How Dental Alignment and Smile Contouring Can Reduce Filler Needs and Improve Balance
In aesthetic medicine, we focus on volume, tone and contour. Dentistry tackles the architecture that props all of it up. Teeth, gingiva and occlusion underpin lip support, vermilion show and the balance of the lower third. Alter that scaffold and you often change the face. Well-planned dental moves can soften nasolabial heaviness, improve lip projection, correct a gummy smile and restore a collapsed lower third without a single syringe. That is not a knock on injectables. It is an argument for sequencing and for choosing the tool that changes cause, not just consequence. As Dr Yasmin Anaboussi, Clinical Director at Smiles and Smiles, puts it, “In our clinic, cosmetic dentistry means creating beautiful smiles that are also healthy and long-lasting. We focus on treatments that provide long-term stability while being minimally invasive, preserving as much of the natural tooth structure as possible. Success for us goes beyond achieving straight, white teeth - it’s about delivering results that look good, function well, and last for as long as possible.”
Lip support starts behind the lips
The lips gain much of their projection from the position and inclination of the incisors. Retroclined or inwardly positioned teeth can flatten the profile and exaggerate fold shadows. Thoughtful proclination or de-retraction can enhance support where appropriate, and careful retraction can refine fullness in other cases. The point is that teeth are levers for the perioral envelope. Dr Anaboussi explains how her team plans this with precision: “When planning a case, we start by gathering comprehensive records, including digital scans, models, and detailed photographs, to fully understand both the dental and facial parameters. We then use advanced software to design digital mock-ups, which allow us to visualise how proposed changes will support facial aesthetics, such as lip support, vermilion show, and lower third harmony. These mock-ups can be transferred into the patient’s mouth as a trial, giving both us and the patient the opportunity to assess potential outcomes before starting treatment.”
That digital-first approach mirrors the broader shift to facially driven smile design, where 2D and 3D planning is mapped to landmarks and verified with mock-ups in the mouth before any enamel is altered. It is a safety net for aesthetics and biology. “Our approach to facial harmony begins with a full assessment of the patient’s facial features, focusing on how the smile integrates with lip support, perioral aesthetics, and overall lower-third balance,” adds Dr Anaboussi. “We carefully record digital scans, photographs, and models, which we then analyse using advanced digital design software. This allows us to simulate how proposed dental changes will influence facial harmony. By creating and transferring mock-ups into the patient’s mouth, we can evaluate the impact on lip support and perioral aesthetics in real life before proceeding. This ensures that the final outcome is not only a beautiful smile but one that naturally enhances the patient’s facial proportions and overall appearance.”
When teeth can do what filler often does
There is a reason some patients need less filler after orthodontics or conservative restorative contouring. By improving tooth inclination and anterior guidance, clinicians can subtly lift vermilion show and ease nasolabial heaviness that was created by dental retrusion rather than by volume loss. Dr Anaboussi makes the mechanism clear: “The lips gain much of their support from the underlying teeth. When teeth are inclined inwards, for example, this can cause the lips to appear retruded and deepen the nasolabial folds. By carefully repositioning the teeth through orthodontic movement or by refining contours restoratively, we can enhance lip support and soften the appearance of the nasolabial area -often reducing or even eliminating the need for filler.”
Gummy smiles: pick the cause, then the tool
Excess gingival display has multiple drivers: altered passive eruption, tooth position, hyperactive elevator muscles or vertical maxillary excess. Treatment choice should follow that map. Periodontal crown lengthening or gingivectomy is predictable when teeth are short from delayed eruption. Lip repositioning can reduce elevator pull where muscle activity dominates. Orthodontic intrusion can help where anterior teeth are overerupted. Neuromodulators can temporarily relax the elevator complex, but they do not remodel tissue or bone. Dr Anaboussi outlines her decision tree and the stability outlook: “With a gummy smile, our first step is always to identify the underlying cause, whether it is related to excessive gingival display, altered passive eruption(tooth has not come out completely), hyperactive elevator muscles, or vertical maxillary excess. Based on this diagnosis, we can tailor treatment: crown lengthening is suitable when the issue is excess gum tissue; lip repositioning or neuromodulators are considered when muscle activity is the main factor; and orthodontic intrusion may be required if tooth position is contributing. Stability over 12 months depends on the cause, but crown lengthening and orthodontic intrusion generally offer the most predictable long-term results, whereas neuromodulators may need repeating for maintenance. At Smiles and Smiles we offer a wide range of treatments like the above to target ‘gummy smiles’. Treatments like these are rapidly growing in popularity, and we’re delighted to provide results to those with this concern.”
Bruxism, masseter bulk and the lower face
Parafunction wears teeth, shortens crowns and can erode the vertical cues that keep the lower third looking supported. The management ladder still starts with diagnosis, occlusal appliances to protect teeth and joints, and behavioural strategies to reduce triggers. Evidence for botulinum toxin in bruxism shows symptom benefits in selected cases, but protocols vary and it is an adjunct, not a replacement for splint therapy and habit work. For masseter hypertrophy that is aesthetically dominant, toxin can soften the angle, but it will not rebuild worn dentition. Dr Anaboussi describes the stepped approach her clinic takes: “Our approach to bruxism and masseter hypertrophy is always tailored to the individual. We begin by identifying contributing factors -whether they are functional, behavioural, or stress-related. Occlusal appliances are often the first step, as they protect the teeth and joints from further damage. At the same time, we provide behavioural advice around parafunctional habits and lifestyle triggers, which can make a significant difference in reducing strain. In cases where muscle overactivity is persistent or hypertrophy is already established, we may introduce neuromodulators to relax the masseter muscles and restore a more balanced facial profile. Each element - appliances, advice, and neuromodulators -has its own role, and it’s the combination, timed appropriately for the patient’s needs, that achieves the best results.”
Restoring the collapsed lower third
Advanced tooth wear can reduce occlusal vertical dimension and dull lower facial definition. While the degree varies case by case, severe wear is associated with functional compromises and an aged appearance. Increasing vertical dimension through additive dentistry, when indicated and tested with provisionals, can re-animate lower facial cues and improve phonetics and mastication. The choice of material matters. Minimally invasive composites and modern monolithic ceramics allow additive or near-additive approaches that respect pulp and periodontium. This is where dentistry sets the canvas for any later aesthetic work.
Bonding, veneers and the longevity question
The pendulum has swung towards conservative, repairable options. Composite bonding can be an elegant way to lengthen teeth, close micro-gaps or refine edge symmetry with little or no drilling. Typical lifespan is often quoted at five to ten years depending on occlusion, hygiene and maintenance. Porcelain lasts longer on average but locks patients into replacement cycles and, when misused, can lead to aggressive preparations and complex remedial work. Patient selection and operator skill remain the differentiators, not the material alone.
How to build a joint plan with aesthetics
If your patient is considering filler for the nasolabial area and shows dental retrusion, refer for an orthodontic opinion first. If a gummy smile is muscle-driven, discuss toxin with clear expectations on duration and explore periodontal or orthodontic routes for stability. If the lower third looks tired and the dentition is worn, the conversation is about additive dentistry and function first, contouring second. The through-line is diagnosis. Put the dentistry and the dermatology in the same room and you often need less of each.
