A genuine smile shows more than teeth. It reflects balance between lips, gums, and bite, and it shifts with age, hydration, and muscle tone. When several millimeters of gum show above the upper teeth, many people call that a gummy smile. I see it weekly in practice, and the first question is always the same: can Botox help? The short answer is often yes, especially when a hyperactive upper lip drives the show. But not every gummy smile shares the same cause, and a lip flip is not a cure‑all. Understanding who benefits, what results look like, and where the technique falls short helps set realistic expectations.
What creates a gummy smile
A gummy smile is an outcome, not a diagnosis. For some, the upper lip rises higher than usual when smiling because the elevator muscles fire more forcefully or the lip is thin and retracts easily. For others, the gums are anatomically longer or the teeth are shorter due to wear, altered eruption, or a covering of gingival tissue. Skeletal patterns also play a role; a long upper jaw can expose more gingiva regardless of lip position. Orthodontic relapse or a high smile line can amplify things. Many patients bring me photos from their twenties and remark that the gums did not show then. As collagen diminishes and lips thin with age, the same smile can uncover more pink.
A careful assessment separates soft tissue movement from structural factors. I measure upper lip length at rest and on smile, note how many millimeters of gingiva show, and check the incisal display. I look at tooth proportions, gum health, and any asymmetries. If the smile shows 2 to 4 millimeters of gingiva primarily because the lip vaults upward, botulinum toxin injections can help. If there is a vertical maxillary excess or tooth size discrepancy, dental or surgical options may be the better foundation, with Botox as a fine‑tuning tool.
How the lip flip works
The term lip flip describes the effect of weakening specific muscles, not a literal flipping of the lip. Small doses of botulinum toxin type A into the elevator muscles of the upper lip reduce the degree of lift when you smile. The central target is often the levator labii superioris alaeque nasi, a narrow muscle that runs from the nasal sidewall toward the upper lip. We sometimes add tiny amounts to the orbicularis oris at the vermilion border to create a subtle outward roll. This can give the impression of more volume without filler and can lessen gum exposure.
Mechanically, botulinum toxin blocks acetylcholine release at the neuromuscular junction. The effect is local and temporary. Within 3 to 5 days, you begin to notice less retraction of the upper lip, with the full result at around two weeks. When placed correctly, the smile looks natural, just a little less “high.” The gums that showed 3 millimeters might now show 1, and for many people, that is the difference between self‑conscious and confident.
I learned early to respect small differences in anatomy. A patient with strong depressor septi nasi activity, for example, may experience a sharper downward pull of the nasal tip during smiling, which makes the lip seem to rise farther by comparison. In that case, a microdose at the depressor septi can balance the movement. Conversely, if the orbicularis oris is over‑treated, speech sounds like “p” and “b” can feel soft for a week, and drinking from a narrow straw can become awkward. Precision matters more than bravado.
Who is a good candidate
Not everyone seeking a lip flip wants the same outcome. Some want to soften a gummy smile for photos and social settings. Others want the look of a fuller upper lip without filler. The best candidates share several traits: good dental and gum health, reasonable expectations, and a gummy display primarily due to lip movement rather than bone length or tooth size. I also look for symmetry at rest, absence of active orthodontic movements that would change the smile arc within weeks, and stable bite function.
There are red flags. Someone who depends on woodwind instruments or competitive singing may find any change in perioral muscle tone disruptive, at least during rehearsal periods. Patients with neuromuscular conditions or those pregnant or breastfeeding should discuss risks and defer elective cosmetic botulinum toxin treatment. If lip incompetence exists at baseline, weakening the elevators can unmask or worsen mouth breathing at rest, though that is uncommon with conservative dosing.
What results to expect
Results from a Botox lip flip are subtle by design. Think of it as a dimmer switch rather than an on‑off button. At two weeks, we want to see a pleasant smile with less gum exposure, better balance between the red show of the upper lip and the upper incisors, and no obvious change in speech. If you measure things, a change of 1 to 3 millimeters of vertical exposure is typical with conservative dosing. Photos help. I take standardized “E” and “Cheeeese” expressions to gauge dynamic movement.
Longevity varies. A first session often peaks by two weeks and begins to soften by eight to ten weeks, with the effect largely worn off by three to four months. Some patients metabolize toxin faster and return at eight weeks. Others hold at the three‑month mark. Repeating treatment at a consistent interval can lengthen duration slightly, though lips tend to move constantly and metabolize faster than the glabella or forehead. I encourage patients to plan for two to four sessions per year if they want to maintain the change.
Natural looking botox is about restraint. A few extra units can cross the line into a smile that feels clamped, which nobody wants. I would rather under‑treat and add a touch at the two‑week mark than overshoot. When someone comes in for the first time, we discuss the option of baby botox, using microdoses to map responsiveness before committing to a full plan.
What the appointment looks like
A typical botox appointment for a lip flip is brief, often under fifteen minutes. After a short botox consultation, we map the relevant injection points with a cosmetic pencil while you practice different smiles. Most patients need 2 to 6 units total for a standard lip flip, sometimes 8 to 10 units if we include the alar region or depressor septi. The needles are tiny. Discomfort is minimal, more of a pinch or sting, and there is rare bruising near the vermilion border where capillaries sit close to the surface.
Many people schedule a botox session on a lunch break and head back to work. You can drive afterward. I suggest avoiding vigorous exercise for the rest of the day, not because activity is dangerous, but to reduce the risk of diffusion and bruising. Skip massages that press the face, and avoid saunas or very hot yoga the same day. Makeup can go on after a gentle cleanse at home.
Safety, side effects, and what can go wrong
Safe botox injections start with anatomy and conservative dosing. When problems occur, it usually stems from treating the wrong pattern or placing product too close to muscles that control speech and eating. The most common minor side effects are pinpoint bruises and tenderness that last a day or two. Headaches happen occasionally in sensitive patients. Rarely, you may experience lip heaviness, a sense that forming consonants is a little harder, or difficulty keeping liquid in while drinking from a bottle. These effects fade as the toxin wears off.
Asymmetry is fixable in most cases. If one side lifts more than the other, a microdrop can even things out. What is not fixable with botulinum toxin is a gummy smile caused by a long upper jaw or very short teeth. Trying to compensate with more units creates an odd, stiff look. The remedy there involves dentistry or orthodontics, sometimes surgery. A trusted botox provider will tell you when toxin is not the right tool and refer you to a dentist, periodontist, or orthodontist.
Allergic reactions to botulinum toxin are exceedingly rare. The product is purified and medical grade. Only FDA‑cleared brands are used in reputable clinics, and vials are stored and reconstituted according to manufacturer guidelines. If you have a history of keloids, autoimmune flares, or atypical reactions to injectables, share that history during your evaluation.
Botox vs fillers vs dental solutions
People often conflate a lip flip with filler. They do different jobs. Botox relaxes muscle to change movement, while filler adds volume to change shape at rest. If your main concern is gummy display when you smile, toxin targets the cause more directly. If your lips look thin even at rest and you want more structure or hydration, hyaluronic acid filler in thoughtful micro‑aliquots can help, often in combination with a modest lip flip.
Dental solutions come into play when tooth proportions or gum contours sit at the center of the problem. Laser gingivectomy, crown lengthening, orthodontic intrusion of the upper incisors, or a plan that addresses altered passive eruption can rebalance the smile without touching the lip. For vertical maxillary excess beyond mild degrees, orthognathic surgery changes the foundation. Many adults prefer less invasive options, which is why botulinum toxin has a role, but durability and scope differ.
I sometimes show a set of before‑and‑afters to illustrate pathways. One patient with 4 millimeters of gingival show from hyperactive elevators improved nicely with 6 units and a tweak at two weeks, no filler required. Another with 5 to 6 millimeters of show and short clinical crowns gained only modest improvement from toxin; crown lengthening and a small dose of filler at the tubercles created the balanced look she wanted. Matching treatment to cause saves time and avoids disappointment.
The role of experience and technique
Botox therapy is deceptively simple to watch and nuanced to perform. The dose that quiets an overactive elevator in a 26‑year‑old may leave a 45‑year‑old feeling too numb if placed in the same vector. Lip thickness, skin elasticity, and dental display at rest all influence plan and placement. A certified botox injector with a track record in facial botox will ask you to smile in several shapes, not just the standard grin. They will palpate, not guess, and will mark points rather than wing it.
I favor precision botox injections with tiny boluses and a light touch on the orbicularis, especially for first timers. It is easier to add than subtract. If we decide to treat the depressor septi nasi to soften a plunging nasal tip on smile, I use a microdose to avoid nasal stuffiness or speech changes. The goal is almost always best botox in New York, NY subtle botox results, not a dramatic freeze.
Cost, value, and maintenance
Botox pricing varies by region, clinic, and brand. For a lip flip, most people pay for a small number of units, so the total cost sits well below a full upper face treatment. In cities, that can range from the price of a nice dinner to something closer to a weekend getaway, depending on the clinic’s experience and materials. Ask whether the clinic uses high quality botox from reputable suppliers and how they reconstitute their vials. A bargain that relies on diluted product or a rushed technique is not a bargain.
Longevity remains a reality check. Where forehead botox often holds three to four months, the lip flip can fade closer to two or three. If you rely on that change for professional photos or a wedding season, schedule a botox appointment two weeks before the event, then return for a botox touch up if needed. Over a year, many patients budget for three or four sessions. Some space them around other treatments, such as botox for crow’s feet before summer or a botox brow lift before holidays.
Finding a provider you trust
Choosing a botox specialist should feel like choosing a dentist, not a retailer. You want clinical judgment, steady technique, and a setting that treats safety as non‑negotiable. A good botox clinic takes a comprehensive history, documents your baseline, and explains trade‑offs. They rehearse aftercare with you and invite you back for a check if anything feels off. Look for a botox doctor or nurse injector who performs both cosmetic botox and therapeutic work. Someone who also does masseter botox for clenching and TMJ botox treatment tends to respect function as much as aesthetics.
People type botox near me and scroll reviews for hours. Reviews help, but a short in‑person consultation tells you more. Notice whether the provider watches how you speak, not just how you smile. Do they talk about units without seeing you move? That is a red flag. A top rated botox practice does not push every add‑on. If they suggest you are a better candidate for dental work or orthodontia, that honesty is worth more than a discount.
When a lip flip is not enough
Some gummy smiles ask for a team approach. Orthodontic alignment can change the smile arc and reduce gum show. If your upper central incisors sit low relative to the canines, intrusion and torque adjustments can transform display. A periodontist can lift gumlines in cases of altered passive eruption, revealing proper tooth length. A cosmetic dentist can correct worn edges that make the incisors look short. Once these foundations are in place, a small botulinum toxin treatment can fine‑tune the last millimeters of lip movement.
I met a patient who had spent years hiding her smile. She had a long upper jaw, short clinical crowns, and a hyperactive upper lip. We created a staged plan. First, crown lengthening and conservative veneers to restore tooth proportion. Second, orthodontic refinement to settle incisor display. Third, a low dose lip flip to soften the last bit of lift. Did she need all of it? Not to survive. But her smile read as hers again, and the botox maintenance became a twice‑yearly habit rather than a desperate fix.
Talking numbers: units, timing, and adjustments
Patients like numbers because they offer a sense of control. A standard lip flip might use 2 units per side into the levator labii superioris alaeque nasi and 1 to 2 micro units in the philtral and vermilion border points. Some injectors prefer a single central point near the base of the columella combined with alar points. Others place tiny drops along the cupid’s bow. All of those patterns can work. What matters is calibration to your anatomy and a willingness to adjust.
If you have had botox for frown lines or forehead botox recently, it does not prevent a lip flip, but total facial dynamics change when multiple areas are treated. A softer glabella can make your smile look friendlier, which may influence how much lip retraction bothers you. I always ask what else you plan to do, including fillers elsewhere, because stacking treatments can magnify effects.
Beyond the smile: adjacent uses worth knowing
Botulinum toxin earns its reputation as a wrinkle relaxer injection, but its most satisfying wins often live off the beaten path. For patients with bruxism, masseter botox can slim the jawline and relieve tension headaches, changing the way the lower face looks and feels. For chronic migraine sufferers, therapeutic botox across a standardized set of head and neck sites can reduce headache days, a different protocol than cosmetic work. None of this replaces a dentist or neurologist, but an injector who understands both cosmetic botox and medical botox brings a more complete view of facial balance and function.
That matters with gummy smiles because the mouth does not move in isolation. A tense jaw can brace the perioral region. Allergic rhinitis can alter nasal airflow and lip posture. Habitual lip biting can shorten the philtrum over time. The best botox treatment accounts for the whole picture, not just the red border.
Answering common questions
Is a lip flip reversible? The effect fades on its own within weeks to months. There is no antidote. That is why conservative dosing makes sense for first time botox.
Will I look different at rest? Most people look the same or slightly fuller at the upper lip border. The main change happens on smile.
Can I still get filler later? Yes. Many patients layer a small amount of hyaluronic acid for structure with a periodic lip flip for movement control. Proper sequencing avoids excessive eversion.
Does it hurt? The sensation is quick and tolerable. Ice or a dab of numbing cream helps if you are anxious.
How soon can I see results? A gentle change appears by day three to five, with peak effect at two weeks. Plan events accordingly.
A practical plan for your first lip flip
- Schedule a consultation with a trusted botox provider and bring photos of your usual smile. Ask about their approach to gummy smiles, not just lips in general. Request conservative dosing for your first session. Set a follow‑up at two weeks to assess movement and discuss a tiny add if needed. Avoid intense workouts and heavy facial massage the day of treatment. Smile normally, but do not overwork the area as a “test.” Take photos at day 0, day 7, and day 14 in the same lighting. Use them to guide future sessions. Track how long the result feels right. Share that timing at your next botox appointment to tailor maintenance.
Final thoughts on fit and expectations
A botox lip flip is a nimble tool for a specific kind of gummy smile. It will not lengthen teeth, reshape bones, or change gum contours. It will, when used thoughtfully, lower the curtain on an over‑eager upper lip and rebalance the stage so teeth, gums, and lips share the spotlight. For many, that small shift is all they wanted. The outcome feels like themselves, just less self‑conscious, with subtle botox results that blend into their expressions rather than hijack them.
If you are weighing options, start with an honest assessment. Ask whether your gummy show stems mainly from movement or from structure. If movement leads, botox cosmetic injections can deliver a light, affordable change with almost no downtime. If structure dominates, your provider should discuss dental or orthodontic paths and how toxin might support them rather than replace them. That kind of conversation is the mark of a trusted botox provider.
One final note from years at the chair: smiles carry stories. The best aesthetic work does not erase them. It refines the frame so your story comes through more clearly. Whether you choose a lip flip, dental contouring, or both, insist on a plan that respects how you move, not just how you look in a still photo. That is how you get results that last beyond the lifespan of any single syringe or session.