Tongue Tie Surgery
Tongue tie surgery… it’s one of those things that you don’t really think about. Until you have to think about it!
Let’s take my situation for example.
My daughter was diagnosed with a tongue tie when breastfeeding was hard for us.
So, we took her to get it “revised” (another way of saying she got tongue tie surgery).
And we learned SO MUCH.
I really wish I would have known more about the surgery before we decided to go forward with it. If you want to hear my full story, click here.
Otherwise keep reading for all the information you need to know about tongue tie surgery for your baby.
Does your baby need tongue tie surgery?
Well… that’s a loaded question.
It depends who you ask.
There isn’t agreement on tongue tie treatment, and some people even question the existence of certain types of tongue ties.
One thing is for sure though, tongue tie diagnosis has increased almost 800% in the last years. Some think that’s because it’s being discovered more while others think there is vast overdiagnosis.
And another thing…
Even if your baby is diagnosed with tongue tie (read about diagnosing tongue ties here), many providers believe that as long as function is good enough surgery isn’t necessary.
The tongue tie can stretch over time – so some providers recommending a “wait and see” approach.
But if your baby is one of the 5% of babies that really does need tongue tie surgery, you should know:
There are different types of tongue tie surgery.
So what are they?
A frenotomy is probably what you’d think of first when imagining tongue tie surgery.
It’s done in a doctor’s office with sterile scissors. You might hear it called a clipping or snipping.
The frenulum is the part of the tongue that connects it to the bottom of the mouth. It has very few nerve endings or blood vessels.
That means it’s a relatively quick procedure and there are only a few drops of blood.
This type of tongue tie surgery isn’t very deep. It’s usually what I recommend if a baby truly has a tongue tie because it’s a relatively fast recovery.
With a frenotomy, breastfeeding can happen immediately.
Usually if the tongue tie was the problem, it resolves as soon as it’s clipped. Immediately afterward, when the baby is put to the breast he or she breastfeeds without problem.
Sometimes the tongue tie surgery doesn’t fix the problem though, which indicates that the tongue tie wasn’t the problem in the first place (I’ll talk more about that later).
Even this type of procedure can cause bleeding, infection, damage to the tongue or saliva glands and reattachment or scarring so do your research before you take your baby and rule out all other possible causes!
Frenectomy, Frenulectomy, or Frenuloplasty
You may have heard of another term. Tongue tie surgery can sometimes be called a frenectomy, frenulectomy or frenuloplasty.
Typically this type of tongue tie surgery is more intense. It cuts deeper into the tissue underneath the tongue and often requires stitches.
The earliest a frenectomy tongue tie surgery is done is typically when a baby is 6 months old. It generally requires anesthesia and often needs stitches. The average length of healing is around 10 days.
This type of tongue tie surgery is traumatic for babies, and generally not recommended. This article explains that more than half of babies referred for tongue tie surgery didn’t need it. They instead required other therapy such as speech therapy to resolve their problems.
Laser Tongue Tie Surgery
Laser tongue tie surgery is rising in popularity but I recommend this one the least. It was what my daughter had done to her, and left her in terrible pain.
Laser tongue tie surgeries are sometimes called laser frenectomies.
They are touted as the best option for tongue tie surgery by their proponents. They result in less bleeding because they cauterize the tissue as they cut.
But the pain for babies is excruciating and scar tissue forms more easily with this method.
The worst part for my baby was the after care.
With a laser tongue tie surgery, the tongue (and lip if that’s cut too) must be stretched every 4-6 hours around the clock. And it’s anything but gentle. It involved pressing your baby’s tongue into their throat, HARD, to prevent the tissue from reattaching.
If it reattaches, it must be pressed hard enough to rip away the reattachment – usually causing bleeding.
Tongue Tie Surgery Cost
If done in a doctor’s office, most often tongue tie surgery costs are covered by insurance.
But pediatric dentists are different.
Some do accept insurance for the procedure, but many don’t.
They usually only do laser tongue tie revisions. And they charge a pretty penny for them.
A laser tongue tie surgery can cost between $500 and $900 per procedure.
In my baby’s case, we paid $650 for the laser tongue tie frenulectomy.
Tongue Tie Surgery Age
Depending on the provider you speak with, you will get a different answer at what age your baby should get tongue tie surgery. Some doctors recommend getting the surgery done as soon as possible.
Others believe that time will help improve symptoms and the tongue will stretch. They lean towards waiting and seeing what happens before cutting.
One thing to consider is the after care with many of these surgeries. A newborn can still feel intense pain during the stretches, but they are easier to do. An older child might make the stretches downright impossible.
Tongue Tie Surgery Side Effects
Tongue tie surgery side effects must be considered when determining if it’s necessary. The benefit should outweigh the risks. No surgery is without risks, and tongue tie surgery is no exception.
Possible side effects from tongue tie surgery include:
- Excessive bleeding
- Scar tissue formation
- Fear of dentist or doctor
- Sleep disturbances
- Damage to the tongue
- Damage to saliva glands
- Could cause the real problem to be missed if tongue tie was misdiagnosed
This study, from New Zealand found that:
“complications including breathing problems, pain, bleeding, weight loss and poor feeding occurred in babies following minor surgery for tongue-tie.”
They also stated:
“Respiratory complications such as apnoea (cessation of breathing) are also occurring following frenotomy in community settings that may not be equipped to deal with these.”
And they concluded:
“Potentially 10 to 20 per cent of all infants in New Zealand are having it done where, in fact, more like 3 per cent would actually benefit from it.”
With the vast number of potential consequences, tongue tie should only be performed when deemed absolutely necessary. You can read more about it here.
Pain from Tongue Tie Surgery
Let’s talk about pain.
Don’t let anybody try and convince you that babies don’t feel pain. There have been countless studies (like this one) showing that babies feel pain, and possibly even feel pain stronger than adults.
Some providers offering laser tongue tie surgery don’t give analgesia (pain killers) beforehand.
Babies might not always show pain on their faces like adults do. But even if it doesn’t appear immediately obvious to us, their brain waves and responses to pain are intense.
Tongue Tie Surgery Before and After
The differences in the tongue before and after tongue tie surgery have mixed results.
Some people report amazing results after tongue tie surgery. If they were having trouble breastfeeding, some women report that it immediately got better.
That wasn’t the case for my daughter and I. Breastfeeding actually got much worse.
But I’m not the only one who’s reported negative results. This article gives an example of another mom and baby who had a bad experience. She says:
“My daughter screamed right away. She’s crying, I was crying. My mom was crying. It was awful,” recalls [the mom]. “I felt so guilty. She looked at me as if she were thinking, ‘Why did he do that to me?’”
All the tears would have been worth it had the tongue-tie procedure, called a frenectomy, helped with the breastfeeding pain. But it didn’t. A couple of weeks later, [the mother] started exclusively pumping.
This woman didn’t have any resolution with her breastfeeding pain.
But many tongue tie surgery providers show studies where a high number of participants showed overwhelmingly positive outcomes. These studies are showed to moms, convincing them that the surgery will solve all their problems.
There’s something wrong with that though.
The negative outcomes are often greatly underreported. This is especially true in most tongue-tie studies. The studies are done primarily by tongue tie activists who have an interest in providing expensive surgeries.
Does tongue tie surgery work?
It really depends on what the the expected outcome is. If the outcome is snipping or cutting a baby’s tongue – yes, tongue tie surgery achieves that end.
But it doesn’t always solve the problem that prompted the surgery in the first place.
If breastfeeding problems are the reason a mom seeks help, they often aren’t solved by the surgery.
Sometimes breastfeeding problems can be caused by torticollis (over tight neck muscles), which produces similar symptoms to a tongue tie.
Or they could simply be because young babies have difficulty breastfeeding.
Some tongue tie activists will tell moms that they have to revise the tongue tie or else their baby will:
- Have speech problems
- Have breathing problems
- Not swallow right
- Need braces in the future
But there is no substantial evidence that a tongue tie surgery could prevent those problems and many people without tongue ties have these problems.
Speech therapy, massage or chiropractic are all great non-surgical options that can solve many of these concerns.
Laser vs. Clipping
In my experience as a Lactation Counselor, I’ve seen few babies with true tongue ties. These babies had their ties snipped by the doctor and 5 minutes later were breastfeeding nearly perfectly.
Deep clipping or laser treatment of the tongue has not been proven to help tongue function versus a shallow snipping.
Be sure to do your research, get many opinions if you must, and find a good provider to diagnose your baby if you think they have a tongue tie.
Lactation consultants are not qualified to diagnose tongue ties so be wary if one tells you your baby has a tie. Only qualified professionals who want to first do no harm should be assessing your baby’s tongue and determining if they need tongue tie surgery.
Common Questions About Tongue Tie Surgery:
Is tongue tie surgery painful?
Yes, tongue tie surgery involves cutting or lasering your baby’s tongue. Babies feel pain, just as adults do and perhaps even more intensely.
Is tongue tie surgery necessary?
It depends on the situation. If your baby is eating well, and breastfeeding doesn’t hurt then generally it isn’t necessary. Getting a tongue tie diagnosed can be difficult because there are many opinions surrounding the procedure.
Try to find someone who is qualified and looks at your baby as a whole. Pediatricians are probably the best providers to diagnose a tongue tie, but midwives, dentists and nurse practitioners are qualified as well. Lactation consultants cannot legally diagnose tongue ties.
How long is recovery from tongue tie surgery?
It depends on the type of tongue tie surgery. A shallow snipping will heal within days and may not show many side effects.
Deeper cuts could take 10 or more days to heal.
Laser tongue tie surgery usually takes 4-6 weeks to heal because of the intense aftercare stretches that are required to prevent scar tissue and reattachment.
More Evidence-Based Information on Tongue-Ties
Kealy Hawk, BSN, RN, CLC
Kealy is a Registered Nurse, Lactation Counselor, and most importantly a mommy! Her own baby feeding struggles gave her a passion to help moms throughout their feeding journey. She specializes in breastfeeding support and evidence-based formula recommendations. To talk with Kealy or take one of her breastfeeding or formula classes, visit https://littlebearcare.com.