Micro-Autologous Fat Transplantation (MAFT) as a Novel Therapeutic Approach for Gummy Smiles: Long-Term Efficacy and Mechanistic Insights

BACKGROUND: Gummy smile (GS), defined as excessive gingival display, compromises facial harmony and self-confidence. Traditional treatments, including orthognathic surgery, botulinum toxin (BTX-A), and lip repositioning, carry limitations in invasiveness, durability, or adaptability. Micro-Autologous Fat Transplantation (MAFT) presents a minimally invasive alternative by volumizing the upper lip and modulating perioral biomechanics. METHODS: A retrospective study was conducted on 52 patients (mean age: 43.4 years; 92.3% female) who underwent MAFT for GS correction between 2014 and 2023. Fat was harvested, purified, and micro-injected using the MAFT-GUN® into the nasolabial groove, ergotrid, and upper lip. Gingival exposure was measured at four maxillary incisor regions pre- and postoperatively. Patient satisfaction was assessed via a 5-point Likert scale; mean follow-up was 56.4 months. RESULTS: Mean preoperative gingival exposure (3.31 mm) significantly decreased to -0.82 mm postoperatively (p < 0.00001), with a mean reduction of 4.13 mm. The right central incisor showed the greatest improvement. Satisfaction scores increased from 1.40 to 4.90. Mean injected fat volume was 16.1 mL (SD: 3.4 mL), with a calculated graft weight of 14.8 g. No significant correlation was found between volume and outcome (p > 0.40), suggesting anatomical responsiveness. Only two patients (4%) required minor touch-ups; no major complications occurred. CONCLUSIONS: MAFT is a safe, effective, and durable treatment for GS. By harmonizing perioral musculature and preserving dynamic lip movement, it bridges the gap between temporary neuromodulators and invasive surgeries, offering a reproducible, minimally invasive solution with long-term aesthetic and functional benefits.