Until recently, Sally White spent her life trying her hardest not to smile. Every time she grinned or laughed, she became painfully aware of the facial features that she thought set her apart from other people: her upper lip that rose far too high and made her gums look obvious.
Parties, social gatherings and family gatherings were a nightmare for her – because someone was required to get out a camera and start taking pictures.
The 53-year-old office manager from Hertfordshire says: ‘I absolutely hated having my picture taken or seeing pictures of myself – I felt awkward and self-conscious because of my awful, gummy smile. If I were to smile or laugh in public, I would either cover my mouth – or force myself to stop.”
However, two years ago, after a chance conversation, Sally made a life-changing discovery that finally allowed her to beam happily from ear to ear – namely that the gummy smile that had plagued her was caused by a recognized medical condition.
And even better: there was a simple treatment that – to her surprise – consisted of a course of anti-wrinkle injections.
She says: ‘It was a game changer. It wasn’t something I had ever heard of. I just wish I’d found out sooner.’
Sally White used to feel incredibly self-conscious about her gummy smile, but since treating it with a course of anti-wrinkle injections she has gained more confidence
A gummy smile is formally known as “excessive gingival display.” Although no precise clinical criteria have been defined, a smile in which more than three or four millimeters of gum tissue is visible above the upper teeth is considered disproportionate.
In total, an estimated 14 percent of women and 7 percent of men in Britain are affected.
The most common cause is overactivity in a muscle with the longest name in the human body – the ‘levator labii superioris alaeque nasi’, also known as the LLSAN.
It runs down from the upper part of the jawbone next to the nose, lifting the upper lip, spreading the nostrils and helping to form facial expressions such as a smile or snarl.
In many people with this type of smile, the muscle is too strong and pulls too hard, meaning the upper lip is lifted higher than normal and too much of the gum tissue becomes visible.
Dr. Kate Carr is a former general practitioner and runs Dr. Kate Aesthetics in North London, one of many private clinics across the country offering treatments.
She said: ‘A significant number of people have excess gum tissue and feel very insecure about it.
‘It is often a problem from a young age. Children can be cruel – and if someone is bullied or taunted because of their smile, it can have a profound and lasting impact. Some patients could never relax while smiling and would even change the way they smiled in public or when having their photo taken.”
The treatment consists of injecting a small dose of botulinum toxin, best known under the brand name Botox.
The chemical is a powerful natural poison widely used in medicine and the beauty industry. By blocking signals between nerves and muscles, it causes temporary muscle relaxation or weakness.
Sally’s smile before treatment… the most common cause is a muscle called the LLSAN pulling too hard, meaning it lifts the upper lip higher than normal
A small dose of Botox injected into Sally’s lip caused the LLSAN muscle to relax, so less gum is visible when she smiles
As a cosmetic treatment, it can be injected into the face to smooth wrinkles, frown lines and crow’s feet.
Doctors also use it for conditions such as chronic migraines, overactive bladder, and severe armpit sweating.
For a gummy smile, the botulinum toxin is injected into the LLSAN to relax the muscle so that it exposes less gum tissue when smiling.
Dr. Carr says, “It doesn’t paralyze the muscle, just weakens it a little, so when someone laughs the lip isn’t pulled as much or lifted as much.”
It’s important, she explains, to start with a small dose.
Dr. Kate Carr says getting the right dose is a fine balance: ‘A larger dose may take longer. But if you overdo it, the lip will drop too far’
“It’s a nice balance,” she says. ‘A larger dose may take longer. But if you overdo it, the lip will drop too far. Instead of showing too much gum when they smiled, they ended up not showing enough of their teeth. It’s better to be careful.’
The effects of botulinum do not occur immediately, but gradually increase over three weeks before subsiding after six to eight weeks.
As a result, the treatment – which costs around €180 each time – usually needs to be repeated every three to four months.
Dr. Carr says: ‘For many people with a gummy smile, this treatment works very well and gives them a smile that makes them feel happy and confident.
‘It’s quick and relatively simple, but can be life-changing. The ability to simply smile naturally can greatly increase a patient’s self-confidence. Yet many people with a gummy smile do not know that it can be treated.’
Sally only heard about the botulinum injections during a conversation with her dentist. “When Botox first came on the market, you would see celebrities with stiff-looking faces,” says Sally. “I swore I would never touch it, that I would just grow old gracefully.
“But then I discovered that just a little bit can completely change the way I feel.”
Although it doesn’t affect eating, drinking or talking, botulinum’s muscle-weakening effect means she can no longer tighten her lips as she used to when applying lip balm or lipstick.
But every morning, while she puts on her makeup, she looks with pleasure at her smile in front of the mirror.
Sally adds: ‘I know when it’s time to book the next appointment. I’m just sorry it took so long for me to hear more about the treatment. I would never want to be without it again. It’s fantastic to finally be able to laugh again.’
