Gum Botox: Why it's injected into the 'muscles', not the gums

Have you ever felt self-conscious because your gums show too much when you smile? While commonly referred to as 'gum Botox,' this procedure is not actually injected directly into the gums. Instead, a small amount of botulinum toxin is administered to the muscles that lift the upper lip, gently reducing how far the lip curls upward when you smile. So, rather than shaving or altering your gums, you can think of it as slightly lowering an 'overly high smile line.'

Here is the core summary: The effects begin to appear 3 to 7 days after the procedure, peak at 1 to 2 weeks, and last for an average of 3 to 6 months. It works best when the primary cause is overactive muscles (muscular cause); if bones or teeth are the root cause, the effects may be limited. Therefore, the starting point is always a diagnosis to identify 'why your gums are showing in the first place.'

😊 Gum Botox, what exactly is this procedure?

A gummy smile refers to a condition where the gums are excessively exposed when smiling. Generally, a gum exposure of 0–2 mm is considered within the normal range, 3 mm or more is often classified as a gummy smile, and 4 mm or more is typically regarded as a candidate for aesthetic improvement consultation.

The main component of gum Botox is botulinum toxin. This component blocks the release of a neurotransmitter called acetylcholine at the junction where nerves and muscles meet, temporarily reducing muscle contractile force. Since the muscles that lift the upper lip exert slightly less force, the lip does not rise as high as before when you smile.

The target muscles include the levator labii superioris alaeque nasi (LLSAN), levator labii superioris (LLS), and zygomaticus minor, among which the LLSAN, which lifts both the nostril and upper lip together, is the key target. A representative reference point for the injection site is the Yonsei Point, the intersection where the lateral ala of the nose meets the nasolabial fold, which is utilized to ensure left-right symmetry.

📌 Key Summary: Gum Botox is a non-surgical procedure that lowers an excessive smile line by injecting toxin into the muscles that lift the upper lip, not into the gums.

⏱️ When do the effects appear, and how long do they last?

The procedure itself is short, taking about 5 to 10 minutes. No incisions or recovery periods are virtually required. However, because botulinum toxin does not react instantly, you need to wait a few days to feel the effects.

The dosage is smaller than you might think. Generally, a small amount of about 2.5 to 5 units per muscle, totaling around 8 to 12 units, is used. The idea that "more will yield a more definite result" is dangerous. An excessive dosage can instead make your smile look unnatural or cause asymmetry.

Since the effect is temporary, repeated procedures are required to maintain it, which means continuous costs. While some reports suggest the duration of efficacy increases slightly with repeated treatments, individual variations are significant.

📌 Key Summary: Effects start within 3–7 days, peak at 1–2 weeks, last for an average of 3–6 months, and the rule of thumb is repeated treatments with small doses.

🔍 Is Botox the answer for my gummy smile?

This is the most important part. This is because the appropriate treatment for a gummy smile varies completely depending on its root cause. The causes can be broadly divided into four categories:

• Muscular: Overactive upper lip muscles → Gum Botox is the best fit

• Dental/Gingival: Gums covering too much of the teeth or overgrowing → Gingivectomy (gum contouring) or crown lengthening is suitable

• Skeletal: Excessive downward growth of the upper jaw (Vertical Maxillary Excess, VME) → The fundamental treatment lies in orthognathic surgery

• Mixed: A combination of multiple causes

Botox truly shines when the cause is muscular. If skeletal or dental issues are the primary cause, the limits of botulinum toxin are clear. For reference, a study by Tjan et al. reported that about 10% of young adults have a smile line that exposes a significant amount of gum tissue, and this is observed more frequently in women.

Lip repositioning surgery, which surgically restricts the upper lip from rising too high, is an option considered by those who experience good results with Botox but find repeated treatments burdensome. However, since this incisional method has its own pros and cons, thorough consultation is required before making a decision.

Onlif does not perform incisional plastic surgeries. Rather than changing facial structures, we focus on gently controlling factors that make facial expressions look unnatural—such as hyperactive muscle movements—through non-surgical methods. Therefore, for gum Botox as well, we first verify 'whether the cause is muscular' and prioritize preserving a natural smile line through precise, small-dosage injections.

📌 Key Summary: Botox is optimal for muscular causes, while other treatments are needed for dental or skeletal causes; identifying the cause is the starting point for choosing a treatment.

⚠️ Side effects and precautions, discussed honestly

Even if it seems simple, we must address what needs to be addressed. A representative side effect is **upper lip ptosis (drooping of the upper lip)**. If the dosage is excessive or the injection site is inaccurate, your smile can become unnatural, asymmetry may occur, or speaking and eating may temporarily become uncomfortable.

Particularly, please keep this in mind: Unlike fillers, gum Botox cannot be immediately reversed with dissolving injections. If overcorrected, you must wait for it to recover naturally as the toxin's effect gradually wears off. That is why it is correct to approach it cautiously with a small dose from the very beginning.

After the procedure, it is recommended to observe the following:

• Avoid rubbing the injection site firmly on the day of the procedure

• Refrain from saunas, high-temperature environments, excessive drinking, and strenuous exercise for a few days

• Avoid lying down for about 4 hours after the procedure

• Avoid facial contouring massages (such as Kyung-rak) for 1 to 2 weeks

If you fall under any of the following, you must inform us before the procedure. If you have neuromuscular diseases such as myasthenia gravis or Lambert-Eaton syndrome, or if you are taking aminoglycoside-class antibiotics, you may react sensitively to the toxin. Due to limited safety data, it is generally not recommended during pregnancy or breastfeeding. In addition, gingival hyperplasia or inflammation (periodontal disease) may be the actual cause, in which case a dental evaluation is the priority.

📌 Key Summary: Since there are potential side effects such as upper lip drooping and they cannot be reversed immediately, verifying contraindications and receiving precise injections in small doses are the keys to safety.

💰 Costs and products, helpful details to know

The cost varies depending on the clinic, product, and dosage. In Korea, it is often priced between 70,000 to 150,000 KRW per session, and because it is mostly for aesthetic purposes, it is not covered by health insurance.

Product selection is also worth discussing. Because botulinum toxin units do not convert exactly the same way across different products, the dosage must be re-evaluated if you switch products. If you undergo repeated procedures over a long period, concerns about resistance (neutralizing antibodies) may arise; in such cases, products from which complexing proteins have been removed, such as Coretox or Xeomin, are often considered as alternatives.

Here is a practical tip: Touch-up policies (re-injection when the effect is weak) vary by clinic, so confirming this before the procedure will give you peace of mind.

📌 Key Summary: A non-covered cost of 70,000 to 150,000 KRW per session is typical, and to manage resistance during repeated treatments, be sure to check product selection and touch-up policies.

🤔 Gum Botox vs. Other Treatments, Comparison Table

As shown in the table, each method targets a different cause. Therefore, rather than asking "Which is the best?" the question should be "Which one fits my cause?"

❓ Frequently Asked Questions (FAQ)

Is gum Botox injected directly into the gums?

No. It is injected in small amounts into the muscles that pull the upper lip upward (such as the LLSAN), not into the gums. It works by slightly reducing muscle strength so that the gums are less exposed when you smile.

How many millimeters of gum exposure warrant considering the procedure?

Generally, a gum exposure of 0–2 mm when smiling is considered normal, and 3 mm or more is often classified as a gummy smile. If it is 4 mm or more, you may consider an aesthetic improvement consultation, but the actual decision should be made alongside a diagnosis of the cause.

When do the effects appear, and how long do they last?

Typically, the effects begin to appear 3 to 7 days after the procedure and peak within 1 to 2 weeks. The duration of efficacy averages 3 to 6 months, with individual variations.

Does it work if the cause is skeletal?

It is limited. If it is a skeletal issue (VME) where the upper jaw has overgrown downward, there are limits to improvement with botulinum toxin alone, making it better to consult on other treatment areas together.

Does a higher dosage mean less gum exposure?

No. On the contrary, excessive dosage can lead to smile asymmetry or drooping of the upper lip. The general rule is to inject a small, precise amount of about 8 to 12 units in total.

If it becomes unnatural or asymmetrical, can it be reversed immediately?

Unlike fillers, it cannot be dissolved immediately. If overcorrected, you must wait for the toxin's effect to gradually wear off and recover naturally, which is why we approach it cautiously with a small dose from the start.

Does repeated treatment cause resistance?

There is a possibility. We manage this by adhering to the minimum effective dose principle and considering products from which complexing proteins have been removed (such as Coretox, Xeomin, etc.) when necessary.

Can I receive the treatment during pregnancy or breastfeeding?

It is not recommended. Due to limited safety data during pregnancy and breastfeeding, the procedure is generally avoided.

Can I return to daily life immediately after the procedure?

Generally, yes. However, it is best to avoid rubbing the injection site firmly on the day of the treatment, refrain from saunas, excessive drinking, and strenuous exercise for a few days, avoid lying down for about 4 hours, and avoid facial massages for 1 to 2 weeks.

How many days before an important event should I get the treatment?

Since the effect stabilizes within 1 to 2 weeks, if you have an important day such as a wedding or a photoshoot, we recommend getting the treatment at least 2 weeks in advance.

Is it covered by insurance?

Most cases are for aesthetic purposes and are therefore not covered by health insurance. Costs vary depending on the clinic, product, and dosage, often ranging from 70,000 to 150,000 KRW per session.

What to check before choosing a clinic for gum Botox

Even for the same procedure, the results and recovery process can vary depending on where, by whom, and how it is performed. Asking these questions during your consultation will help you make an informed decision.

• Is this a procedure they perform frequently? — Clinics have different areas of focus. Check if they regularly perform gum Botox.

• Can I verify the products and equipment used? — Ask if you can verify the product name and authenticity (whether it is an officially imported product and if there is an opening verification process) during the consultation.

• Do they explain the breakdown of costs? — Rather than just hearing a lump sum, you need an explanation of which product is used, how much, and on which areas to make a proper judgment.

• Do they design the treatment considering the whole face? — Even for the same procedure, the injection points and dosage vary depending on facial shape, skin condition, and left-right asymmetry.

• Do they explain adverse reactions and the recovery process beforehand? — A clinic that informs you of potential adverse reactions and coping methods is better for making a decision than a consultation that only highlights expected positive changes.

• Is there a follow-up channel after the procedure? — Check if there is a designated timeline for progress checks, a method to contact them if there are issues, and criteria for follow-up visits.

This is how Onlif Clinic performs gum Botox

• We divide responsibilities — Believing that a single doctor should not handle every single procedure, Onlif allocates dedicated doctors for each specialized field.

• We verify products and equipment together during the consultation — We guide you through the products used and the package opening verification process during your consultation.

• Costs are guided along with the treatment plan after diagnosis — Because the target area, dosage, and scope differ for each individual, we explain exactly what is being charged and why.

• We design based on overall facial balance — We evaluate the face through three pillars—texture, balance, and signs of youthfulness—and plan to refine areas that obscure your natural expression rather than changing your facial structure.

• We discuss adverse reactions and the recovery process beforehand — Along with expected improvements, we guide you through individual variations, potential adverse reactions, and coping methods before the procedure.

• We monitor progress after the procedure together — If verification is needed during the recovery period, we provide guidance on follow-up visits and contact channels.

If you are considering gum Botox, it is best to first check what is possible and what is difficult in your current state. An accurate diagnosis and treatment plan can only be determined through an in-person consultation. Find out through a consultation at Gangnam Onlif Clinic.