The most common complications with the treatment of gummy smile are asymmetries and upper lip drooping. As nobody is 100% symmetric, it is important that any asymmetry should be shown to the patients before the treatment. Photographic documentation should also be undertaken.

Symmetrical injections in asymmetrical patients may result in worsening of the asymmetry. Usually, static analysis does not show any sign of imbalance; it is seen only during animation. Mild asymmetries are tolerable and should be corrected as required by the patients. However, moderate to severe asymmetries should be corrected as soon as evidenced. To avoid further complications, 25 to 50% of the initial dose should be administered and the outcome evaluated after 7-15 days.

Excessive drooping of the medial part of the upper lip may happen if excessive blocking is undertaken. As a consequence, there is excessive lateral pulling of the zygomaticus major, and the 'joker' smile may result. A slight blocking of

5.9.8 References

Corliss R (2002) Smile--you're on botox! Time 159(7^59 Tulley P et al. (2000) Paralysis of the marginal mandibular branch of the facial nerve: treatment options. Br J Plast Surg 53(5)378-85

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