A frenulotomy is a minor surgical procedure that releases the frenulum to enhance tongue mobility.
The procedure involves making a small incision in the frenulum with sterile scissors. It’s quick, often completed in a few minutes, and typically performed in a clinic or at home by a trained professional.
Immediate feeding post-procedure helps manage any minor bleeding, soothe the infant and allows them to adapt to the increased range of motion. While the procedure is considered safe, it is not without potential risks, and parents should fully understand the implications before proceeding.
What to expect at a frenulotomy appointment:
- Reassessment of symptoms, oral function and body tension
- Tongue Tie division
- Post division feeding support
- Aftercare information
- Information on how to support optimal healing
- Individualised feeding plan
- Individualised oral exercise programme
- Access to unlimited follow-up – additional fee apply
Risks of the frenulotomy procedure:
- severe bleeding
- infection
- damage to surrounding structures
- ulceration
- pain
- adapting to new mobility of the tongue
- reoccurrence
- no improvement or worse feeding outcomes
How likely am I to experience complications?
Severe bleeding
It is expected that there will be little to no bleeding after a division. You will be asked to feed your baby immediately after the procedure, which usually applies enough pressure to the wound to stem any bleeding that may have occured.
In a small number of patients (estimated 1 in 500), it is also required to apply pressure using a sterile gauze for approximately 20 minutes. It is extremely rare for a patient to need any further intervention than this (less than 1 in 1000).
Infection
If there is an active infection in your baby’s mouth, then the procedure may be delayed until the underlying infection has been treated. Further to this, there is added protection for breastfed babies, as breastmilk is known to be protective against infection. Signs of an infection would be if your baby seems sleepy, unsettled, refusing feeds, fever. Infection is very rarely reported In the literature so incident rates are difficult to determine.
Damage to surrounding tissue/structures
The frenulum is close to other structures under the tongue, including the salivary ducts, small blood vessels, nerves, muscles, and the mucous membrane and fascial tissues that form part of the floor of the mouth and surrounding attachments. During frenulotomy, there is a small risk of unintentionally injuring these nearby structures.
One of the largest UK randomised controlled trials investigating infant frenotomy, the FROSTTIE trial, reported two cases of injury to nearby structures out of 169 procedures (approximately 1.2%). These included one salivary duct injury and one accidental cut to the tongue with associated salivary duct injury. No long-term complications were reported in relation to these injuries; however, these events demonstrate that injury to nearby structures, although uncommon, is a recognised potential risk.
The exact risk is difficult to measure because small injuries may not always be recognised or recorded at the time of the procedure, may heal quickly without causing symptoms, and may not be identified during routine follow-up. Differences in clinical experience, recognition of potential complications, documentation methods, clinical photography, and follow-up processes between services may also affect how often these events are detected and reported.
The Natal Network routinely monitors outcomes from procedures performed within our network using clinical photography, documentation, and independent peer review. Between August 2025 and August 2026 injury to nearby structures/ tissue was identified in 1.1% of procedures.
This figure represents our own service monitoring data and should not be considered a universal risk estimate for all practitioners or settings. However, routine review helps us identify patterns, improve clinical practice, and support ongoing patient safety.
Current evidence does not allow us to provide an exact percentage risk of permanent injury to the tongue, salivary ducts, nerves, or muscles following frenulotomy. The risk of lasting problems appears to be very low, but it cannot be considered zero.
Ulceration
Approximately 48 hours following the procedure, there will be a white or yellow diamond-shaped wound under the tongue. This resembles an ulcer, as the moisture within the mouth prevents a scab from forming, taking approximately 14 days to heal. It can be easy to mistake this wound for an infection, especially if yellow patches become visible. Be reassured that these yellow patches are usually bilirubin and common in the healing process. It is not an indication of infection.
Pain
During a frenulotomy, your baby may cry or show signs of discomfort briefly, much like they would during a vaccination or a heel prick. The discomfort usually lasts only a few seconds, and most babies are quickly soothed by breastfeeding, cuddling, or skin-to-skin contact right afterward. The procedure is quick and over in seconds, and babies often settle almost immediately. Interestingly, one study reported that 18% of babies slept through the procedure. This can be accounted for by the lack of nerve endings within the frenulum.
Anaesthetic is not recommended, as even local anaesthetics may impact feeding post-procedure and the injection itself would likely be more upsetting to the infant than the procedure.
Babies over 3 months can be given liquid paracetamol; those younger than 3 months can consult with their GP before the appointment and obtain a prescription for pain relief. Medical pain relief, however, is not generally necessary.
Reoccurrence of tongue tie
Reattachment of the tongue-tie (frenulum) refers to the reformation of restrictive tissue or scar tissue at the site of the frenulotomy, which can lead to a return of tongue restriction and feeding or functional difficulties. While it’s one of the more commonly discussed complications, the actual incidence is relatively low when post-procedure care is appropriate (4 in 100)
No improvement or worse feeding outcomes
Unfortunately, we cannot guarantee positive outcomes, as releasing a tongue tie is only part of the solution. It may take time for improvements to be seen, and in some cases, symptoms have been reported to have become worse post-procedure.
The evidence is clear that the most favourable outcomes are seen when a release is performed alongside skilled infant feeding support and a multidisciplinary team approach. Further appointments and support may be recommended by your practitioner as part of the ongoing care. Favourable outcomes can never be guaranteed.
What are the benefits of frenulotomy (tongue tie division)
Following an accurate diagnosis of a restricted frenulum, tongue tie division has been shown to be an effective treatment for a wide range of infant feeding difficulties. Research indicates that many parents notice improvements in feeding, with a significant number reporting increased comfort during breastfeeding. Over time, babies typically achieve normal tongue function and many show improvements in related issues such as reflux symptoms. Tongue tie division has also been associated with better growth outcomes in infants who were previously struggling and a higher continuation of breastfeeding over the longer term.
What if my baby hasn’t received vitamin K?
We can still perform a frenulotomy if your baby hasn’t received vitamin K, as long as you fully understand and accept the increased risk of uncontrolled bleeding.
Although the risk of Vitamin K Deficiency Bleeding (VKDB) is low, it cannot be predicted in infants who have not received vitamin K. VKDB can occur in three forms:
- Early VKDB (within 24 hours) affects around 1 in 250 to 1,000
- Classical VKDB (between 2–7 days old) affects about 1 in 10,000 to 25,000 infants
- Late VKDB (between 2 weeks to 6 months) occurs in approximately 1 in 50,000 to 150,000 infants.
Without supplementation, there’s a chance your baby could bleed more heavily than expected after the procedure, and in very rare cases, this could be life-threatening.
If your baby hasn’t received vitamin K, you will be asked to give informed consent before proceeding with the frenulotomy. The clinician will clearly explain the potential risks, answer any questions you may have, and ensure you feel comfortable and confident in your decision.
If you prefer, you also have the option to delay the procedure until your baby has received vitamin K. If you’re still unsure or have any concerns about vitamin K, VKDB, or the frenulotomy itself, please speak with your midwife, GP, or one of our clinicians, who can provide you with up-to-date information and support you in making the best choice for you and your baby.
