# Modified Lip Repositioning Surgery in the Treatment of
## 3 Discussion  
For many years, aesthetic problems treated by dentists were limited to those involving teeth, without considering the gums. However, it is now well established that these structures must be in balance to appear aesthetically pleasing. More than 3 mm of gingival exposure during smiling is considered excessive gingival display, also known as a gummy smile, which is unattractive [13; 14; 15; 16]. When achieving an ideal smile, it is also well established that structures--dental, gingival, skeletal, and muscular--must be in balance to appear aesthetically pleasing [4; 13]. The literature classifies gummy smiles according to their different etiologies and reports the possibility of a combination of some of these factors [4; 17; 18; 19]. The latest classifications confirm that this variety of factors can act alone or in combination. These factors include altered passive eruption, vertical maxillary excess, short upper lip, hyperactive upper lip, among other factors that cause gingival enlargement [4]. In some cases, it is not possible to treat the patient solely through gingival recontouring because the amount of gingival exposure remains significant [20; 21; 22]. Many cases of EGD have multiple etiologies and require more than one technique to achieve desirable aesthetic results. Several techniques and variations have been reported, including myotomy or repositioning of the levator labii superioris muscle, Le Fort impaction, maxillary gingirectomies, botulinum toxin injections, and lip stabilization. Treatment is tailored to each type of etiology, and two or more techniques can be combined to resolve the issue [17; 23; 24; 25; 26; 27; 28]. Surgical lip repositioning (LipStat) for the treatment of EGD in mild to moderate cases is a less invasive procedure, with fewer post-operative complications and provides faster recovery compared to orthognathic surgery [4; 18; 27; 29; 30]. It can be said that LipStat is a viable treatment option for improving the gummy smile, provided that a systematic evaluation of the case is performed to choose the appropriate treatment option [29; 31]. The contraindications of the technique include cases with severe vertical maxillary excess (>8 mm). These severe skeletal deformities should ideally be treated with orthognathic surgery [4; 18]. A reduced width of the inserted gingiva can result in scar exposure during smiling. In such situations, the possibility of scar exposure over the mucogingival line is a limitation for this technique and should be explained to the patient [27]. Reports in the literature have shown some post-operative complications, such as discomfort, bruising, and edema of the upper lip. A less frequent complication may be the formation of a mucocele due to the cutting of the minor salivary glands in the upper lip, which arises in the post-operative period [18]. Other rare complications reported in the literature include paresthesia and transient paralysis [32]. Complications reported regarding the lip repositioning surgery are generally minor and include post-operative edema, mild pain, and tension when smiling or speaking, especially during the first week. Complications such as transient numbness and paresthesia, early recurrence, suture loss, bruising, mucocele development, and double-lip formation are rarer, while mild scarring near the mucogingival junction is often present. When more invasive approaches, such as muscle detachment, are used, complications can increase in both prevalence and duration. Although some authors report significant recurrence rates and severity, several studies show good long-term stability of results; these discrepancies may depend on the technique and possibly the operator. In addition to these complications, inadequate diagnosis or poor treatment planning, where other underlying causes are not adequately considered, can lead to inappropriate use of the lip repositioning surgery, resulting in questionable aesthetic outcomes [27].