Metal Mouth Message Board

The LeFort osteotomy can be used to treat a gummy smile, but aesthetic disappointment happens often, and that's because surgeons do not explain the gum display-tooth-display trade-off to patients. Let me explain: if you're going to show less gum, it will necessarily happen at the expense of maxillary incisor display (i.e., your upper teeth). So what happens often is that surgeons eliminate the gummy smile, but then the patient shows no upper teeth at rest. This looks bad. It's very aging. Except in extreme cases, it looks worse than a gummy smile and lots of teeth showing at rest. It happened to me, and now I'm in the process of seeking a revision.

There are alternatives. Botox, lip repositioning, orthodontics. These are good alternatives to orthognathic surgery in many cases. If you are set on treating a gummy smile with a LeFort, you must scrutinize your surgical plan down to the millimiter. Ask your surgeon how much incisor display you'll have at rest and have him defend that decision. And then ask yourself if that's the outcome you would be comfortable with. Know that as you age, your upper lip will lengthen, and your gummy smile won't be as gummy.

A good surgeon should be able to find a middle ground where you still have 1-2mm gum showing, or at least should be able to make sure that you have several mm of your upper incisors showing post-op. I agree that it’s worth warning people about the potential for over-impaction tho!