Botulinum Toxins and Lip Repositioning Surgery with Repeated Botulinum Toxin Injection: A Combined Approach for Gummy Smile Treatment

This study was conducted to evaluate the longevity and efficacy of neurotoxin injection before lip repositioning surgery in addition to reinjection of two sustaining doses along three different postoperative intervals (2, 4, and 8 months). This experimental study included 10 female patients who had a gummy smile resulting from upper lip hypermobility or short upper lip. Preoperative measurements were taken during spontaneous smiling: the interlabial distance and the amount of gingival exposure. IncoBotulinum Toxin A was injected into the elevator muscles of the upper lip followed by performing the lip repositioning surgery after 2 weeks of IncoBotulinum Toxin A injection. IncoBotulinum Toxin A was then reinjected at three different postoperative intervals (2, 4, and 8 months). All patients were followed up at 14 days, 4 months, 8 months, and 12 months. Postoperative measurements at 14 days follow-up showed a significant reduction in the amount of gum exposure and in the interlabial distance during smiling. Both changes remained stable up to 1 year, despite the minimal relapse that was observed; all the patients reported a high degree of satisfaction. Combining neurotoxins before and after the lip repositioning surgery may provide long-lasting results up to 1 year and better stability for the success rate of the surgery, where the use of each approach alone (IncoBotulinum Toxin A alone/surgery alone) may offer a temporary improvement.