the harmony of the smile is determined not only by the shape , the position , and the colour of teeth but also by the gingival tissues it is one of the several developmental or acquired deformities and conditions that manifest in the periodontium . it is an aesthetic concern that can affect a large portion of the population , with a reported prevalence between 10.5% and 29% . in the recent years , egd has received an increased emphasis in dental literature and various treatment options are now available for correction of gummy smile . the various causes of gummy smile include vertical maxillary excess , anterior dentoalveolar extrusion , altered passive eruption , short or hyperactive upper lip , or combinations thereof . treatment of egd by esthetic crown lengthening with or without osseous resection is well documented . egd , due to vertical maxillary excess , can be successfully treated by orthognathic surgery . however , this surgery is associated with significant morbidity and requires hospitalization . lip repositioning results in shallow vestibule restricting the muscle pull thereby limiting the gingival display during smiling . a 22-year - old female patient undergoing orthodontic treatment , presented with the complaint of gummy smile following retraction of maxillary anterior teeth [ figure 1 ] . patient 's teeth were visible from maxillary right first molar to maxillary left first molar with 5 - 6 mm of gingival display . orthognathic surgery as a treatment option was discussed with the patient . however , patient preferred less invasive lip repositioning procedure over orthognathic surgery . adequate local anesthetic ( lignocaine 2% with epinephrine 1:100,000 ) was administered in vestibular mucosa and lip from maxillary right first molar to maxillary left first molar . a partial thickness flap was raised from mesial line angle of left maxillary first molar to the mesial line angle of right maxillary first molar at the mucogingival junction [ figure 2 ] . a second incision 1012 mm above the first incision was made in the labial mucosa . the two incisions were joined on either side and a strip of partial thickness flap was removed , exposing the underlying connective tissue [ figure 3 ] . removal of split thickness flap exposed underlying connective tissue margins approximated by sutures patient was prescribed nonsteroidal anti - inflammatory drugs ( diclofenac sodium 50 mg three times daily for 3 days ) and oral antibiotics ( amoxicillin 500 mg three times daily for 5 days ) . patient was instructed to apply ice pack post operatively and minimize lip movement for 1 week . suture line healed in the form of a scar which was covered by labial mucosa and therefore not visible on smiling [ figure 5 ] . adequate local anesthetic ( lignocaine 2% with epinephrine 1:100,000 ) was administered in vestibular mucosa and lip from maxillary right first molar to maxillary left first molar . a partial thickness flap was raised from mesial line angle of left maxillary first molar to the mesial line angle of right maxillary first molar at the mucogingival junction [ figure 2 ] . a second incision 1012 mm above the first incision was made in the labial mucosa . the two incisions were joined on either side and a strip of partial thickness flap was removed , exposing the underlying connective tissue [ figure 3 ] . removal of split thickness flap exposed underlying connective tissue margins approximated by sutures patient was prescribed nonsteroidal anti - inflammatory drugs ( diclofenac sodium 50 mg three times daily for 3 days ) and oral antibiotics ( amoxicillin 500 mg three times daily for 5 days ) . patient was instructed to apply ice pack post operatively and minimize lip movement for 1 week . suture line healed in the form of a scar which was covered by labial mucosa and therefore not visible on smiling [ figure 5 ] . gingival display at baseline was 5 - 6 mm which changed drastically at 3 and 6 months postoperatively [ figure 6 ] . at 3 month and at 6 months . however , the lip reverted back to its original position with almost complete relapse after 12 months [ figure 7 ] . this report aimed to document lip repositioning technique to decrease the amount of gingival display in patients with gummy smile . the results showed esthetic satisfaction up to 6 months postoperatively after which lip slowly reverted back towards its original position with almost complete relapse at the end of 1 year . studies have shown that minimal gingival display during smile is considered esthetically acceptable . however , aesthetic perception varies depending on social environment , personal experience and culture . the amount of gingival display that is considered attractive varies from 1 - 3 mm . the results showed that the employed surgical procedure successfully reduced the gingival display with low morbidity . lip repositioning procedure began as a plastic surgical treatment and ever since variations have been reported . the original technique did not include severing the muscle attachment after flap reflection . however , some authors suggested performing myectomies to detach smile muscle attachment to prevent relapse . another method to prevent reattachment of smile elevator muscles is the placement of spacer between elevator muscles of lip and anterior nasal spine thereby preventing superior displacement of repositioned lip . contraindications for lip repositioning surgery include inadequate width of attached gingiva in maxillary anterior sextent . patients with severe vertical maxillary excess cases are also not the ideal candidates for lip repositioning and should be treated with orthognathic surgery . silva et al . in 2012 reported successful management of excessive gingival display in a study wherein thirteen patients with excessive gingival display were treated with a modified lip repositioning technique . treatment consisted of the removal of two strips of mucosa , bilaterally to the maxillary labial frenum and coronal repositioning of the new mucosal margin . the baseline gingival display of 5.8  2.1 mm significantly decreased to 1.4  1.0 mm at 3 months and was maintained until 6 months ( 1.3  1.6 mm ) . subjects were satisfied with their smile after surgery and would likely choose to undergo the procedure again ( 92% ) . similar results were obtained in other case reports by rosenbaltt , simon , and humayun et al . who achieved approximately 4 mm of reduction in gummy smile . jacobs et al . in 2013 reported a case series where seven patients were successfully managed with trial , and then definitive , lip repositioning wherein a mean reduction in gingival display of 6.4  1.5 mm was achieved . presented case report of two patients treated with modified lip repositioning technique and obtained significant improvement in the amount of gingival exposure and esthetic satisfaction after a 6 month follow up . several authors have presented case reports of single patients successfully treated with lip repositioning surgery with a follow up period of 6 months . this case report shows that although the results of lip repositioning surgery appear stable for up to 6 months postoperatively , its utility as a long term treatment option remains questionable . more studies with larger sample size and long term follow - up are necessary to establish the level of scientific evidence of this procedure . however , long - term stability of the results needs to be seen . none the less , this procedure appears to be a promising alternative treatment option for excessive gingival display .