Women and men bothered by their gummy smiles or discolored gums come from Beverly Hills, Los Angeles, and beyond to see cosmetic dentist Dr. Alex A. Farnoosh. He has decades of experience addressing these conditions and restoring the confidence for his patients with safe, effective treatment options. To help you learn more, Dr. Farnoosh has complied a list of common questions he is asked about gummy smiles, gummy smile surgery, and treatments for discolored gums.
As a Los Angeles County periodontist, Dr. Farnoosh offers each and every one of his patients technical artistry and personal attention. Request a consultation online or call (310) 657-0503 to set up a consultation.
For answers to common questions, select from the areas below:
About Dr. Farnoosh
Has Dr. Farnoosh published his treatment method to treat gum discoloration?
Yes, the concept of treatment of gum discoloration to enhance aesthetics and create a more attractive smile was published in part in the peer-reviewed International Journal of Periodontics & Restorative Dentistry. In addition, his innovative treatment of gum discoloration and examples of Dr. Farnoosh’s patient cases were published in the 2006 New York Times best seller Billion Dollar Smile: A Complete Guide to Your Extreme Smile Makeover by Dr. Bill Dorfman. Dr. Farnoosh’s method of treatment was also shown on the “The Doctors” television show on CBS presented by Dr. Dorfman.
About Gummy Smile
What is a “Gummy Smile”?
Anyone who shows a significant amount of their upper gums when they smile may be considered to have this condition, which creates an unbalanced look in which the gums are emphasized over the teeth. Excess gum tissue or an upper lip that lifts considerably (hypermobile lip) when a person smiles are the main causes for a gummy smile appearance.
What are my treatment options?
Dr. Farnoosh can perform his lip lowering technique for gummy smile correction, which modifies the area where your upper lip and gum tissue join and in addition, reshaping and leveling the gum line will be done in some cases. This procedure creates excellent results for many patients, including those who need only subtle lip lowering. The last alternative is complex orthognathic surgery that requires cutting and repositioning the jaw. Dr. Farnoosh believes that this method should be used only in more extreme cases. It requires a very long recovery, has many complications, is very costly and not too many people want to go through the procedure.
Will my upper lip/face look different or saggy after this procedure?
No. After surgery, your lip/face will look just like it does now when it is in a normal position. The main benefit is that gummy smile correction limits how high your lip lifts when you smile. In fact, if you have a thin lip, it appears “fuller” after treatment for most of the patients.
How long is the recovery period?
The majority of the patients who choose gummy smile correction with a lip lowering procedure have minimal downtime following their surgery. Discomfort is also minimal for most patients. Be sure to follow Dr. Farnoosh’s post-procedure instructions carefully to avoid the risk of complications.
About Lip Lowering for the Treatment of Gummy Smile
Dr. Farnoosh, can you comment on the possibility of relapse following the surgery?
Like treatment of any other disease or condition, making the correct diagnosis is the first and most important factor in determining the right treatment plan. If the cause of gummy smile is excessive developmental growth of midface and is due to skeletal problem, orthognatic (iaw) surgery (cutting the jaw bone to realign it) is needed to correct the problem, especially when it is associated with excessive over-jet, or over-bite. Naturally, the lip lowering procedure may not achieve a satisfactory result and the chance of relapse does exist. It also depends on genetically determined hyperactivity of the muscles or the strength of the elevating muscles responsible for lifting the lip (hypermobile lip), which may be even more active on one side causing asymmetry of the lip (one side lip is higher and showing more gum tissue).
What is Dr. Farnoosh’s opinion about the comment “smile does not look natural” after surgery?
Assuming the surgery is performed properly by a periodontist, the upper lip will be tight for approximately 10 days. The patient will be instructed to avoid laughing suddenly and making a big smile, as it may pull the stitches and create problems, including delayed healing. After 2 weeks, the lips will gradually return to normal with no negative, permanent impact on facial expression, speech, and smile. On the contrary, Dr. Farnoosh has observed in the majority of his own patients that the upper lip appears “fuller” after treatment, which makes the upper lip more complementary and in harmony with the lower lip in addition to making the smile more attractive.
In your opinion, what does control the final outcome of surgery, including formation of scar in the site of surgery?
In addition to proper diagnosis and the complexity of the case, how the surgery is performed and the experience of the surgeon are critical elements of paramount importance. For example, formation of “scar” in the site of incision line depends on a number of factors such as:
Where and how the incision is made so it is not visible.
Type of suture (stitches) being used and the suturing technique.
Careful evaluation of the patient’s history if the patient has a tendency for abnormal healing and scar formation. Every attempt should be made to hide the incision line so when patients smile, it is not visible. Even if a scar or the incision line is visible, there are techniques that I have utilized to minimize the scar’s size and appearance.
How the surgery is performed and tissue management in terms of suturing the different layers of tissue together is very critical. For example, if you just pull the skin (mucosa) without dissecting or undermining the affecting muscles to relax, the chance of relapse is much higher. By utilizing certain techniques, you could minimize the chance of relapse.
What does Dr. Farnoosh recommend about the use of BOTOX® for treatment of gummy smile?
Dr. Farnoosh does not recommend BOTOX as the definitive treatment modality for gummy smile correction since the effect of BOTOX is temporary. Additionally, he does not recommend BOTOX before surgery, because the muscles become relaxed, obscuring the true extent of the problem, which can lead to less than ideal results. However, in some cases where Dr. Farnoosh expects a strong pulling effect of muscles, he recommends using BOTOX only 2 to 3 months after surgery to gradually relax or deactivate the muscles that are lifting the upper lip. BOTOX needs to be aimed at the muscles contributing to the hypermobile lip.
What do you think of reshaping, cutting the gum or lengthening the teeth to treat “Gummy Smile”?
This is called “crown lengthening” and whether or not it’s a good option depends on the diagnosis of the case. If the teeth are short or not fully erupted and plenty of gum tissue exists (it is called passive eruption), crown lengthening will help, but to a limited extent. However, if the length of teeth are normal and there is no state of passive eruption, Dr. Farnoosh does not recommend reshaping and cutting the gum tissue, whether by laser or conventional surgery using a scalpel, since it may pose a new aesthetic problem by making the teeth too long or may necessitate covering the teeth with veneers or crowns. In some cases, crown lengthening or reshaping the gum line may be needed in conjunction with lip lowering procedure, which is the primary treatment of choice to minimize the gummy smile.
Can you comment on patient’s expectation of the end result?
Case selection, patient education, and patient expectation of treatment are extremely important. If the patient expects a perfect smile regardless of the complexity of the case, it may not be possible to achieve it. An example is hypermobile lip associated with asymmetry of the upper lip. Even though I try to reduce it and surgically compensate for the discrepancy, it would be difficult to completely eliminate the problem because of the inherited muscle pull or anatomical aberrations on one side. As an experienced periodontist, I always remind my patients before surgery that the goal of treatment is to minimize the excessive display of gum tissue and reduce the gummy smile appearance.
What causes gum discoloration?
In many cases, gum discoloration is genetic, just like the color of your skin. Individuals with darker skin have increased levels of melanin, which, in addition to tinting the skin, can also be present in the gums. Other contributing factors for black gums include smoking, taking certain medications like minocycline for treatment of acne, having metal crowns or fillings that have corroded, or other systemic conditions.
Who is the ideal candidate for gum bleaching?
An attractive smile looks good in every way. In addition to beautiful teeth, your smile requires good looking and anatomically pleasant gums. If you have discolored gums, you can benefit from this procedure.
Treatment for Dark Gums
What is dark gums treatment like?
Treatment varies depending on the cause and degree of discoloration. Some patients have discoloration only in the superficial (outermost) layers of the gum, while others experience pigmentation in deeper layers as well. Depending on your needs, Dr. Farnoosh will decide which of his treatment methods – used successfully in his office for almost two decades – will benefit you most.
Is gum bleaching painful?
Most patients experience no discomfort during or after the treatment. In the majority of cases, Dr. Farnoosh uses a topical numbing paste to desensitize the gums during the procedure. In some cases local anesthesia may be needed to numb the area.
How long does a dark gums treatment take?
Treatment time will depend on the extent of discoloration, but most patients complete their visit to Dr. Farnoosh’s Beverly Hills office in 45 minutes to 1 hour.
After Treatment for Dark Gums
What kind of post-operative care is required?
Patients should follow their usual routine of brushing and flossing. There is no special care needed after the treatment, though Dr. Farnoosh requires those patients who smoke to quit at least until the gums have healed completely.
Are there side effects or common complications?
Dr. Farnoosh has not seen or heard about any complications from gum bleaching during the many years he has performed the procedure.
How long until I can talk and eat normally?
Patients can talk, eat, and carry on with their regular activities as soon as they leave the office. There is no downtime following the procedure.
How long can I expect my healthy gum appearance to last?
Dr. Farnoosh still sees some of his original gum bleaching patients, who have had no change in gum color after 17 years. It is permanent.
Is there a follow up visit needed after gum bleaching?
Usually not. However, Dr. Farnoosh likes to see post treatment results whenever possible, so patients who fly in for the procedure are encouraged to stop by the office if they plan to visit Los Angeles again.
What is the rate of success with this procedure?
Your results may vary, but Dr. Farnoosh usually sees improvement in 100% of his patients.
Gum Bleaching Considerations
I don’t live in Los Angeles. Can I be treated by another dentist in my area/city?
Dr. Farnoosh is the inventor of gum bleaching methods, which have been published in leading scientific journals. He has not trained any other dentist and is unaware of any other dental health professional who can achieve the same result. He has seen many patients from all over the world who fly in for his specialized procedure. Patients from out of town can coordinate their appointment in advance, fly to Los Angeles for their treatment on a Friday, and leave the same weekend.
This sounds like it’s for me, but how much does it cost?
Cost will depend on many factors, such as the degree, depth and location of discoloration. The best way to get an estimate of the cost if you are outside the Los Angeles area is to have an “intraoral photo” taken showing the area of discolored gums and send it by mail or email to Dr. Farnoosh. Upon his review, he will contact you to discuss the treatment and approximate cost.