–7 days; peaks at 2 weeks.
- Duration: 3–4 months; longer with repeated treatment as muscle adapts.
- Cost (Gangnam, 2026): $150–$400 per session.
- Reversible: entirely; effect fades naturally.
- Risks: over-paralysis can produce asymmetric or limited smile; conservative dosing reduces risk.
Tier 2: Gum contouring (gingivectomy)
For excess gum tissue covering the natural tooth crown:
- Mechanism: excess gum tissue is reshaped and removed, exposing more of the underlying tooth.
- Method: laser (preferred for less bleeding and faster healing) or scalpel.
- Procedure: 30–60 minutes under local anesthesia.
- Recovery: 5–10 days for full healing.
- Cost (Gangnam, 2026): $400–$1,500 depending on number of teeth.
- Permanence: typically permanent.
- Limit: only addresses gum tissue overgrowth; doesn\'t change muscle activity or bone structure.
Tier 3: Lip lowering surgery
For short upper lips or to compensate for hyperactive lip muscle without recurring botox:
- Mechanism: incision inside the upper lip; soft tissue is repositioned downward; the upper lip elevates less when smiling.
- Procedure: 30–60 minutes under local anesthesia.
- Recovery: 5–7 days; sutures absorb internally.
- Cost (Gangnam, 2026): $1,500–$3,500.
- Permanence: generally permanent.
- Visible scar: internal incision; no external scar.
- Risks: over-correction can produce a "frozen smile" appearance; conservative technique preferred.
Tier 4: Orthognathic (LeFort I) surgery
For vertical maxillary excess where the upper jaw is structurally too long:
- Mechanism: LeFort I osteotomy moves the entire upper jaw upward, repositioning teeth and gums.
- Procedure: 2–4 hour operation under general anesthesia, in hospital setting.
- Recovery: 4–6 weeks for major recovery; full result over 6–12 months.
- Cost (Korea, 2026): $9,000–$18,000.
- When indicated: typically combined with broader bite/orthognathic problems; rarely a cosmetic-only choice.
- Note: requires orthodontic preparation before and after surgery.
How Korean clinicians actually decide
A typical decision tree:
- Mild gummy display (2–4 mm) with hyperactive lip: botox first; consider lip lowering if patient wants permanent solution.
- Moderate gum display with excess gum tissue: gum contouring, often combined with botox.
- Significant gum display (6+ mm) with normal teeth and lips: evaluate for vertical maxillary excess; orthognathic consultation.
- Combined causes: staged or combined treatment based on dominant component.
Combination strategies
Common combinations:
- Botox + gum contouring — addresses both lip activity and gum tissue.
- Lip lowering + gum contouring — permanent muscle effect plus tissue adjustment.
- Veneers + gum contouring — for patients combining cosmetic dental work with gum reshaping.
- Orthognathic + orthodontics — for skeletal cases.
What to ask in your consultation
- What is the dominant cause of my gummy smile in your assessment?
- Botox, surgery, or combined — and why this approach?
- What does my smile look like simulated post-treatment?
- What is the maintenance requirement?
- What is your revision policy if the result is over- or under-corrected?
Risks across the spectrum
- Botox: temporary asymmetry, smile rigidity if over-dosed.
- Gum contouring: uneven healing, gum recession in over-corrected cases.
- Lip lowering: over-correction with reduced smile expression.
- Orthognathic: all the considerations of major bone surgery.
Who to see
- For botox: dermatologist or plastic surgeon experienced with facial botox.
- For gum contouring: cosmetic dentist or periodontist; some plastic-surgery clinics offer this through dental partners.
- For lip lowering: plastic surgeon with lip-surgery focus.
- For orthognathic: board-certified plastic surgeon or oral and maxillofacial surgeon (OMFS) at hospital-grade facility.
The honest framing
Gummy smile is often "fixed" with the wrong treatment because the cause wasn\'t accurately diagnosed. The right intervention can produce dramatic, satisfying improvement; the wrong one wastes money and leaves the patient still bothered. Diagnosis first, treatment second — and Korean clinics with experienced gummy-smile assessment will provide the diagnosis honestly even when the appropriate treatment is at a different clinic than they offer.