today we're discussing how to treat a gummy smile
hi guys my name is dr. Sarah Tonks I'm a cosmetic physician in London today I'm
going to be discussing with you the various different methods we can use in
order to treat a gummy smile now first of all it goes without saying that the
most comprehensive and complete way to treat a gummy smile if the indication is
severe enough is actually with surgery so there's a type of surgery that one
can do which basically moves the bone that the teeth sit in into a slightly
different position and it changes the plane at which the teeth sit now if
your gummy smile is not severe enough to undergo surgery like this then it might
be appropriate to try and use Botox and dermal fillers in order to disguise that
the other thing to mention about gummy smiles is it's important to check the
length of the teeth for example if the teeth themselves look very very short
then in some cases crown lengthening surgery can be performed on the gums in
order to make the gum itself appear smaller and the tooth longer without
changing the structural underlying position of the teeth so there are a few
things that we need to check before knowing which is the best treatment to
perform you need to check the underlying bone structure the shape and length of
the tooth and any associated muscle pull say surgeries out for you and crown
lengthening surgeries out for you or not appropriate the other available options
being Botox and dermal filler can be used in a variety of different ways
let's go over to our patient today and do a facial assessment in order to see
what treatment we're going to perform on this first image she's not smiling the
more astute amongst you you may have guessed that you know in my videos I
don't just like to treat one thing so I'm going to do a full facial assessment
for her first and then we'll have a look at her smiling so you can see here that
her low a facial third is really short and she's actually really using her chin
muscles and her lip muscles to try and close her bites this is due to the
position of the teeth and underlying bone structure you can see here there's
some dimpling on the chin and that's because she's trying really hard to form
this seal on her lips the next thing that I noticed is the cheek bone so
she's kind of flat here and it would be nice to just get a little bit more of a
vector here so that the face is in more of a v-shape so you can imagine if we
extend the chin down and we vector the cheek bone up more well it just looks
nice though doesn't it can you see how there's this downwards droop as well in
the eyebrow and also in the eyelid ideally I would like to put a bit of
Botox there in order to lift up the outer corner of the brow I don't think
we did that on her actually and it might be quite nice to put a bit of filler
there as well in order to push the outer edge of the brow up ideally it would be
nice to put a bit of Botox in the brow to lift the outer edge up and also some
filler here to push the lateral edge of the eye up I don't think we did that
so let's look at her smiling yeah we can see there a reasonable amount of gum
show so I think it's fair to say that you wouldn't be able to make the crown
so the bit that's visible off the teeth longer without it looking weird your
other options would be to drop the upper lip so that on smiling the muscle isn't
pulling the lip up as much or do something surgical okay so the first
thing we did was used some Teosyal ultimate in the cheek area so I went to the front
part of the cheek and also the lateral part I then used Teosyal ultra deep in the
cheek area and then used a cannula to go in from the left side of the chin to the
chin point and the marionette region and I didn't if you could see on the
pre-existing photos but the left side was actually much worse than the right
so I put a whole couple of syringes actually in
this region alone and then by that time we'd used 4 mils
so let's have a look at how this looks so you can see that already the
cheekbone is looking a little better from doing this the outer corner of the
eye has been pushed up slightly which is good it means that you can't see as much
of the white underneath the colored part of the eye and the chin has been
extended down so that's 4 mils looking pretty good then I used red yes 0.75
mils per side to create what's called the next top model' look I find that a
bit cheesy but nevertheless that is what people are calling it so that is what I
did and then I used Teosyal kiss in the lips you could probably see that
there was some asymmetry in the lip so the left side was much bigger than the
right so I used the kiss in the right lateral lip and along the board and then
upper lip tensing on the right and a little bit on the left I then used a wee
bit of it in the lower lip as well and there are some asymmetry in the lower
lip with the most fullness being to the left part of the lower lip so we tried
to centralize that and the last thing was to use the Botox in there now when I
do these injections using Botox I'm kind of really cautious because it's
sometimes uncomfortable for people when it starts to kick in and it changes the
way that their face moves obviously because that's what it's supposed to do
but I find that sometimes people prefer it if it's carried out over more than
one session so I only saw her once so I was very cautious with the amount that I
put in anyway let's have a look
at how she looked after she'd had all the filler done and this is her
immediately I do know between her having this Villa done and now she did
experience quite a bit of bruising so this is her after three weeks cheekbones
are looking good I think the chin has really sort of come
into its own there I think that looks really nice it's really extended the
vertical dimension of the lower facial third and the fullest part of the lower
lip is now much more centralised I think it looks much better you could make the
argument for adding more filler in the upper lip personally I think it's enough
I would leave that one up to the patient but let's take a look at her smiling and
as I mentioned to you I was quite cautious when putting the Botox in if I
could see her again I would definitely put more I didn't see her in the interim
so there was no opportunity for adjustment the toxin in the chin however
has worked really well you see that there is much less muscle pull in the
chin and now she's really not fighting to relax that muscle on smiling it just
looks a lot more harmonious and that's actually an interesting point guys
because often people will ask well if I get my cheeks filled does it mean that
I'm going to look weird when I'm smiling and as you can see she's smiling and she
looks normal so I guess the answer for her would
definitely be no just FYI another way to use filler to drop down
the lip when smiling is to place it at the base of the nose so right here and
sometimes that will cause a physical blockade so that the muscle isn't able
to contract up as much so it means that the lip when smiling will be slightly
lower normally I like to do a combination of doing that with a bit of
Botox but for her it wasn't really appropriate so I left it where
okay guys so that's it for today I hope you enjoyed the video if you have any
questions about the procedures you've just seen please just let me know in the
comment section below and start the chat as well if you've ever had a gummy smile
and perhaps you've had Botox or fillers or maybe even surgery join me again next
week where we will be talking about another case and in the meantime we're
super if you would subscribe to the channel and like the video I'll see you
later
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