Ask Dr. Barber

Q. I am a young healthy 36 year old woman and I don’t like my smile.  The reason is because I have a gummy smile.  To me that means that I can see too much of the gums above my upper teeth when I smile.  For this reason, I purposely try to minimize my smiling which I also do not like to do.  I have been told that surgery is sometimes an option to reduce the gummy smile but I am absolutely not interested in surgery.  Is there any other alternative?

A. There are several reasons that someone might have a gummy smile, and sometimes surgery is the recommended treatment, especially if the problem is an over elongated upper jaw.  However, the surgery for treating this condition is a major procedure and therefore careful consideration should be given as to whether it is worth an invasive surgery to permanently resolve the issue.  Fortunately, there is a non-operative option that can make a significant improvement, but the result is not permanent.  The non-surgical option requires an injection of Botox ® or Dysport®.  Botox® and Dysport® are very similar neuromuscular blockers that produce the same effect, but are manufactured by competing companies.  When the lip elevating muscles are injected with either of these products, it causes the muscles to relax and reduces the upward pull of the lip during smiling.  This allows the upper lip to remain at a lower position relative to the upper teeth.  Therefore when you smile, the lip only comes up to the top of the teeth or a couple millimeters above the gum line.  This relaxing effect can last between 12 and 24 weeks.  The risks of this injection includes over relaxing of the muscle such that the upper lip is too low when smiling, asymmetry so that one side elevates differently than the other, bruising, and temporary swelling.  It should be emphasized that injecting into the muscles that elevate the lip is an off label use of these products.  It should also be noted that injecting into this area of the face should be reserved for the very experienced injector in order to minimize complications. It is a very safe procedure when performed by an experienced person.

Q. I have been told that sleeping on the side of the face every night can cause more wrinkles on the side that is against the pillow.  Is there any truth to this or is it a myth?

A. Believe it or not, it is true that sleeping in the side position with the side of your face into the pillow does create wrinkles.  They are called sleep wrinkles, and they tend to get worse as we get older, not too surprising.  In a recent study published in the September 2016 issue of Aesthetic Surgery Journal, the study documented that sleeping on your side, which by the way 60% of the population prefers, does accelerate wrinkling on the face.  These wrinkles can occur around the eyes, the side of the nose, the outer forehead, the outer eyebrow area, and the cheeks.  The best way to minimize or prevent these wrinkles is to sleep on your back.  That is easier said than done, as most people find it almost impossible to change preferred sleep position successfully.  Unfortunately, sleep wrinkles are difficult to get rid of without surgery or laser skin resurfacing.  Botox does not work on sleep wrinkles because the lines are not caused by muscle activity but rather memorized pressure lines.

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