Procedure, Exercises, & Aftercare

Tongue & Lip Ties - Procedure, Exercises, & Aftercare

Upper lip tie in older child immediately post-procedure

Frenectomy Procedure

Dr. Agarwal at Agave Pediatrics has performed thousands of tie release procedures for tongue (lingual frenectomy) and lip (labial frenectomy) ties over the years. On the day of the procedure, Dr. Agarwal will assess your child once again and discuss the procedure and any possible complications with you. The procedure involves little to no pain for the child and has improved feeding and speech for many children. ● Tie release is a brief and minor procedure done in a treatment room in our office (at either the Chandler, Goodyear, or Glendale location). ● The child is given a local anesthetic injection to numb the site. ● A laser is used to release and cauterize the tissue under the tongue or lip. As the tissue is being released, it is continually checked for any bleeding, as well as for appropriate range of motion such as lift and extension. ● After the procedure Dr. Agarwal will show you the results. ● Exercises and wound care will be reviewed with you ● Pain management will be reviewed with you. ● If you are breastfeeding or bottle feeding, we will encourage you to complete a full feeding cycle while in the office so that both infant and you are as comfortable as possible for your trip home.

After the Procedure

Immediately after the procedure, our staff IBCLC will guide you to a lactation room and assist you in latching your infant. If you are working with a lactation consultant, you will be referred back to your IBCLC for follow-up approximately 3 to 5 days post-procedure.

You will be encouraged to complete a full feeding while in the office so that both mother and infant are as comfortable as possible for the trip home.

Please take note of what the incision looks like immediately after the procedure. Take a photo of the white diamond shaped wound that becomes visible under the tongue in the first 24 hours after the procedure. The white diamond should remain the same size; it should not get smaller or disappear.
The aftercare handout can be found here. Healing tongue tie showing white diamond With every set of exercises, check for re-attachment by noting the size and shape of the white diamond. The white diamond should remain the same shape with distinct, straight edges. It should be even from side to side: the edges should not look muddled or “tucked in.” You should not see tissue protruding from the base.
If you detect re-attachment, please call the office for further instruction. Some reattachment is expected, but minimizing it is important for over-all improvement. Possible Bleeding: At times, the exercise sessions can cause a small amount of bleeding. If this occurs apply firm pressure to the wound with a clean cloth or cotton ball. Breastfeeding your infant will also help bleeding to stop. If bleeding does not stop, the child needs to be evaluated immediately. If you have questions, check out our FAQs, contact us, or visit the tongue tie support clinic.* *The in-person tongue tie support clinic is currently on hold due to COVID-19 precautions, but we offer support via text, email, or phone. With a lactation consultation, you can bring your infant for in-person guidance, support, and discussion with our IBCLCs.

Pain Management

Proactive pain management is very important. For most children, the first 72 hours are the hardest. The use of Tylenol or Ibuprofen based on your child’s age and weight and Arnica 30 C, (a homeopathic remedy) will be helpful. Dosage information is included in the packet you received at your consult, as well as in the email that was sent to you, and is also available on the aftercare handout. ● Initially, your child’s mouth will be numb at the site of the procedure. This will last for approximately 2 hours. ● Please prepare to ease your child’s discomfort by having pain medication on hand before procedure day. ● If you have traveled a distance of a couple of hours, please bring Tylenol or Ibuprofen so that you can give a first dose before traveling home. ● If your child is uncomfortable with the exercises, be sure that their pain is being managed.

Post-Procedure Exercises

You will be shown the post-procedure exercises immediately after the procedure is done, and there are explanations of the exercises in the aftercare handout. There are also videos of the exercises in the email you received regarding the procedure. Stretches should begin 6-8 hours after the procedure, and should repeat every 4 hours (6 times a day) for the first two weeks. At your follow up appointment, you will be told how often to do the stretches for the next two weeks. This part of aftercare can feel overwhelming and challenging for parents, but they are incredibly important. The goal of these exercises is to keep the healing tissue open and separate, in order to prevent reattachment, and to encourage the movement of the tongue. These exercises do not need to be forceful: they should be gentle but firm. You do not need to touch the wound during the exercises, as all the stretching is done by lifting around the wound, NOT directly on the wound. However, if you do touch the wound, it is fine, and does not increase the chances of infection. Talk to your child, make funny sounds and faces. You can do the exercises randomly so your child doesn’t negatively anticipate them. They can be done before or after a feeding, nap, diaper change, etc. Position your baby on a stable surface such as your lap or a changing table so that you can see into baby’s mouth. If helpful, place a rolled-up hand towel or receiving blanket behind their neck to help their head flex back, making it easier to see the inside of their mouth. You can do these exercises facing the baby, or from above the baby’s head, with their feet pointing away from you. Sometimes when the baby is crying and their
tongue is raised, a quick set of exercises can be done. Some babies will sleep through the stretches.