The levator labii superioris alequae nasi originates on the medial wall of the maxilla and then divides into two heads that insert into the nasal ala and medial orbicularis oris (FIG 1).

Patients may present complaining of “too much teeth or gums showing while smiling” or may also state that their “upper lip is too short” with animation.

Nonoperative management using any form of the currently available botulinum toxins (onabotulinumtoxinA, abobotulinumtoxinA, and incobotulinumtoxinA) can successfully treat a gummy smile. Typically, 2 to 4 units per side are selected as a starting dose, depending on degree of deformity and prior patient injection history.