A frenotomy is a quick surgical procedure that releases a tight band of tissue, called the frenulum, that restricts movement of the tongue or lip. It’s most commonly performed on newborns whose tongue-tie (ankyloglossia) interferes with breastfeeding, though older children and adults sometimes need one too. The procedure takes only seconds in most cases and can be done in a doctor’s office without anesthesia.
The Anatomy Behind Tongue-Tie
The lingual frenulum is a fold of mucous membrane that runs from the floor of the mouth to the midline of the underside of the tongue. Everyone has one. But in some babies, this frenulum attaches too close to the tip of the tongue and is unusually short, tight, or thick. When it restricts tongue movement enough to cause problems, that’s ankyloglossia, or tongue-tie.
Estimates of how many newborns have tongue-tie range from 1.7% to 10.7%, depending on the study and how strictly the condition is defined. The wide range reflects ongoing debate about where normal variation ends and a true restriction begins. Not every short frenulum causes symptoms, and the key distinction is whether it actually limits what the tongue can do.
Why Frenotomy Is Recommended
The most common reason is breastfeeding difficulty. A restricted tongue can’t move properly to latch onto the breast, which causes a cascade of problems for both baby and mother. Infants may latch poorly, repeatedly lose their latch, become irritable during feeds, or gain weight slowly. Mothers often experience significant pain while nursing, and in some cases develop nipple ulceration, bleeding, or infection. Inadequate milk removal can also reduce milk supply over time.
Frenotomy is typically recommended only after other conservative approaches have been tried, such as working with a lactation consultant to improve positioning and latch technique. Other potential causes of feeding difficulty also need to be ruled out first. The goal is to confirm that the frenulum itself is the problem before cutting it.
Clinicians use scoring tools to assess both the anatomy of the frenulum and the function of the tongue. One widely used tool, the Hazelbaker Assessment Tool for Lingual Frenulum Function, scores anatomy on a 10-point scale and function on a 14-point scale. If the function score is perfect (14), surgery isn’t recommended regardless of how the frenulum looks. A function score below 11, combined with a low anatomy score, points toward frenotomy. The important takeaway: restricted movement matters more than appearance.
Beyond infancy, tongue-tie can affect speech. A restricted tongue may struggle with consonants and sounds like “s,” “z,” “t,” “d,” “l,” “r,” and “th.” Adults with untreated ankyloglossia sometimes report difficulty licking their lips, kissing, or eating certain foods like ice cream. Some experience discomfort under the tongue or cuts from their teeth pressing against the tight tissue.
What Happens During the Procedure
For infants, frenotomy is remarkably simple. The baby is positioned on an exam table or in a parent’s lap, and the provider clips the frenulum with sterile scissors. The whole cut takes seconds. Babies don’t need anesthesia for this procedure because the frenulum in young infants has very few nerve endings and minimal blood supply. Some providers offer a sugar solution beforehand to help soothe the baby, and most infants can breastfeed immediately afterward for comfort.
A laser can also be used instead of scissors. CO2 lasers offer more precision and may cause less impact on surrounding tissue, but they require specialized equipment and training, which makes them less widely available and more expensive. Both methods accomplish the same thing: releasing the restrictive tissue so the tongue can move freely.
The terminology can be confusing. “Frenotomy” specifically refers to cutting or incising the frenulum. “Frenectomy” means fully removing it. “Frenuloplasty” involves excision with more complex tissue rearrangement. For most newborns, a simple frenotomy is all that’s needed.
How Well It Works
Research on breastfeeding outcomes after frenotomy shows meaningful improvements. In one study, maternal pain scores during latching dropped from a median of 6 out of 10 before the procedure to 3 within 24 hours, and down to 0 at one week. Latch quality scores nearly doubled, rising from a median of 5 to 9 (out of 10) within a week. About 73% of mothers in the frenotomy group reported reduced latching pain, compared to roughly 44% in a group that didn’t have the procedure. Latch scores improved in 95% of babies who had frenotomy versus 69% of those who didn’t.
These numbers are encouraging, but they don’t guarantee a perfect breastfeeding experience. Some families still need ongoing support from a lactation consultant after the procedure to retrain feeding patterns that developed while the tongue was restricted.
Risks and Complications
Frenotomy is considered low-risk, but it’s not entirely without complications. In a survey of healthcare professionals who referred infants for or performed the procedure, the most frequently reported issue was the need for a repeat procedure, affecting about 32% of cases. This happens when the cut tissue heals back together, partially re-restricting the tongue.
The revision rate drops significantly with proper follow-up. One practice found that switching from two-week to one-week follow-up appointments cut their revision rate from nearly 13% to about 5%. Other reported complications included oral aversion or feeding refusal (28%), scarring at the site (12%), pain reported by parents (10%), and bleeding requiring medical attention (10%). Infection was rare, occurring in about 2% of cases.
The oral aversion finding is worth noting. Some babies become temporarily resistant to feeding after having the inside of their mouth manipulated, which is the opposite of the intended outcome. This is usually temporary but can be distressing for parents.
Aftercare and Stretching Exercises
The mouth heals fast, which is both a benefit and a challenge. The same rapid healing that makes the wound close quickly can also cause the cut surfaces to reattach if they aren’t kept apart. This is why most providers prescribe stretching exercises after a frenotomy.
The typical stretching routine looks like this:
- Day one: Begin stretching the evening of the procedure, then again the next morning.
- Weeks one and two: Stretch roughly every 3 hours, aiming for 5 to 6 sessions spread across the day. A middle-of-the-night session is important to prevent tightening during long sleep stretches.
- Weeks three and four: Taper down to 3 to 4 sessions per day, dropping the overnight session first if the baby is sleeping through the night.
For the tongue, the stretches involve placing clean fingers under the tongue and gently lifting it upward toward the roof of the mouth. For an upper lip release, you slide a finger under the lip and sweep it upward, then gently side to side. The movements should be quick and precise, not forceful. Swaddling the baby’s arms helps keep them still. The exercises can be uncomfortable and babies often cry, but each session only takes a few seconds.
Cost and Insurance Coverage
Frenotomy can be billed as either a medical or dental procedure, which affects how insurance handles it. On the medical side, common billing codes include CPT 41010 for a lingual frenotomy (tongue) and 40806 for a labial frenotomy (lip). Dental billing uses CDT codes D7962 for lingual and D7961 for labial procedures. Whether your insurance covers the procedure, and how much you’ll owe out of pocket, depends entirely on your specific plan. Some plans cover it fully when breastfeeding difficulty is documented, while others classify it as elective. If you’re considering the procedure, calling your insurance company with the relevant billing code beforehand is the most reliable way to find out what you’ll pay.