This study aims to evaluate the effectiveness of both injection botulinum toxin type A (botox) and surgical lip reposition in the correction of the gummy smile due to hyperactive upper lip according to the resulting smile and the patients' satisfaction. This is done to determine the less damaging to the tissues and more stable alternative in giving results with statistical importance and aesthetically satisfying results. The method consists of 24 patients: 12 received the BTX-A injection and the remaining 12 underwent the surgical procedure (lip reposition). The patients rated their satisfaction according to their gingival display that was defined as the difference between the lower margin of the upper lip and the superior margin of the right incisor, and patients were followed at 2 weeks, 2 months and 6 months. Post injection and post surgery with changes documented by photographs. Both groups answered a questionnaire addressing the overall appearance and they were asked to rate the improvement of their smile according to a 5-point aesthetic scale.
BTX-A injection exhibits better results than those of surgery and had given safer and more satisfactory results than lip reposition. The patients rated the effects of BTX-A as highly favorable if we take into consideration that BTX-A was temporary effect but the surgical procedure (lip reposition) is 80% recurrent surgery because the lip reverted back to its original position with almost complete relapse after 6 months later and containing all the dangers affiliated with the surgical procedures.