Q: Dr. Eppley, I have a question about gummy smile surgery. I’ve always had a long mid-face with significant gum in my smile (5mm with normal smile, 7-8mm with excessive smile). I would be interested in hearing your thoughts about mid-face reduction surgical options.
A: When it comes to gummy smile surgery there are two fundamental treatment approaches. The most common approach is a soft tissue one with a lowering maxillary vestibulopasty and legator myotomies with V-Y upper lip lengthening. This soft tissue approach prevents the lip from retracting upward as much and also drops it down a few millimeters at rest. This is by far the most common gummy smile surgery. The other approach, more historic but still of value in the proper selected patient, is a maxillary impaction surgery. (aka LeFort I impaction) This is the proper gummy smile surgery for those patients that have vertical maxillary excess which is evident by excessive tooth at rest and extreme gum show when smiling. It is not indicated when one does not have excessive tooth at rest. Otherwise a maxillary impaction will bury the upper teeth under the upper lip giving one an aged appearance.
Dr. Barry Eppley