This case type is where a smiling patient shows much more of the gums than would normally be seen. While a normal smile would only show all of the white tooth and only a small amount of gum tissue, the High Lip Line case shows the gum tissues sometimes as high as the tip of the root of the tooth. Patients can't prevent the lip from going so high since that is their natural smile. Surgery can be done to prevent the lip from going higher, to expose more tooth
and reduce the overwhelming appearance of gum redness. If the teeth are uneven in length before the surgery, it may be better to shorten the long ones in order that the pre-surgical appearance is more even. The surgery will then expose the teeth more evenly.
High Lip Line Option-The Coronally Positioned Mucosal Flap (CPMF)
The high lip line problem is usually the result of what is called the "hypermobile lip". This means that the lip goes too far up upon smiling. A surgical procedure is now being introduced that was initially discussed in the 1970's. This procedure is done with a local anesthetic and involves the surgical re-attachment of the gum tissue under the lip in such a way as to restrict the extent that the lip can go excessively upward when smiling. As more of these cases are being done, I will report on the success. It appears initially favorable. A result of the CPMF surgery is that the "thinning" of the upper lip is reduced and the upper lip may look "fuller" upon smiling.
This 33 year old woman has been unhappy with her gummy smile and how high her lip goes due to her "Hypermobile Lip".
At rest, her lip is not as thin as you see. Only when she smiles does the lip "thin" It is very important to determine if the patient has a "lip seal" when they are "at rest" -- not smiling. If the lips are contacting and no tooth is seen (a lip seal) at rest, then the chance for a good post-surgical result is better than if no "lip seal" exists at rest. If the lips have "thinned", there is no guarantee that the Hypermobile Lip Surgery will cause them to be the same thickness that is found when the patient is not smiling.
The post-surgical result has created a much more natural smile without showing all of the gummy smile. The patient will notice that the lip is "tighter" since the surgery is intending to reduce the movement of the lip in an upward fashion. You can notice how the thin upper lip that was present pre-surgically has been changed to a thicker, fuller upper lip. No changes in speech are present and she could talk well the day of surgery.
Post-Surgical Appearance When the patient is "at rest" her lips look normal.
surgery only changed the appearance when she smiled.
This 38 year old female has not only had a high lip line from a hypermobile lip when she smiles, but she has had some gum recession from gum disease (periodontitis). The Coronally Positioned Mucosal Flap surgery (CPMF) has the potential to reduce her gummy smile, but you should also notice how her teeth (her cuspids) are very prominent and "pointed". It is important to recontour the teeth as part of the CPMF procedure in order to create cosmetic balance.
The high lip movement has created a less than desirable appearance and makes the teeth and gums too prominent.
The CPMF surgery has reduced the degree to which the lip may raise when she smiles. You can notice that her lip appears not so thin. Also notice that her lip on her right is fuller than on her left --this uneveness was present pre-surgically. The CPMF can't correct lip uneveness.
Post-Surgical Lip Position Her lip position "at rest" is not affected by
the CPMF surgery.
This 25 year old female has been unhappy with her high lip line. She has sought opinions and was led to believe that nothing could be done for her. You will note that upon smiling her upper lip goes very high and as is usually the custom, the smile is uneven. With the Coronally Positioned Mucosal Flap surgery (CPMF), it is not possible, with any degree of predictability, to make the smile “even”. It is never possible to guarantee the degree of success, but it is possible to pledge to do as much as is possible to give the patient an improved appearance. Please remember that the CPMF surgery does not cause the lips to look different when the patient’s smile is “at rest”. It simply prevents the lip from going too high.
This is the patient’s natural smile. A gummy appearance that is undesirable for her needs. ** Note the small smile “creases” in her cheeks and compare them with the post-surgical result!
This post-surgical result has created a much more pleasing appearance. Her lips look fuller, but have not had any type of treatment other than the Coronally Positioned Mucosal Flap surgery.
Lips “at rest” The “at rest” lip position is what we see when the patient is relaxed, not smiling and not talking. It is not possible to photographically duplicate the exact “at-rest” positions, but these are similar. The CPMF surgery does not change how the mouth and lips appear “at-rest” – only how the lips appear upon smiling.
The following cases 6d and 6e are not treated with the Hypermobile Lip Surgery since the patients are under 18 years of age -- the minimum age for the Hypermobile Lip Surgery in order to assure that facial growth has been completed.
A 14 year old girl presents with a smile with which she is unhappy. This gummy smile is the result of a high lip line. When the patient smiles, her upper lip rises up further than normal. This results in much more coral pink gum tissue being seen. This can occur with teeth that are too small or teeth that are normal in length but where too much gum tissue covers the teeth. In this case, there is too much gum tissue, the removal of which will allow for a decrease in the negative appearance of the high lip line.
The high lip line exposes too much gum and teeth that are appearing smaller than their normal size.
The surgical removal of the excess gum tissue creates a much better balanced smile and a much happier patient.
This is the twin sister of the preceeding case. Both sisters have a high lip line, but this sister's smile does not expose as much of the gum tissue as does her sister's smile. This degree of a high lip line is easier to create a more pleasing smile with minimally-invasive surgery.
The exposure of the gums upon smiling is greater than what is seen with a more normal lip line.
With the removal of a small amount of gum tissue, the smile becomes less "gummy"
There is another option regarding the surgical fracturing of the upper jaw and removing some of the bone in order to show less of the gums and teeth. I do not recommend this unless someone has severe skeletal-growth problems -- something that most high lip line cases do NOT have.