Tongue tie surgery is a quick procedure that releases a tight band of tissue under the tongue, allowing it to move more freely. The tissue being cut is called the lingual frenulum, a small fold connecting the underside of the tongue to the floor of the mouth. When this fold is too short or too thick, it can restrict the tongue’s range of motion, causing problems with breastfeeding in infants and sometimes speech difficulties in older children and adults.
How the Procedure Works
A trained provider snips the lingual frenulum with a small cut, which immediately frees the tongue to move with a fuller range of motion. The traditional and most established method uses sterile scissors. Some providers use a laser instead, though scissors remain the gold standard. The procedure itself takes only a few minutes.
You may hear it called a frenotomy or a frenectomy. Despite the different names, these refer to the same procedure. In newborns, the frenulum is thin and has minimal blood supply, which is why the cut produces very little bleeding and typically heals quickly.
Why It’s Done
In infants, the most common reason for tongue tie surgery is difficulty breastfeeding. A restricted tongue can prevent a baby from latching properly or staying attached to the breast, which leads to poor milk transfer, slow weight gain, and significant nipple pain for the nursing parent. The American Academy of Pediatrics defines symptomatic tongue tie as a restrictive frenulum that causes breastfeeding problems not improved with lactation support alone.
That last part is important. Not every tongue tie needs surgery. Infants with a visible tongue tie but normal feeding patterns need no intervention. The AAP recommends that every nursing pair with painful or ineffective feeding get a complete breastfeeding assessment before any surgical treatment is offered, because suboptimal breastfeeding has many possible causes and a tight frenulum is only one of them.
For older children and adults, tongue tie release is sometimes pursued for speech issues. Children with moderate to severe speech impairment before surgery tend to see the most improvement afterward. One study found that 100% of children in this group achieved better speech and language outcomes following the procedure, compared to 82% of those with only mild impairment beforehand. That said, the AAP notes that performing the surgery on infants purely to prevent future speech problems is not supported by current evidence.
How Providers Decide Surgery Is Needed
Diagnosis involves looking at both the appearance and function of the tongue. Clinicians check for specific signs: a heart-shaped tongue tip when the baby tries to extend it, damaged nipples in the nursing parent, poor milk transfer, and consistently weak sucking patterns. Family history of tongue tie also factors into the assessment.
Range of motion is the most critical factor in determining whether a tongue tie will affect feeding. A severely restrictive frenulum typically keeps the tongue behind the gum line, making effective breastfeeding nearly impossible. Providers use standardized scoring tools to rate both how the frenulum looks and how well the tongue functions. Below certain threshold scores, surgery is recommended.
The AAP specifically cautions against two things. First, “posterior tongue tie” is a poorly defined term without expert consensus and should not be used as a justification for surgery. Second, the lip and cheek frenula (small tissue folds inside the lips and cheeks) are normal structures unrelated to breastfeeding and do not require surgical release.
What to Expect During and After
For newborns, the procedure is fast. The baby is positioned, the provider makes the cut, and the baby can usually breastfeed immediately afterward. Many parents notice an improvement in latch right away, though some babies need time and practice to adjust to their new tongue mobility.
Pain is generally minimal. Babies are typically calmed by skin-to-skin contact and feeding. Most do well without pain medication. If your usual soothing methods aren’t enough, infant acetaminophen (Tylenol) can be given based on weight. Ibuprofen should not be given to babies under six months. Some parents opt for arnica, a holistic alternative, used as directed on the packaging.
A pooled analysis of five randomized controlled trials found that frenotomy was associated with reduced nipple pain in breastfeeding mothers. The evidence for broader breastfeeding improvements, while promising, has been limited by small study sizes and inconsistent definitions of tongue tie across research.
Risks and Complications
Tongue tie surgery is considered low risk, but complications do occur. A prospective study tracking outcomes over 24 months found that reported complications included poor feeding (44%), breathing events (25%), pain (19%), and bleeding (19%). These percentages came from cases serious enough to be flagged in a national surveillance system, so they reflect the more notable adverse outcomes rather than the typical experience.
One finding worth noting: in that same study, 19% of children had an underlying medical condition that was initially overlooked because their feeding difficulties were attributed to tongue tie. This reinforces why a thorough evaluation before surgery matters. Feeding problems in infants can stem from many causes, and tongue tie surgery only helps when the frenulum is genuinely the issue.
Reattachment is another possibility. The tissue under the tongue can heal back together to some degree, particularly if post-procedure stretching exercises aren’t performed as directed. Providers typically instruct parents on gentle stretches to keep the wound open as it heals.
Surgery in Older Children and Adults
While most tongue tie procedures happen in the newborn period, older children and adults can also benefit. The procedure for older patients is more involved, often requiring local anesthesia and sometimes sutures to close the wound. Research suggests that sutured closure actually leads to better speech outcomes, with 100% of sutured patients improving compared to 83% of those whose wounds were left to heal on their own.
Adults with untreated tongue tie may experience difficulty with certain speech sounds, trouble licking their lips or playing wind instruments, and challenges with oral hygiene because the tongue can’t sweep food debris from the teeth. After surgery, tongue mobility, protrusion, and speech clarity all tend to improve, though adults may need speech therapy alongside the procedure to retrain movement patterns they’ve compensated for over years.