PLASTIC SURGERY 2009, Abstract Supplement

REFERENCES: Efficiency of Gummy Smile Correction

1. M. Bircoll, Cosmetic breast augmentation utilizing Using the Myotomy of the Elevator of the
autologous fat and liposuction techniques, Plast Reconstr Upper Lip Muscle
Surg 79 (1987), pp. 267–271.
Luis H. Ishida, MD; Luiz C. Ishida, MD;
2. S.R. Coleman, Structural fat grafts: the ideal filler?, Clin
Plast Surg 28 (2001), pp. 111–119. Jorge Ishida, MD; Julio Grynglas, MD;
3. S.R. Coleman and Alesia P. Saboeiro, Fat grafting to the Nivaldo Alonso, MD; Marcus C. Ferreira,
breast revisited: safety and efficacy, Plast Reconstr Surg MD
119 (3) (2007), pp. 775–785.
INTRODUCTION: The purpose of this study is to test the
4. S.L. Spear, H.B. Wilson and M.D. Lockwood, Fat injection efficiency of a technique for treatment of the gummy smile. The
to correct contour deformities in the reconstructed breast, procedure involves the myotomy of the elevator of the upper
Plastic Reconstr Surg 116 (2005), pp. 1300–1305. lip muscle and soft tissue remodeling.

METHODS: Ten female patients with excessive gingival

exposure were operated. They were filmed performing their
fullest smile using a high definition digital video camera before
and 6 months after the surgery. Images of the maximum gingival
exposures were measured and analyzed using the ImageJ®
software (1).

Technique: Two 5mm incisions are made at the inner lateral

aspect of the nostrils, and one in the columella. Using a
periosteum elevator, the gingival mucosa is freed from the
maxilla. Skin and subcutaneous tissue were blunted dissected
from the underlying musculature of the upper lip. A frenuloplasty
is performed to lengthen the upper lip. Both elevator of the upper
lip muscles are dissected and divided.

RESULTS: There was a reduction of the gingival exposure with

an esthetic improvement of the smile in all patients (figure 1).
The mean gingival exposure before the surgery was 5.16 ±1.67
mm, and six months after the surgery, 1.89±1.74cm (figure 2).
There was a reduction of 3.27±1.25 mm (p<0.001), ranging
from 1.59 to 4.83 mm.

CONCLUSION: The myotomies results in a similar effect

caused by the Botulinum toxin type A injection described to
treat this kind of alteration (2). Subperiostal dissection lowers
the superior gingival sulcus and the frenuloplasty lengthen the
upper lip, helping to cover the exposed gum.

Treatment of excessive gingival display usually involves large

procedures like Le Fort impaction or gingivectomies. Often,
the alteration is milder and does not justify such procedures.
The authors propose an alternative technique to significantly
diminish the gingival exposure.

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