If your baby has been diagnosed with a functionally significant tongue tie, your provider may recommend a frenotomy—a quick procedure to release the restricted frenulum. As a pediatrician who performs frenotomies regularly, I want to walk you through exactly what happens so there are no surprises.
What Is a Frenotomy?
A frenotomy (also called a frenulotomy or tongue tie release) is a simple procedure where the tight band of tissue under the tongue is cut or released. For young infants, this is typically done in the office—no general anesthesia, no operating room.
The frenulum in young babies is thin and has minimal blood supply and nerve endings. This is why the procedure is quick and well-tolerated when done early.
Before the Procedure
Evaluation Comes First
I never perform a frenotomy without first completing a thorough assessment:
- Observing a breastfeeding session
- Performing an oral exam
- Confirming that the tie is causing functional problems
- Discussing the expected benefits and what improvement might look like
If the tie isn't causing functional issues, I won't recommend the procedure—even if the tie is anatomically present.
Informed Consent
I'll explain exactly what I'm going to do, the risks (minimal but real), the expected benefits, and what alternatives exist. You'll have time to ask questions.
Timing
The ideal window for a frenotomy in my practice is the first few weeks to 3 months. In this age range:
- The frenulum is thin and easy to release
- Baby adapts quickly to the new tongue mobility
- Breastfeeding improvements can happen within hours to days
- The procedure can be done comfortably in the office
Older babies (4+ months) may still benefit, but the frenulum becomes thicker with age and the procedure may require different considerations.
During the Procedure
Here's what happens step by step:
1. Positioning
Baby is swaddled (for comfort and to keep hands out of the way) and held securely, either by an assistant or in a specially designed holder. You may be asked to step out briefly or you may stay—I'll discuss your preference.
2. Elevation of the Tongue
I gently lift baby's tongue to visualize the frenulum clearly and identify exactly where to release.
3. The Release
Using sterile scissors (or in some practices, a laser), I quickly clip or release the frenulum. The actual cut takes 1–2 seconds.
What baby feels: The clipping itself causes brief discomfort—most babies cry for about 15–30 seconds. There is very little bleeding (usually just a few drops) because the frenulum in young babies has minimal blood supply.
4. Immediate Breastfeeding
I encourage mom to nurse baby right away. Breastfeeding immediately:
- Comforts baby
- Tests the new tongue mobility in real time
- Applies natural pressure to the site
- Often shows immediate improvement in latch
Many moms tell me the first post-procedure feeding already feels different—deeper latch, less pain, more comfortable.
What to Expect After
The First 24 Hours
- Some fussiness is normal. Baby had a minor procedure in a sensitive area. Extra comfort nursing is expected.
- A white patch will form under the tongue. This is the healing wound—it looks like a small white diamond or patch. This is NOT an infection. It's normal healing tissue (similar to a canker sore appearance).
- Minimal bleeding. A small amount of blood-tinged saliva is normal. Significant bleeding is very rare.
- Feeding may be immediately improved or may take a few days. Some babies latch better right away. Others need a few days to learn how to use their newly mobile tongue.
The First 1–2 Weeks
- The white patch will gradually shrink and heal over 7–14 days.
- Baby may be uncomfortable with the stretching exercises (described below) but should otherwise feed and behave normally.
- Breastfeeding should progressively improve over the first week.
Post-Procedure Exercises (Stretches)
This is arguably the most important part of the aftercare. The wound under the tongue can reattach as it heals if the area isn't gently stretched.
I'll show you exactly how to do these before you leave the office:
- Frequency: 4–6 times per day for 3–4 weeks
- Technique: Gently lift the tongue with clean fingers and hold for a few seconds. Apply slight upward pressure under the tongue to keep the wound open.
- Duration: Each stretch takes about 5 seconds. The whole routine is done in under a minute.
Baby won't love the stretches. But they're important for a good outcome. Do them consistently for the full course.
Risks and Complications
Frenotomy is a very low-risk procedure. Possible complications include:
- Bleeding — Almost always minimal. I keep silver nitrate on hand for the rare case that needs it.
- Reattachment — The most common issue. Can occur if stretches aren't done consistently. If it reattaches significantly, the procedure may need to be repeated.
- Infection — Extremely rare. The mouth heals quickly and breast milk has antimicrobial properties.
- Injury to surrounding structures — Very rare in experienced hands.
Success Rates
In my experience, the majority of families see meaningful improvement in breastfeeding after a frenotomy when the indication was appropriate. Studies show:
- Breastfeeding pain typically improves immediately or within a few days
- Latch quality improves in most cases
- Milk transfer and weight gain improve over the following weeks
- Most moms who were considering stopping breastfeeding due to pain continue after the procedure
That said, frenotomy isn't 100% effective for every family. Some babies have other contributing factors (jaw tension, high palate, oversupply) that also need to be addressed. A frenotomy removes one barrier, but it may not be the only barrier.
After the Healing Period
By 3–4 weeks post-procedure, the wound should be fully healed. At this point:
- Stretches can stop
- Feeding should be well-established
- Any remaining breastfeeding concerns should be addressed with a lactation follow-up
If feeding didn't improve as expected, we'll reassess. Sometimes the release wasn't deep enough, or there are other factors contributing to the difficulty.
The Decision Is Yours
I present the findings, explain the options, and share what I expect the outcome to be. But the decision is always yours. Some families prefer to try conservative management first. Others want to address the tie quickly. Both approaches are valid, and I support whatever you decide.