How to cut a tongue-tie

How is a baby’s tongue-tie clipped?

Tongue-ties are most commonly cut with scissors (clipping) and this remains the gold standard. Recently, laser surgery has become popular. The latter is more expensive and may take longer to heal than clipping. Clipping a tongue-tie in a baby is usually done using a special tool to lift the tongue and stretch the frenulum, making it easier to cut. Most babies tolerate the procedure well, with little crying and bleeding. Tongue-ties can also be cut using a laser to burn away the frenulum. It seems relatively safe, but there is little information on the long-term risks and benefits. Babies can be given a small amount of a sugar solution right before the procedure to decrease the pain. Babies who breastfeed can be breastfed right afterward. Tongue-tie surgery can be done on healthy babies soon after birth, but sick babies should not have it until they are growing and healthy. 

A) When to cut a tongue-tie

Clipping a tongue-tie. A special tool (grooved director) lifts the tongue and scissors cut the frenulum.

Healthy babies may have a tongue-tie cut soon after birth. Toddlers and older children generally need sedation for the procedure, creating more risks for the child. For this reason, parents often decide to have the tongue-tie cut when their baby is young instead of taking a wait-and-see approach.

Cutting should be delayed until the baby is growing and healthy if the baby:

  • Is sick and unstable.
  • Has other abnormalities of the mouth.
  • Has muscle weakness.
  • Has a bleeding disorder.
  • Has not received vitamin K.
  • Has not been not been growing well.

B) How to cut a tongue-tie

A special tool (grooved director) to lift the tongue and stretch the frenulum.

A tongue-tie can be cut by:

  • Using:
    • Scissors (clipping)
    • A scalpel
  • By burning with:
    • A laser
    • Electricity (electrocautery)

Adults having tongue-tie surgery are often given local freezing before the procedure to control the pain, but babies are generally not as it does not appear to offer benefits and can pose risks (ABM 2004; Bhattad 2013; Messner 2020; Mettias 2013). Babies can be given a small amount of a sugar solution right before the cutting to decrease the pain and those who breastfeed can be put to the breast right afterward (Stevens 2016).

1) Cutting with scissors

Cutting the baby's tongue-tie with scissors (clipping) is often done using a special tool to lift the tongue and stretch the frenulum. The frenulum is then cut with scissors. This is the most common method for cutting a tongue-tie.  

Babies who have their tongue-ties clipped with scissors usually tolerate the procedure well, with little crying and bleeding afterwards (Griffiths 2004).

2) Laser surgery

Another kind of surgery uses electricity or a laser to burn the frenulum. This kind of surgery seals blood vessels, so there is generally no further action needed to stop bleeding. However, life-threatening bleeding can still happen (Kim 2020).

Laser surgery seems relatively safe, but there is a marked lack of information on the short- and long-term risks and benefits. Studies on the issue are poor (CADT 2016).

3) More aggressive surgery

In one study of the anatomy of the frenulum, there was no evidence that the deeper tissues of the frenulum, including the tongue muscle (genioglossus), prevented normal movement of the tongue (Mills 2019). They argue that there is no need for cuts to be made into the tongue muscle and that this only increases the risk of pain and scarring. As such, very deep cuts should be avoided.

Deep cuts may be necessary in rare circumstances and are performed by specialized surgeons. These require general anesthesia and the risk of complications is higher (Bahadure 2016; Khan 2017).

4) Choosing a method

To date, there are no published studies comparing the safety or effectiveness of these different methods (Hill 2020; Khan 2020; LeFort 2021; Messner 2020). Tongue-ties have been cut using scissors for a long time and this remains the gold standard (LeFort 2021). Animal studies show faster healing when scissors are used compared to laser surgery; this may also apply to babies. The delay in healing may be caused by heat injury to the frenulum and areas around it (LeFort 2021).

Individual prices vary but laser surgery is significantly more expensive than clipping.

C) Aftercare

It is important that babies are followed by their health-care providers after surgery to identify complications and ensure continued good growth.

Tongue-ties sometimes reattach themselves. The estimated rate of reattachment ranges from 0.003% to 13% (Brookes 2014). One study found that posterior tongue-ties were more likely to reattach (21%) than anterior ones (3.7%) (Hong 2010) . 

Reattachment can be seen as soon as one week after cutting with scissors and it is possible that further surgery can be prevented by tearing the new growth manually at that time (Nelson 2021).

Some health-care providers tell parents to stretch the baby’s wound after laser surgery so it does not scar and re-tighten. These stretching exercises are generally done several times daily for two to six weeks. Many mothers have told us the exercises are very painful and upset their babies and caused occasional bleeding of the wound. Experts have stated that there is no evidence to support massage or stretching after surgery (LeFort 2021; Messner 2020).

D) Complications

Minor bleeding is more likely with clipping then with laser surgery. It can be stopped with:

  • Pressure on the bleeding area.
  • Silver nitrate, which chemically seals the blood vessels.
  • A stitch.

Major and minor complications of tongue-tie cutting include (Solis-Pazmino 2020; Varadan 2019):

  • Infection
  • Bleeding (Tracy 2017;Walsh 2017)
  • Life-threatening bleeding (shock)
  • Infection (Isaiah 2013)
  • Life-threatening infection of the base of the mouth (Ludwig’s angina)
  • Cutting or injury of:
    • The salivary duct
    • The nerves of the tongue causing decreased feeling or movement
  • Cyst growth
  • Regrowth, reattachment, and scarring
  • New or worse feeding problems (Hale 2019)
  • New or worsening of existing speech problems
  • Airway blockage (Genther 2015; Hale 2019)
  • Refusal to take in milk by mouth (oral aversion)


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