A gummy smile — where the upper lip rises high enough when smiling to expose a significant amount of gum tissue — is one of the most common reasons patients book a lip flip. It’s also the application where the lip flip produces its most specific, targeted result, because the mechanism of the treatment directly addresses the mechanism of the concern.
Regulatory context: Using botulinum toxin for a lip flip or gummy-smile correction is off-label; these are not indications in the BOTOX Cosmetic prescribing information. Discuss the expected benefit, alternatives, and risks with a qualified injector. Units of different botulinum toxin products are not interchangeable.
But the lip flip doesn’t correct every gummy smile. The degree of gum exposure, the underlying cause, and the patient’s anatomy all determine whether a lip flip is the right solution, a partial solution, or not the right approach at all. This post explains how the lip flip addresses gummy smile, quantifies what degree of correction is realistic, identifies the anatomical factors that make someone a good or poor candidate, and covers the situations where a different intervention is needed.
What Causes a Gummy Smile in the First Place
Understanding the cause matters because the lip flip only addresses one of them. A gummy smile can result from several different anatomical factors — sometimes a single factor, sometimes a combination.
Hypermobile upper lip (muscular cause). The muscles that elevate the upper lip during smiling — primarily the levator labii superioris and the zygomaticus minor — pull the lip higher than average, exposing gum tissue that other people’s lips would cover. The lip itself may be a normal size and the gums may be a normal length; the issue is that the muscles are stronger or more active than typical, creating excessive upward movement. This is the cause the lip flip treats directly.
Short upper lip (anatomical cause). Some patients have a naturally shorter distance between the base of the nose and the upper lip border. Even with normal muscle activity, the lip doesn’t have enough physical length to cover the gums during a full smile. This is a structural issue that muscle relaxation alone cannot fully address — the lip can’t cover what it’s not long enough to reach.
Excess gingival display (dental/skeletal cause). In some patients, the issue isn’t the lip or the muscles — it’s the gums or the jaw. Conditions like altered passive eruption (where the gum tissue didn’t recede normally during tooth eruption, leaving excess gum covering the teeth), vertical maxillary excess (where the upper jawbone is longer than average), or excessive tooth eruption can all create the appearance of a gummy smile regardless of lip position. These are dental or orthognathic concerns that require evaluation by a dentist, periodontist, or oral surgeon.
Combination of factors. Many gummy smiles involve more than one contributing factor — a moderately hypermobile lip combined with slightly short lip length, for example, or normal lip mobility with mild excess gingival tissue. The lip flip can address the muscular component in combination cases, but it may only produce a partial correction if other factors are significant contributors.
How the Lip Flip Corrects Gummy Smile
The lip flip uses a small amount of Botox or Dysport injected into the orbicularis oris and, in some cases, into the levator labii superioris muscles near the nasolabial fold. The neurotoxin partially relaxes these muscles, reducing the force with which they elevate the upper lip during smiling.
The result is that the upper lip doesn’t rise as high as it did before treatment. It still moves — you still smile normally — but the peak elevation is reduced by a few millimeters. Those few millimeters mean the difference between gum tissue being visible and the lip covering it.
The injection pattern for gummy smile correction is slightly different from a standard lip flip aimed at simple upper lip eversion. Your injector at ELLEMES may adjust the placement, targeting the levator muscles more directly rather than focusing exclusively on the orbicularis oris at the lip border. The total unit count is typically similar — 4–8 units of Botox — but the distribution of those units within the perioral area may differ based on which muscles are contributing most to the excessive elevation.
How Much Correction Is Realistic
This is the section that matters most for setting expectations, because the degree of correction the lip flip provides is modest — and “modest” means something different depending on how much gum you’re starting with.
A lip flip for gummy smile typically reduces gum exposure by approximately 2–4 millimeters. That’s a small number on paper, but in the context of a smile — where fractions of a centimeter change the entire appearance — it’s a meaningful visual difference.
Mild gummy smile (2–4mm of gum showing). This is the ideal lip flip candidate. A 2–4mm reduction can bring gum visibility to near-zero during a normal smile, effectively resolving the concern entirely. Patients in this category are typically the most satisfied with lip flip results because the treatment can fully address the issue.
Moderate gummy smile (4–6mm of gum showing). The lip flip produces a noticeable improvement — the gum exposure is reduced, the smile looks more balanced — but some gum tissue will still be visible during a full, wide smile. The result is a softening rather than a complete elimination. Many patients in this category are satisfied because the improvement is significant enough to change how they feel about their smile, even if it’s not a complete correction.
Severe gummy smile (6mm+ of gum showing). The lip flip alone is unlikely to produce a satisfying result for patients with significant gum exposure. A 2–4mm reduction on a baseline of 8–10mm still leaves substantial gum visible. Patients in this category should discuss whether a lip flip is worth pursuing as a partial measure, or whether a different intervention — or a combination approach — would better address the concern.
Your injector assesses gum exposure during the consultation by measuring the distance between the lower border of the upper lip and the gum line during a natural, full smile. This measurement determines which category you fall into and shapes the honest conversation about what the lip flip can and can’t achieve for you specifically.
Who Gets the Best Results
The patients who are most satisfied with a lip flip for gummy smile share a consistent set of characteristics.
The gummy smile is primarily muscular. The lip rises too high during smiling, but at rest, the lip length is adequate and the gum line is proportional. When the patient holds a relaxed, closed-mouth expression, the lip looks normal — the issue only appears with animation. These patients respond directly to the muscle relaxation the lip flip provides.
The gum exposure is in the mild-to-moderate range. Patients showing 2–5mm of gum tissue during smiling get the most complete correction from a lip flip. The treatment’s 2–4mm of reduction either fully or mostly addresses the concern.
The patient wants a subtle correction, not an elimination. Some patients don’t want zero gum visibility — they just want less. A slight reduction that softens the smile without fundamentally changing it is exactly what the lip flip delivers. Patients with this mindset tend to be very satisfied because the treatment aligns with their goal.
The patient is comfortable with the maintenance schedule. A lip flip for gummy smile lasts 2–3 months, just like a lip flip for any other indication. That means the correction is temporary and requires ongoing maintenance. Patients who are already on a regular Botox schedule for other areas (forehead, crow’s feet) often add the gummy smile lip flip to their existing appointment cycle, which makes the maintenance seamless. For a detailed breakdown of how long the effect lasts and maintenance strategies, see our post on how long a lip flip lasts.
Who Should Consider a Different Approach
The lip flip isn’t the right solution for every gummy smile. Being direct about this upfront saves patients time, money, and disappointment.
Patients with a short upper lip. If the lip itself is physically short — there isn’t enough lip tissue to cover the gums even at rest — relaxing the muscles won’t create additional lip length. The lip can’t cover what it can’t reach. For these patients, lip filler can add volume to the lip body, increasing the surface area that’s visible during smiling. In some cases, combining lip filler with a lip flip produces a better result than either treatment alone — the filler adds the physical mass, and the flip prevents the muscles from overriding it.
Patients with excess gum tissue (altered passive eruption). If the issue is that the gums themselves cover too much of the teeth — making the teeth appear short and the gums appear large — the correction is dental, not muscular. Crown lengthening or gum contouring (gingivectomy) performed by a periodontist removes excess gum tissue to reveal more tooth structure. A lip flip can complement this procedure by reducing lip elevation after the gum tissue has been addressed, but it doesn’t substitute for it.
Patients with vertical maxillary excess. If the upper jaw is physically longer than average, the entire dental-gingival complex sits lower relative to the lip, creating gum exposure that no amount of muscle relaxation can overcome. This is an orthognathic (jaw surgery) concern. It’s relatively uncommon as the sole cause of a gummy smile, but when it’s a significant contributor, the correction is surgical rather than cosmetic.
Patients who want a permanent fix. The lip flip is a maintenance treatment — it lasts 2–3 months and must be repeated to sustain the effect. For patients who want a one-time correction, surgical options exist (lip repositioning surgery, for example), though they carry the risks and recovery profile of a surgical procedure. Your injector can discuss whether a surgical consultation is warranted if you’re seeking a permanent solution.
The Combination Approach
For moderate gummy smiles or cases where multiple factors contribute, combining the lip flip with other treatments can produce a more complete result than any single treatment alone.
Lip flip + lip filler. The lip flip reduces how high the lip rises. Lip filler adds volume and surface area to the lip body, creating more tissue to cover the gums. Together, you get both less elevation and more coverage. This is the most common combination for gummy smile correction at ELLEMES and can address moderate presentations that the lip flip alone only partially corrects. For a detailed comparison of how the two treatments work independently and together, see our post on lip filler vs. lip flip.
Lip flip + gum contouring. If the gum tissue itself is excessive, a periodontist can sculpt the gum line to reveal more tooth structure, and the lip flip then prevents the lip from rising too high above the improved gum line. This two-provider approach addresses both the dental and muscular components of the concern.
Lip flip + broader facial balancing. In some patients, the gummy smile is more noticeable because of overall facial proportions — for example, a flat midface or recessed chin can accentuate the appearance of upper gum exposure. Cheek and chin filler can improve facial proportions, and the lip flip addresses the smile dynamics. This isn’t a standard gummy smile treatment plan, but for patients who are also interested in overall facial balancing, the gummy smile can be addressed as part of a broader aesthetic strategy.
What to Expect During and After the Procedure
The lip flip for gummy smile follows the same basic procedure as a standard lip flip. Your injector marks the injection points — which may include points slightly higher along the nasolabial fold than a standard lip flip, targeting the levator muscles more directly. The injection takes under two minutes. No numbing is typically required. You walk out immediately.
Results for gummy smile correction follow the same timeline as the standard lip flip: initial onset at 3–5 days, full effect at 10–14 days. The gummy smile doesn’t disappear overnight — it fades gradually as the muscles relax. By day 14, you can evaluate the result accurately.
The same functional side effects apply: mild difficulty with straws, slight lip heaviness in the first week, possible subtle speech changes. These are more fully addressed in our post on lip flip side effects.
Duration is 2–3 months. When the neurotoxin wears off, the muscles regain their full strength and the gummy smile returns to its pre-treatment level. There is no cumulative or lasting correction from repeated treatments — the effect is entirely maintained by the presence of the neurotoxin.
The Consultation Is Where This Decision Gets Made
The critical step for gummy smile correction isn’t the injection — it’s the assessment that happens before it. Your injector needs to evaluate the cause of the gummy smile (muscular, structural, dental, or combination), measure the gum exposure during a full smile, assess whether the lip flip alone can produce a satisfying result, and discuss realistic expectations before any product is placed.
At ELLEMES, this assessment is built into the appointment. If the lip flip is the right approach, your injector proceeds. If it’s only a partial solution, they’ll explain what else might be needed. If it’s not the right intervention at all — if the concern is dental or skeletal — they’ll tell you that directly and recommend the appropriate provider.
The goal isn’t to sell the treatment. It’s to solve the concern. Sometimes the lip flip does that. Sometimes it’s part of the solution. And sometimes the honest answer is that the concern requires a different type of intervention entirely.
Learn more about the Lip Flip at ELLEMES Medical Spa →
ELLEMES Medical Spa is located at 5505 Peachtree Dunwoody Road in Sandy Springs, GA — serving patients from Buckhead, Brookhaven, Dunwoody, and greater Atlanta.