Gummy Smile Consultation

Patients with gummy smile have often spent years aware of it, sometimes self conscious about smiling broadly in photographs or social settings. The conversation that begins consultation is rarely about the muscle. It is about the experience of smiling and what the patient would like to change. The clinical detail comes second.

The right intervention depends entirely on what is causing the visible gum show, and the assessment that determines this is more important than the treatment that follows.

Why some smiles show more gum

Several anatomical contributors can produce visible upper gum show during smiling. The first is muscular: hyperactivity of the levator labii superioris alaeque nasi (LLAN), the muscle that runs alongside the nose and elevates both the upper lip and the nasal alae during expression. The LLAN can pull the upper lip higher than the average smile, exposing more of the upper gingiva. This is the indication that responds to neuromodulator treatment.

The second is dental: a relatively short clinical crown of the upper incisors, often associated with altered passive eruption, where the visible tooth surface is shorter than the underlying tooth and the gum is correspondingly more visible. The third is skeletal: vertical maxillary excess, where the upper jaw projects further inferiorly than average and the entire upper tooth and gum complex sits in a lower position. The fourth is a combination of any of the above.

Why this distinction matters before any treatment

Neuromodulator treatment of the LLAN addresses the muscular contributor. It does not address dental or skeletal contributors. A patient with predominantly dental gummy smile who receives neuromodulator treatment may notice some improvement, but the change will be smaller than they hoped for, because the LLAN was not the dominant contributor. A patient with predominantly skeletal gummy smile will get little benefit at all, because the underlying issue is bony rather than muscular.

Differentiating between these contributors is part of the consultation assessment. Where the contributor is predominantly dental or skeletal, the right next step is referral to dentistry or to maxillofacial surgery for evaluation of the appropriate intervention. We say so directly rather than trying to fit the patient goal to what we can offer.

The LLAN and what dosing it does

The LLAN originates from the maxilla above the orbital margin and divides into two slips that insert into the upper lip tissue and the nasal alae. It is one of the muscles that elevate the upper lip during expression. Reducing its activity allows the upper lip to elevate less during smiling, covering a fraction more of the upper gingiva. The dose required is small, typically two to four units per side placed superficially near the muscle origin in the nasolabial fold area.

This is among the smallest doses used in any cosmetic neuromodulator indication, and the placement is precise. The technique requires care because the surrounding muscles (zygomaticus minor, the orbicularis oris, the levator anguli oris) all contribute to smile dynamics, and inadvertent dosing of the wrong muscle produces a smile that does not look like the patient smile.

What treatment involves

The treatment is brief. After consultation and consent, the practitioner identifies the placement positions on each side and places small volumes of prescription neuromodulator superficially. One injection per side is typical, sometimes two. Discomfort is minimal because the volumes are tiny. There is no practical downtime. Patients return to normal activity immediately.

Onset is gradual. Most patients begin noticing softer upper lip elevation during smiling at five to seven days, with full effect at around two weeks. The visible change is subtle. The aim is to soften the elevation, not to flatten the smile. Patients who arrive expecting a visible immediate transformation are often surprised by how subtle the conservative result actually is.

Conservative dosing as the default

The C.O.R.E. Method approach in this region is to start with the lower end of the dose range, two units per side, with structured review at two weeks where additional dose can be added if response has been insufficient. Going to four units per side as a default first dose carries higher risk of producing a smile that looks unfamiliar to the patient or to people close to them, which is one of the most common forms of regret expressed about gummy smile treatment performed too aggressively elsewhere.

The conservative approach errs in favour of preserving expression at the cost of an occasional second visit for top up. The aggressive approach errs in favour of single session result at the cost of occasional over correction. The first approach is the default for first time patients in this clinic.

Side effects and what we monitor

Local side effects (small bruise at an injection point, brief tenderness, occasional small lump that resolves over days) are the most common reported issues. Specific to this region, over dosing or imprecise placement can produce flattening of the smile, asymmetry, drooping of the upper lip, or change in the appearance of the smile that the patient or their family find unfamiliar. These effects, when they occur, typically resolve over six to twelve weeks as the neuromodulator wears off. There is no specific reversal agent. Conservative dosing substantially reduces these risks.

Patients are given written aftercare and a direct contact for the practitioner if any concerns arise after the appointment.

Duration and maintenance

Duration in this region is similar to other small dose facial neuromodulator indications, typically three to four months at first treatment, sometimes longer with repeated treatment. The maintenance rhythm is part of the consultation conversation, particularly for patients whose primary concern is photographic appearance and who want to time treatment around specific events.

Why we do not name the prescription product

Australian regulation prohibits the advertising of Schedule 4 prescription medicines to the public. That includes brand names, abbreviations and hashtags. The TGA has been increasingly active in enforcing this provision in the aesthetic treatments sector. We can talk in clinical detail about the mechanism, dose ranges, response profile and safety considerations. We do not name brands or otherwise identify products to the public, because the law explicitly prohibits us from doing so.

AHPRA September 2025 considerations

The AHPRA guidelines for nonsurgical cosmetic procedures that came into force in September 2025 require an in person or video consultation with the prescribing practitioner each time a aesthetic treatment is prescribed. Suitability assessment must explicitly explore patient motivations and expectations. For gummy smile specifically, the September 2025 framework reinforces the importance of confirming the muscular contribution before treatment, and naming when the contributor is predominantly dental or skeletal.

Working with Corey

Corey Anderson is the only practitioner at Core Aesthetics. Registered with the Nursing and Midwifery Board of Australia since January 1996 (AHPRA NMW0001047575), Corey runs a one practitioner, low volume clinic in Oakleigh. For small, precise indications like gummy smile treatment, the consistency of practitioner technique across years of repeated visits supports the kind of calibrated dosing that produces stable, predictable results without functional compromise.

Patients see Corey at every visit. Treatment notes carry the dose, the placement detail and the response duration forward across years.

What we do not claim

Three claims sometimes made about gummy smile treatment do not survive clinical scrutiny and we do not make them. The first is that one treatment will permanently eliminate gummy smile. Treatment is reversible and lasts three to four months at first treatment, with maintenance required. The second is that neuromodulator treatment will address all forms of gummy smile. It will not. Dental and skeletal contributors require dental or maxillofacial intervention. The third is that the result will look identical at every treatment cycle. Individual response varies and the plan is adjusted at each cycle.

Cost framing

Pricing is straightforward. Gummy smile treatment is priced on the actual product and time involved, quoted in writing as part of the consultation. There is no surge pricing, no time limited promotional pricing and no loyalty discounting. Patients receive a written treatment plan that includes the realistic anticipated frequency of maintenance.

Booking a consultation

Gummy smile consultation can be a stand alone appointment or part of a broader perioral conversation. The consultation is a clinical assessment in its own right, with no obligation to proceed in the same session. If treatment is appropriate and the patient is ready to proceed, treatment can be performed in the same visit. Where assessment indicates that the contributor is predominantly dental or skeletal, we say so and refer.

Core Aesthetics operates from 12A Atherton Road, Oakleigh, in Melbourne south east. Booking is direct online or by contacting the clinic.

A note on patient experience

Patients who choose gummy smile treatment and find it suits them often describe the result in modest terms. The smile looks more relaxed in photographs. The upper gum show during broad smiling is reduced. Friends and family sometimes do not notice the change at all, which is the conservative result the treatment is designed for. Patients who arrived expecting a more visible transformation sometimes need a second visit at the two week review to add a small additional dose, which is exactly what the conservative starting approach is designed to allow.

Why this treatment is sometimes part of a broader perioral plan

For patients whose smile concern involves multiple components (gum show plus thin upper lip plus inward roll during smiling), the conversation typically separates the contributors and treats them in sequence. Treating the LLAN may be one element. Treating the orbicularis oris (a lip flip) may be another. Lip treatment may complete the picture for some patients. Each is its own clinical decision; none is a default add on. Sequencing usually starts with the contributor that has the most visible impact, with subsequent decisions made at the structured review of the first result.

The overall consultation is therefore often longer than the treatment itself. The complexity sits in the planning rather than in the execution. This is one of the central commitments of the consultation based model: the time spent before treatment determines whether the treatment delivers what the patient was looking for.

On photographic documentation

Standardised pretreatment and post treatment photographs in repose and during animated smiling are recorded as part of the medical record. Reviewing these side by side at the same magnification is essential for honest assessment of the result. The change is small enough that, without the comparison photographs, patients sometimes find it difficult to identify whether the treatment has worked. The documentation is part of the standard review process and is one of the practical reasons that consistency of practitioner across visits matters.

On the limits and the honest framing

Gummy smile treatment is a small intervention with modest, reversible effects on a specific muscle. It is not a transformation of the smile, not a permanent solution, and not a substitute for dental or maxillofacial intervention where those are the appropriate paths. Patients who arrive with realistic expectations of what conservative neuromodulator treatment can achieve in this region tend to be satisfied with the result. Patients who arrive expecting a visible immediate transformation sometimes find the conservative result too subtle, which is exactly why the framework before treatment matters more than the treatment itself.

The honest framing is part of how a consultation based practice protects patient interests. Promising more than the evidence supports sets up disappointment. Promising what the evidence supports sets up satisfaction with the realistic outcome. The first approach is common across the aesthetic treatments sector. The second is the one we operate by.

Booking and the practical next step

The next step is a consultation. The consultation is a clinical assessment in its own right and includes the differentiation between muscular, dental and skeletal contributors that determines whether neuromodulator treatment is the right path. Where it is, treatment can be performed in the same visit or scheduled for a later time the patient prefers. Where it is not, the consultation closes with a clear recommendation about the appropriate referral.

On the broader anatomy of the smile

Smile aesthetics involves the position of the upper lip during animation, the visibility of the upper teeth and gingiva, the symmetry of the smile, the appearance of the lower lip and the relative balance of the surrounding facial muscles. A gummy smile assessment looks at all of these together rather than focusing on a single muscle. Where the LLAN is the dominant contributor, neuromodulator treatment is the appropriate intervention. Where other components dominate, the right intervention may be different. Naming this clearly at the start of the conversation is part of consultation based practice.

For patients whose concern is the appearance of the upper teeth themselves rather than the gum show, dental options (orthodontics, restorative dentistry, periodontal procedures where altered passive eruption is the issue) are outside our scope but are usually the right path.

Consultations are individually scheduled. The first available appointment is generally within a week or two depending on the time of year. Patients receive a written confirmation and any specific guidance relevant to the indication being discussed before the appointment.

The clinic is at 12A Atherton Road, Oakleigh, easily reached by train, car or public transport from across the south east corridor and the surrounding suburbs.

For patients travelling from further afield, the clinic offers off street parking and is a short walk from Oakleigh railway station, which makes the practical logistics of a maintenance treatment cycle straightforward.

The conversation begins with what the patient wants to change, then moves to assessment, then to a recommended path. The path may include treatment here, treatment elsewhere, or no treatment for now. Each is a clinically reasonable outcome.

Long-Term considerations

For patients who have repeated treatment cycles across years, the gummy smile usually stabilises with consistent maintenance. The dose required tends to remain similar across cycles rather than decreasing the way it sometimes does in larger muscles like the jaw muscle. Maintenance can be paused at any time; the treatment is reversible and the muscle activity returns to baseline within months. Patients who decide they no longer want maintenance simply stop, with no rebound effect to wait out.