Are Injectables Changing Your Smile?

The smile staring back at you may not be the one you once knew.
Written by Elise Minton Tabin
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Are Injectables Changing Your Smile? Sam Moqadam/Unsplash

We rely on neuromodulators and fillers to stave off the hands of time, but could all their wrinkle-reducing and plumping powers change the look of your smile? Interestingly enough, the answer is yes. Sometimes, it’s for the better. Other times, it's not. The key to achieving a face-flattering smile — whether you intend to tweak it or keep it exactly the same — comes down to the technique of the injector and the products used, which is why it's in your best interest to be as well-versed in both as possible. Here, we’re breaking down everything you need to know about how injectables can impact your smile.

A Sudden Change

If you undergo injectables and wake the next day (or soon after that) to what seems like a different smile, it's not your mind playing tricks on you. Strange but true, cosmetic injectables (read: neurotoxins and filler) can make a noteworthy difference in the appearance of the mouth – whether you ask your injector for it or not. Depending on the products that your injector uses and the precise injection locations, a bit of filler or neuromodulator here or there can alter the lower face.

Lip fillers are known (and loved) for their ability to address lip shape and lip size concerns. They can help balance out any asymmetries and plump, but it is important to fill in moderation. Excess filler can hide the smile by bringing the lips down and casting a shadow over the teeth, explains Sharon Huang, DDS, a board certified cosmetic dentist in New York City. Product placement should always be strategic and proportionate between the upper and lower lips.

Selecting the appropriate filler for the lips is vital. Flexible hyaluronic acid (HA)-based gels tend to fare best since they look and feel the most natural. However, when using too stiff of a filler, the smile can appear ‘overstuffed,’ says Darren Smith, MD, a board certified plastic and reconstructive surgeon in New York City. “Proper placement of mid-face and lower face filler should not significantly affect the smile,” he shares. With that said, “if an overly firm filler is used or if the region is overfilled, an unnatural appearance can result as the lips push against stiff surrounding tissues,” he adds.

Perhaps the most crucial component in maintaining a natural yet aesthetically appealing smile is symmetry. The lips are a vital component to the balance and aesthetics of the face, says Neda Mehr, MD, a board certified dermatologist in Newport Beach, CA. “According to science, the lips ideally should take up 40 percent of the width of the lower face with the upper lip being half the size of the lower lip from the front view and projecting two millimeters further out than the upper lip from the side view,” Dr. Mehr explains. But that isn't the smile that most of us have naturally, which is where strategically placed injectables come in.

What Comes First: Injectables or Cosmetic Dentistry?

In the anti-aging smile game, many elements factor into how the pout, mouth, and lower face as a whole looks, including the proportion of the lips, the teeth, the gum lines, and even the degree to which the jaw and jawline extend. While injectables are a big part of the preservation and/or rejuvenation, cosmetic dentistry can be equally important. Whether you plan on incorporating a bit of both or just one, how do you know which procedure to do first?

Dr. Mehr recommends starting with the mouth. “Many times, having a tooth extracted or getting veneers can change the symmetry and contours of their face, she notes. Ideally, there will be synchronicity between your treatment plans. If not, instances can arise where fillers or injectables negate the effects of otherwise excellent dental work. For example, when the teeth are hiding under a layer of excessive filler, the work – be it orthodontics, whitening, or veneers – can be overshadowed by lips that are too large. Patients can't fully appreciate the dental work without the perfect frame to complement and enhance it, says Anjali Rajpal, DMD, a cosmetic dentist in Beverly Hills. “Thus, the position of the lips is an important element in smile makeovers because they serve as the essential frame,” she notes.

By doing dental work first, the structure of the teeth will be in place. This will allow the Botox® or fillers to be injected accordingly, meaning the proportions shouldn’t need to be adjusted. Even so, less is still more. “You can always add more filler,” Dr. Rajpal shares. “It is better to do a little initially and add more if wanted.”

Enhance Your Lips, Maximize Your Smile

When injected judiciously, hyaluronic acid-based fillers and/or neurotoxins (read: Botox®, Dysport®, Jeuveau®, and Xeomin®) can enhance the smile as a whole. Below are some of the ways cosmetic injectables can be used to improve the lower third of the face in a cohesive and proportional way.

1. Fill-er Up

Lip injections using HA filler are a common request in most dermatology and plastic surgery offices as a quick and reliable way to shape and plump the lips. “Fillers in the lip can be an excellent option to provide both volume or hydration to the aging or asymmetric lip and highlight a person's natural smile,” Dr. Mehr says. And there’s a way to do it that doesn’t alter the smile — unless that’s the end goal.

Natural asymmetries in the lips or the smile — due to genetics, age, volume loss, and even past cosmetic dental work — can cause the mouth to fall over the teeth and lips. Sometimes, one side of the mouth is fuller or more prolonged than the other, making the smile appear crooked or heavier. Lip filler can be used to restore a more balanced pout, but discounting these asymmetries while attempting to correct the smile can throw off the entire balance of the face. This is where the expertise and artistry of the injector are key.

2. Flip That Lip

You’ve no doubt seen the so-called ‘lip flip’ on your social media feeds. The ideal candidate? Those with a thin smile and a top lip that seems to disappear when smiling. If this is the result of naturally pulling or bending the upper lip inward when smiling, Dr. Rajpal says Botox® in the top lip may be able to help. It can prevent the curling under without the need to augment the size. Injecting neuromodulators into the cupid’s bow area and at the corners of the mouth can relax the muscles that allow the lips to curl outward so that they appear more defined in shape.

Unlike filler, there is no additional volume added to the lips. The size will remain the same while improving the shape and, ultimately, the smile. Keep in mind that, while a lip flip can enhance the appearance of the smile, it can, in some cases, affect lip function. Visiting a highly skilled injector with a deep understanding of the anatomy of the area will help to ensure a safe and effective result that lasts about three to four months.

3. Turn That Frown Upside Down

As Dr. Huang explains, filler helps lift the corners of the mouth so that the mouth doesn't appear to be frowning. “We can also fill the marionette lines for less of a downturned smile or droopy mouth,” she adds. Whether or not you consider frowning or RBF (IYKYK) to be a concern, some providers consider it part of a lip filler treatment. Dr. Mehr, for example, injects filler into the lower corners of the mouth almost every time so that “patients look happy at rest.” As a result, “any attention we draw to their lips is positive,” she adds.

4. Gummy Smile Be Gone

Increasing the volume in the upper lip with filler is often the go-to for minimizing a gummy smile. But, while it works well for some, it's not the best solution for everyone. If a patient's upper gum excessively shows when smiling, injecting Botox® helps soften and lower the upper lip muscles so they can't pull down on the lip. For more extreme cases, an in-office procedure performed at the dentist's office, known as laser gum contouring, can remove a small amount of gum tissue to correct discrepancies between teeth gum levels.

5. The Right Way to Relax the Jaw

There is a reason more and more people are opting for jawline slimming with neurotoxins. It can non-surgically contour the jawline for three to four months at a time, while also relaxing a clenched jaw or correcting TMJ. But, as with anything, too much of a good thing isn’t good. Injecting directly into the area where the jawbone and muscle meet is crucial; otherwise, specific facial muscles can become temporarily paralyzed and throw the smile off-kilter.

In addition to limited movement in the mouth and around it, poorly placed neuromodulators can also cause the smile to be noticeably uneven. When that’s the case, patience is required. Father time has to work his magic. After about three months, the toxin effects should wear off, and the smile should return to normal.

How to Tell If You’re Overfilled

At this point you’ve likely gleaned that adding volume to the lips doesn't affect just their size. It can alter their proportion and cause the upper lip to become larger than the bottom one, especially if too much product is injected. Plus, as Dr. Smith shares, an overfilled lip can restrict movement and interfere with facial expression. In extreme cases, it may interfere with the ability to close the lips. The goal of lip filler is to enhance the smile, not to push the upper lip further up. That can actually create a gummy smile or force the lips down and cover the teeth.

When smiling, an overfilled lip can make the teeth appear almost nonexistent and create the illusion that the lip is overrunning the smile. “Some patients with excess filler notice that their teeth seem to disappear because the lips have become so thick that they push down from the filler and completely hide the teeth even when smiling,” Dr. Rajpal cautions. If overfilled lips have reduced visibility of the teeth, your dentist may lengthen the teeth slightly – so long as it does not compromise function. “Porcelain veneers and crowns can be designed in a way to help support the lip and improve the fullness as well,” she adds.

Another issue that can arise from disproportionate amounts of filler is harsh lip lines that blur the line between where the lips start and end. Patients that become obsessed with filling their lips blunt the lines around their lips — the vermillion border — and the lipstick lines almost bleed into their upper lip, Dr. Mehr says. “When this happens, they lose an element of their natural beauty,” she laments.

But that’s not all. Filler migration happens when a product placed in the upper lip slowly shifts from one area to another in a matter of millimeters or less. Although it’s not life-threatening and does not require treatment, migrated filler can distort the look of the lips and cause the mouth as a whole to take on a duck-like or rolled up and out appearance – especially when smiling.

Any time excessive filler use is the problem, hyaluronidase injections are usually the answer, as they dissolve hyaluronic acid in a short period. This is not a solution, however, for Botox® and like. If you are unhappy with those results, you’ll have to wait it out.

The Takeaway

Dental work is permanent. Fillers and neurotoxins are temporary. If poor or overdone fillers are impeding your smile, it's best to dissolve them with hyaluronidase and, if needed, start fresh. Meanwhile, let your neurotoxin injections wear off. This way, your dermatologist and dentist can assess your lower face as a whole and determine the best course of action to enhance and maximize your smile.

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ELISE MINTON TABINis a contributing writer for AEDIT.

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