Background <p>Excessive gingival display is a common and often distressing aesthetic concern among patients. With the increasing emphasis on dental aesthetics, it has become essential to investigate and develop various treatment modalities to address patients’ expectations. Achieving a balanced and attractive smile has therefore become a key challenge for dental practitioners <i>worldwide</i>.</p> Methods <p>This study is a single-center, parallel, randomized controlled open-label trial aimed to compare performing lip repositioning surgery (LRS) utilizing carbon dioxide (CO₂) laser with conventional scalpel in managing excessive gingival display (EGD) (4–6&#xa0;mm) with special consideration to lip dimensions, and 20 participants were included in this study setting in the Faculty of Dentistry, 70% females and 30% males, with an average age of 26.4 and 24.8&#xa0;years in laser and scalpel groups, respectively, randomly allocated into two groups. All patients fulfilled the study.</p> <p>A partial thickness flap was excised from the vestibule, with both edges of the donor wound closed using sutures; clinical measurements were recorded preoperatively and followed up for 6&#xa0;months.</p> Results <p>Postoperative pain was significantly reduced in the laser group; both groups demonstrated a significant decrease in gingival display at 6-month post-operation: external upper lip length was significantly longer in the laser group in smile position at 1-month post-operation, and internal upper lip length at rest was significantly longer in the scalpel group at 3-month post-surgery (significance level was set at <i>P</i> &lt; 0.05).</p> Conclusions <p>The CO₂ laser is an effective, safe, and conservative alternative to the scalpel in performing LRS, offering decreased pain and improved visualization. Adequate training in laser techniques and safety is essential.</p> Trial registration <p>The study is registered at International Standard Randomized Controlled Trial, registration number ISRCTN.</p>