What Makes

The Agave Approach 


We are proud to offer a complete solution to issues related to oral ties. The ‘Agave Approach’ is executed by pediatric professionals who are driven by sound clinical judgment, cutting edge research, and a highly individualized approach to every family, clinical and social situation.

We have more than a decade long history with over 10,000 procedures performed with extremely high success rates. However, we also manage a significant proportion of referrals to us through careful observation without performing a procedure. Our team at Agave Pediatrics is committed to being advocates for your children and helping your family to get the best results. 

Our team has been instrumental in disseminating information and educating providers all over the world on our approach to tongue and lip ties through national & international conferences. Please visit our Events page for more information about upcoming clinics, meetings, or conferences (none currently due to COVID).

The following sections highlight our approach and how these core values make us different.

Holistic Pediatric Lens

We view your child through a holistic, pediatric lens. While the research estimates vary, tongue tie is probably more common than recognized. Some studies indicate that as many as 5-20% of children may be affected by ankyloglossia (tongue tie) and many cases are familial.

Agave Pediatrics, under the direction of Dr. Rajeev Agarwal, has developed a clinically successful, evidence-based, compassionate and thorough approach to the treatment of tongue tie and upper lip tie. With well over a decade of experience and having completed over 10,000 successful corrective procedures, our conservative model of care is highly sought after.

Dr Agarwal examining tongue tie in infant

Lip Ties Are Different

While an upper lip tie may cause problems, research indicates the tongue as the primary contributor to feeding challenges, speech difficulties, and oral motor dysfunction. Agave providers take all procedures involving children very seriously and we approach the surgical correction of oral ties with a conservative, necessity-based model of care.


A lip tie may or may not need correction. New evidence on this topic continues to emerge but current research does not support the necessity of performing both procedures, ie tongue and lip tie, at the same visit. In fact, many children never undergo release of the upper lip tie because of the improvement noted to feeding or speech after a tongue tie procedure alone. In roughly 50% of patients, this “watchful waiting” results in improved feeding or speech without having undergone an upper lip tie procedure. Two or more surgical wounds in a child’s mouth, with limited options for pain management, may increase a child’s risk of poor feeding related to pain and subsequent dehydration, oral or feeding aversions, bleeding, and reattachment to at least one site as parents must perform double the amount of wound care exercises. These are well-defined risks and all the more reason to take caution when making surgical decisions.

Do No Harm

Do No Harm: With this concept as our guiding principle, Agave Pediatrics consistently follows a well-established protocol for the treatment of tongue ties. Our model of care includes a coordinated, well-rounded approach by our multi-disciplinary team which has achieved a high rate of success in improving
lives of children diagnosed with tongue tie.
Specialists on our tongue tie team include pediatricians, nurse practitioners, speech language pathologists, lactation consultants, bodyworkers, and our all-important tongue tie schedulers and coordinators.

Parent education about the procedure, including aftercare, are important components of our program.
We have a balanced approach that allows time for parents to absorb information and receive ongoing support as the treatment process moves forward.

In respect to corrective procedures, we believe in the concept that “less is more”. We usually perform a tongue tie procedure first and do the lip tie two weeks later, only if needed. Such children are followed by close observation to see if a lip procedure is needed. One procedure alone is often all that such children need for successful management.

Multi-Disciplinary Approach

Our multi-disciplinary team of doctors, lactation consultants, speech pathologist and nurse practitioners specializes in diagnosing and treating children of varying ages with tongue ties and lip ties not just in Phoenix, but all over the state. We have performed thousands of corrective procedures with astounding success, facilitating healthy breastfeeding for babies and mothers as well as improved speech and dental health for older children. 

We have pioneered the concept of pre-procedure consult and post-procedure follow up in our care protocols. In addition we offer specialty post-frenectomy clinics and use cutting edge laser technology to perform the frenectomy. Many other practitioners  do not do pre or post procedure consults and follow up. They may also use scissors or electro-cautery, which may increase the risk of bleeding, or pain after the procedure, when compared to the laser method.


Dr. Agarwal at Agave Pediatrics has performed thousands of these procedures and has an impeccable safety and success record. Our team at Agave Pediatrics is committed to remaining advocates of infant and child health. 

Education & Research

Our team has been very active &  instrumental in disseminating information and educating providers about tongue tie all over the world. This  has been achieved through on-site training in our clinics, as well as participation in national & international conferences

Agave has also been conducting original research in the tongue and lip tie fields. The team members of Agave are working on several IRB-approved clinical and translational research projects, including genetics and diagnostics of tongue/lip ties, relationship between tongue/lip tie and neurodevelopmental disorders, and development of a novel oral manometer to aid in oral dysfunction diagnostics.


Collaborative research partners include Phoenix Children's Hospital, Arizona State University, and leading companies like LightScalpel and PADT, Inc.


We have a large number of satisfied parents, of kids who were treated for tongue and/or lip tie, who have provided testimonials over the years. We also have a Facebook group devoted to kids who have had a frenectomy or may be candidates for the procedure. 


Check out our testimonials page for what some of the parents of children treated at Agave are saying. 

Child looking at office decor