The lip repositioning technique (LRT) is considered a safe and predictable gummy smile (GS) treatment. However, since Rubinstein and Kostianovsky introduced it in 1973, it has undergone several modifications. This article aims to review and provide a historical compilation of LRT evolution to help clinicians understand each technique's description and the rationale for its modifications to treat GS.An electronic search was performed in Medline, Scopus, and Cochrane Library up to May 2021 including the terms lip repositioning, lip repositioning technique, or lip repositioning surgery and studies evaluating or discussing the original LRT's modifications in detail. The search had no language or time restrictions. Additionally, a hand-searching of references of all included articles was performed.Modifications described in the literature include muscle severance, subperiosteal dissection of the gingiva, frenectomies, and the use of adjuvant products. They aim to minimize relapse, morbidity, and improve stability. Discomfort, scar formation, and pain were the most frequent complications reported. The choice to use a modification should be analyzed and customized to the individual patient's needs.