Q. When I smile, my upper lip comes up such that I can see a lot of the gum above my front teeth.  I have always disliked this about my smile.  Is there anything that can be done to get rid of this “gummy smile”?

A. Yes, there are two options, one permanent and one temporary.  The first option is to partially cut the muscle that controls the elevation of the upper lip.  The partial cut of the muscle will weaken the muscle such that when you smile, the lip does not come up as much.  This is a pretty aggressive approach to this problem and one that I typically do not recommend.  The advantage of the surgical approach is that it is more likely to be a permanent fix, the disadvantage is that it is surgery and there are more potential complications than a non-surgical approach.  In my practice, we have been using injections of a neuromuscular blocker such as Dysport® or Botox® to weaken the muscle and therefore decrease the elevation of the lip when you smile.  This is a very simple fix for the problem; however the disadvantage is that it will only last about 2-4 months.  The neuromuscular blocker is injected directly into the tiny muscle that controls lip elevation.  It will take about a week to see the change in lip elevation.  Keep in mind that the muscle still works, but it is not as strong as normal and therefore the lip does not come up as far during a smile and the gums are not exposed.  If this is something that you are interested in investigating more, you can call my office and make an appointment with one of my nurse injectors.

Q. My husband has numerous small blood vessels on his cheeks and some on his nose.  They are more noticeable when it is hot outside and when he drinks red wine.  Although he does not complain about them, I know that he is self-conscious.  What is the recommended treatment to get rid of these vessels?

A. Small capillaries on the skin surface are very common and almost everyone has some visible capillaries on their face.  The problem occurs when there are a large number of small vessels that are easily visible from conversational distance.  These vessels usually do not indicate anything metabolically wrong; they tend to be more common in men and women with fair complexion, and in women with thinner skin and reddish complexion, and tend to have some hereditary component.  The treatment options for these capillaries have fortunately improved over the years, and now there is a laser that is remarkably successful at reducing the number of visible capillaries.

The treatment can be done in the office with no anesthesia or downtime.  There sometimes can be a little bruising associated with the laser treatment, but usually not.  If the capillaries are distinct as individual vessels on the skin, each capillary is individually lasered, after which it will immediately disappear.  Typically, the entire cheek and nose area can be treated in less than 30 minutes.

Our experience over the years with the vascular laser is that about half the treated capillaries will permanently disappear and about half will return within a week or so.  Therefore with a single treatment, you can reduce the number of visible capillaries by about 50%.  I advise my patients to expect to require several treatments over a 6 month period in order to reduce the number of capillaries to an acceptable number.  Unfortunately, as time goes by, new capillaries will form and so you should expect that yearly touch ups may be necessary.  I do not think that it is necessary to erase every capillary to get a good result, usually most patients are happy after a 50% to 75% reduction in the number of visible vessels.

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William Byron Barber II, M.D. has been practicing plastic surgery in Greensboro for 20 years and is certified by the American Board of Plastic Surgery.  He is Chief of Plastic Surgery for Moses Cone Health System, and is an active member of numerous local, regional and national plastic surgery associations.

Visit his website at: www.BarberPlasticSurgery.com or e-mail him at: AskDrBarber@BarberPlasticSurgery.com