Objectives: Objective of the presentation: To describe scientific literature and my technique to treat gummy smile.
Introduction: Of all the human facial expressions, the smile is probably the most pleasing. It expresses a wide range of feelings and it has an important role in facial aesthetics.
An esthetically harmonious smile should be symmetric and display less than 2mm of the gum. The exposure of the gum upon smiling beyond 2mm is known as gummy smile (GS) or gingival smile, and it is often considered unattractive.
Materials / method: The hyperactivity of upper lip elevator muscles is one of the factors involved in this condition, and although it is an off-label treatment in some countries, scientific publications have shown the safety and efficacy of onabotulinumtoxinA (ONA) and abobotulinumtoxinA (ABO) for this condition.
Four types of gingival smile have been described (anterior, posterior, mixed and asymmetric) and respective muscles involved in each type. It should be considered when treating the patient, as well as other individual characteristics.
Results: Since all the musculature in the lower face directly or indirectly connected to the mouth and it is very responsive to BoNT-A, proper technique and doses should be carefully selected for this area. Concomitant treatment of other lower face indications must be well evaluated previously.
The last global aesthetics consensus for BoNT-A suggests the injection of 0.5 to 2 U of ONA in each point. One to 2 injections points per side can be treated, and total doses can range from 1 to 4 U. This consensus considers treatment doses of up to 8 U depending on the patient.
Conclusion: Small doses of BoNT-A injected superficially are efficacious and have lower potential for complications. It is recommended to inject lower face together with upper face to have a more harmonious result and to avoid the development of possible resistance to the toxin.
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