A lip tie is a condition where the small band of tissue connecting a baby’s upper lip to the upper gum is unusually short, thick, or tight, restricting how far the lip can move. This tissue, called the upper labial frenulum, exists in virtually every person. It only becomes a concern when it’s restrictive enough to interfere with breastfeeding or, later, dental development. The point at which a normal frenulum crosses into a “lip tie” remains a matter of genuine debate among pediatricians and dentists.
The Anatomy Behind a Lip Tie
The upper labial frenulum is a fold of mucous membrane that runs from the inside of your upper lip down to the gum ridge in the center of the upper jaw. It’s made of tight connective tissue with some muscle fibers woven in from the lip muscle itself. There are no major blood vessels inside it, which is one reason procedures to release it tend to involve minimal bleeding.
In a typical infant, this band of tissue is flexible enough that the upper lip can flare outward freely. When it’s too tight or attaches too close to the gum line (or even wraps onto the roof of the mouth), the lip stays tucked in. That restricted movement is what people mean when they say “lip tie.”
How a Lip Tie Affects Breastfeeding
For a baby to breastfeed effectively, both lips need to flange outward to create a seal around the areola, not just the nipple. A tight upper frenulum prevents that flange, forcing the baby to clamp down on less tissue. The result is a shallow, inefficient latch that can cause problems for both baby and mother.
Signs you might notice in the baby include:
- Clicking sounds during feeding, caused by the seal repeatedly breaking
- Gassiness and fussiness from swallowing extra air through a poor seal
- Falling asleep at the breast from fatigue, since the baby works harder to extract milk
- Frequent feeding demands around the clock, because each session transfers less milk
- A callus on the upper lip at the midline, though this isn’t always present
- Inability to take a pacifier
For the nursing parent, the consequences cascade. Painful, damaged nipples are common because the baby compensates with compression rather than suction. In one study of 237 breastfeeding pairs where the infant had a tethered lip or tongue, 60% of mothers reported poor or incomplete breast drainage, 21% had plugged ducts, and 14% had developed mastitis or nipple thrush. Over time, incomplete drainage signals the body to produce less milk, creating a supply problem that compounds the original latch issue.
How Lip Ties Are Classified
The most commonly referenced system is the Kotlow classification, which grades lip ties from I to IV based on where the frenulum attaches:
- Grade I: The least restrictive. The frenulum attaches well above the gum line.
- Grade II: The attachment reaches just above or between the gum margins of the two front teeth.
- Grade III: The frenulum inserts into the front gum tissue (the papilla between the central incisors).
- Grade IV: The most restrictive. The tissue inserts into or through the papilla and may wrap onto the palate.
Here’s the catch: this grading system has significant reliability problems. When researchers had multiple examiners assess the same group of newborns using the Kotlow scale, they found poor agreement between examiners and even poor consistency when the same examiner looked twice. More strikingly, over 80% of all the healthy newborns examined scored as having the highest grade of frenulum. That finding suggests the scale may pathologize what is actually normal infant anatomy, and it’s a major reason why no medical organization has endorsed a standard diagnostic threshold for lip ties.
What Medical Organizations Say
The American Academy of Pediatrics published a clinical report in 2024 noting that the upper labial frenulum is a normal oral structure present in all infants and has only recently been implicated in breastfeeding difficulties. The AAP stopped short of establishing diagnostic criteria or recommending routine treatment for lip ties, largely because the evidence connecting them to feeding problems independent of tongue ties remains thin.
This is an important distinction. Tongue ties (ankyloglossia), diagnosed in roughly 2% to 11% of newborns depending on the study, have a longer history of clinical research. Lip ties are frequently found alongside tongue ties, and disentangling which restriction is actually causing the feeding difficulty is not straightforward. Many providers who treat lip ties do so in combination with a tongue tie release rather than as a standalone procedure.
Treatment: Frenectomy Procedures
When a lip tie is judged severe enough to cause functional problems, the treatment is a frenectomy, a minor procedure that releases the restrictive tissue. There are two main approaches.
Conventional (Surgical) Frenectomy
A provider clamps the tissue and cuts it with a scalpel or scissors, then places several small stitches to close the wound. Some bleeding is expected. Stitches typically come out after 10 days, though in about a third of cases, removal needs to wait a full two weeks because the wound is still healing.
Laser Frenectomy
A diode laser cuts and cauterizes the tissue simultaneously, so there’s virtually no bleeding and no stitches are needed. Studies comparing the two methods show significantly less pain with laser: patients reported roughly 80% less discomfort immediately after the procedure and nearly 87% less pain at the one-week mark compared to the surgical approach. Wound healing quality in the first 24 hours was about 45% better in the laser group, and most laser patients needed no antibiotics or anti-inflammatory medication afterward.
Both procedures are quick, often taking just a few minutes. For infants, they’re typically performed in an office setting, sometimes with only topical numbing gel.
Recovery and Preventing Reattachment
The tissue released during a frenectomy can reattach as it heals, which would undo the benefit of the procedure. To prevent this, parents are generally instructed to perform gentle stretching exercises on the release site three to five times per day for several weeks. Each stretch lasts about 10 to 15 seconds. The goal is to keep the healing edges apart so new tissue fills in with flexibility rather than tightness.
Most babies are fussy during stretches for the first few days but tolerate them well after that. Breastfeeding can typically resume immediately after the procedure, and many parents notice an improvement in latch within the first few days, though it can take a couple of weeks for the baby to fully adapt to their new range of motion. Working with a lactation consultant during this transition period can help both parent and baby adjust.
Lip Ties Beyond Infancy
Not all lip ties cause breastfeeding problems, and many children with a prominent frenulum never need intervention. In older children, a tight upper frenulum can contribute to a gap between the two front teeth (diastema) that doesn’t close on its own as adult teeth come in. It can also make tooth brushing along the upper gum line uncomfortable, potentially increasing the risk of cavities in that area. Some children have the frenulum released for these dental reasons later in childhood, when the procedure is straightforward and recovery is similarly quick.