I often get asked what normal healing is and how one will know if their baby’s tongue or lip-tie has reattached. When we release a tie we expect the frenulum to reform. Our goal is that the frenulum will reform in a way that allows for greater mobility of the tongue or lip. A successful procedure is one where all of the symptoms that the mom and baby were experiencing completely disappear by the end of the healing time.
Immediately after the tongue and lip are revised, you will be able to see a diamond shaped wound. This diamond is what allows for more mobility. We do not want the top and bottom of the triangle to attach to each other, which would result in a short, tight frenulum and little to no change. Our goa; is that the sides will heal together and form a new frenulum that is long and gives the tongue or lip adequate mobility. Over the next couple of days, the diamonds will turn white, yellow and greenish; this is what a wound that is healing in the mouth looks like.
Healing: What is Normal?
In order to facilitate the proper healing of lip and tongue releases, we strongly recommend a regimen of stretches to be done six times a day, no more than six hours apart. This does mean you will have to stretch the wound site in the middle of the night, even if it means waking your little one. Most parents of my patients do five sets of stretches during waking hours and one during the night. As the wound heals, scar tissue will grow into the revision site to reform the frenulum. This is normal. The purpose of the stretches is to get this tissue to reform differently: long and further back along the tongue than it was before. If stretches aren’t done, there is a high likelihood that tongue will form a short frenulum again, which may require another procedure. This is why it is so important to be diligent and effective when it comes to the stretches. Doing the stretches is one of the main components of a successful revision.
The healing process can feel like a rollercoaster ride. When your little one is returned to you right after the procedure you may or may not notice any difference in how breastfeeding goes. The most common thing I hear from moms is that their little one seemed confused and “it felt different”. Often it’s not painful in the way it was previously. Don’t be surprised if the latch right after the procedure is the best latch you have for a few days. It may get worse before it gets better. Some babies do well to be stretched right before breastfeeding, others will need to be stretched after. If your baby refuses to nurse, mix things up. I most often see a turning point in how well breastfeeding is going around the two-week mark. Be strong and diligent; the benefits are worth the initial effort! Over time, the diamond under the lip and tongue will start to look more and more like a normal frenulum but this is normal.
For some babies, releasing the frenulum is only part of the picture. The baby may need help relearning how to use her “new mouth.” This team is often made up of a lactation consultant, your pediatrician, your frenectomy provider, and a body work provider. Working with the other members in your team will help get you the rest of the way to success.
Healing: What is Abnormal?
Many parents ask how they will know if the site becomes infected. One of the wonderful aspects of the laser is that it sterilizes the wound as it makes it by vaporizing anything it touches. As the healing process progresses, the biggest sign of an infection would actually be if your little one develops a fever. If this happens, call your provider right away.
Using the term reattachment to define an unsuccessful procedure is misleading. As discussed earlier, all of the tongues and lips that I revise have the frenulum reform. If either mother or baby’s symptoms return, or the baby is unable (not just temporarily unwilling) to eat from either breast or bottle, contact your provider.
Why would the tongue or lip need to be revised again? Sadly, some baby’s have to have their lip or tongue released multiple times. Our goal is to ensure that the first release is the only release. There are two factors that affect the final mobility and therefore success for your little one. The first problem arises from an incomplete release of the ties. Many babies are only having their anterior tongue ties released. For most babies, this won’t be enough. If the posterior tongue tie is not released, your little one won’t have the proper upwards mobility of their tongue. The other problem arises from improper wound management after a release. If the lip or tongue heals improperly, they won’t have proper mobility. Post-op stretches are key to ensuring proper healing.