A tongue tie procedure is a minor surgery that releases a tight band of tissue (called the lingual frenulum) connecting the underside of the tongue to the floor of the mouth. The most common version, called a frenotomy, takes only a few minutes and is often performed in a doctor’s or dentist’s office without general anesthesia. It’s most frequently done on infants who are struggling to breastfeed, though older children and adults can have it done too.
Why the Procedure Is Done
The tissue connecting the tongue to the floor of the mouth varies from person to person. In some infants, this tissue is short, thick, or tight enough to restrict tongue movement, a condition called ankyloglossia. The most common reason for surgical release is difficulty breastfeeding: the baby can’t latch well, can’t extract milk efficiently, or causes significant nipple pain for the mother. The American Academy of Pediatrics defines symptomatic tongue tie specifically as a restrictive frenulum that causes breastfeeding problems not improved with lactation support.
Not every tongue tie needs treatment. Infants with a visible tongue tie but normal feeding patterns need no intervention. The AAP is also clear that releasing a tongue tie to prevent potential future problems, like speech issues or sleep apnea, is not supported by evidence. Surgery is appropriate only after other causes of feeding difficulty have been evaluated and addressed, typically with the help of a lactation consultant.
Types of Tongue Tie
Tongue ties are classified into four types. Type I is the most obvious: a thin, elastic band attaching near the tip of the tongue to the gum ridge, giving the tongue a distinctive heart shape. Type II is similar but anchored 2 to 4 millimeters behind the tip. These two are easy to spot on a visual exam.
Types III and IV are called posterior tongue ties, and they’re harder to detect. Type III involves a thick, fibrous band connecting the middle of the tongue to the floor of the mouth. Type IV can’t even be seen; it can only be felt by touch, with a thick anchoring hidden beneath the mucous membrane. The AAP notes that “posterior ankyloglossia” is a poorly defined term without expert consensus, and it should not be used as a standalone reason for surgery.
How Providers Assess Severity
Many providers use a standardized scoring tool called the Hazelbaker Assessment, which rates both how the tongue looks and how well it functions. The function portion evaluates seven movements: whether the tongue can move side to side, lift to the roof of the mouth, extend past the lower lip, spread wide, cup into a bowl shape, and generate a proper sucking motion. The appearance portion looks at tongue shape when lifted, frenulum elasticity, frenulum length, and where the tissue attaches.
A perfect function score is 14. A score below 11 signals impaired tongue movement, and when combined with an appearance score below 8, the assessment indicates a frenotomy is necessary.
Frenotomy vs. Frenectomy
There are two main surgical approaches with an important distinction. A frenotomy is a simple incision that cuts and repositions the frenulum. A frenectomy is a complete removal of the frenulum, including its attachment to the underlying bone. For infants with breastfeeding problems, frenotomy is the standard approach. It’s quick, minimally invasive, and can be done in a clinic.
The procedure itself is straightforward. A provider stabilizes the tongue, typically using a grooved instrument, and cuts through the tissue with sterile scissors, a scalpel, or a laser. In newborns and very young infants (roughly the first month of life), this is often done with only a topical numbing agent or even no anesthesia at all. Research has found that topical anesthetics only partially control infant pain during the procedure regardless. Simple frenotomy is generally well tolerated up to about three months of age. For older children who need the release, the procedure is usually performed under general anesthesia and may involve a more complex repair called a frenuloplasty.
Laser vs. Scissors
Many providers now use a CO2 laser instead of scissors or a scalpel. The laser offers several practical advantages: it seals blood vessels and nerve endings as it cuts, which means less bleeding during the procedure and potentially less pain afterward. The laser also sterilizes the tissue as it works, lowering infection risk. Recovery time tends to be shorter with laser release. However, the AAP’s guidance states that surgical intervention (scissors or scalpel) “can reasonably be offered” for symptomatic tongue tie, and neither method has been proven clearly superior in long-term outcomes.
What Results Look Like
For breastfeeding infants, the evidence is encouraging. In studies comparing babies who received a frenotomy to those who did not, about 73% of mothers in the frenotomy group reported reduced latching pain, and 95% reported improvement in latch quality scores. These are significant margins, and the improvements were measurable shortly after the procedure. Many families notice a difference in breastfeeding within the first few days.
The overall complication rate is low, roughly 1% for minor complications. The most common issue is minor bleeding at the site. More serious complications are rare but have been reported, including poor feeding after the procedure, respiratory symptoms, pain, and temporary weight loss.
The Healing Process
After a tongue tie release, you’ll see a diamond-shaped wound under your baby’s tongue. This is normal and expected. The wound goes through a contraction phase that lasts about four weeks. During the first week, the wound will look white or yellowish as a scab forms. This is healing tissue, not infection.
The most important thing to watch for is reattachment. At the one-week mark, about 90% of wounds show some degree of the tissue starting to stick back together, even when families are doing their stretches. Reattachment typically begins in the middle of the diamond shape, appearing as a horizontal line where the edges are fusing. This is why aftercare exercises matter so much.
Aftercare Stretches
Post-procedure stretching exercises are critical for preventing the wound from healing back into its original restricted position. Different providers recommend slightly different routines, but the core idea is the same: you gently lift the tongue and apply pressure to the wound site to keep it open as it heals.
A common approach involves placing a clean finger under the baby’s tongue and gently pushing into the center of the wound while moving side to side, then holding for about five seconds. Some providers also recommend stimulating the cheeks and palate with gentle rotational finger movements to encourage proper tongue function. Frequency recommendations vary, from three times daily to four to six times daily for several weeks. Your provider will give you a specific schedule.
Beyond wound stretches, exercises that encourage natural tongue movement help strengthen the muscle. For infants, this includes stimulating the sucking reflex by letting the baby suck on a clean finger while you apply gentle pressure on the palate. Massaging the muscles along the jawline in small circles can also help. These exercises are typically continued for three to four weeks after the procedure, aligning with the wound contraction phase of healing.
What to Expect Day by Day
On the day of the procedure, most infants can breastfeed immediately afterward. Some babies latch better right away; others need a few days to adjust to their new range of motion. Mild fussiness for the first day or two is common. The wound site will look raw and white for the first several days. By the end of the first week, you should be doing your follow-up visit, where the provider checks for early signs of reattachment and adjusts your stretching technique if needed.
Weeks two and three are when consistent stretching matters most. The wound is actively contracting and closing during this period. By three weeks, the tissue under the lip (if a lip tie was also released) is typically healed. The tongue wound takes the full four weeks to complete its contraction phase, and many providers recommend continuing gentle exercises through this entire window. After four weeks, the site is generally well healed, and you can ease off the exercises based on your provider’s guidance.