Lip repositioning for gummy smile: A case series evaluating postoperative lip length and patient satisfaction with 6-month follow-up

A harmonious smile is a key component of facial aesthetics, with normal gingival display ranging from 1 to 3 mm. Excessive gingival exposure, defined as a gummy smile, can result from skeletal, dentoalveolar, or soft tissue factors, negatively impacting patient self-confidence. Three patients presenting with a mild gummy smile were treated using different approaches: (i) conventional lip repositioning, (ii) modified lip repositioning, and (iii) botulinum toxin (Botox) injection. Each patient was followed over six months, with evaluations at two weeks, one month, three months, and six months to observe healing and monitor changes in gingival display, lip length at rest and during smiling, and how satisfied each patient felt with their smile. Lip length increased following both conventional and modified lip repositioning procedures, primarily due to elongation of the vermilion portion, with no notable difference between the two approaches. No change in lip length was observed after Botox injection. Patient satisfaction correlated directly with the degree of improvement in gingival display—patients reported higher satisfaction when gingival exposure decreased, followed by a gradual decline in satisfaction as relapse occurred over time. • To our knowledge, this is the first study to evaluate Lip length and patients’ satisfaction for these three approaches: (i) conventional lip repositioning surgery, (ii) modified lip repositioning surgery, and (iii) Botox injection. • This study was designed to evaluate three minimally invasive methods for managing a gummy smile. • This study compared surgical and non-surgical techniques for correcting a gummy smile.