When should a lip tie be cut?

When to Cut a Lip Tie

A lip tie should be cut when it causes functional problems such as breastfeeding difficulties, or when it leads to anatomical issues like alveolar hypoplasia, but most cases should be addressed only after non-surgical interventions have failed.

Assessment and Indications for Lip Tie Release

When evaluating whether a lip tie requires surgical intervention, consider:

Functional Problems

• Breastfeeding difficulties
  • Poor latch due to inability of the upper lip to flange properly 1
  • Maternal nipple pain 2
  • Inadequate infant weight gain 3
• Reflux symptoms (which may improve after frenotomy) 2
• Restricted lip mobility affecting feeding 4

Anatomical Concerns

• Severe restriction causing alveolar hypoplasia or bony anomalies 4
• Deep philtral sulcus with low vermilion border due to tight frenulum 4

Decision Algorithm for Lip Tie Management

1. First line: Non-surgical management

   • Breastfeeding support and consultation
   • Positioning adjustments
   • Manual stretching exercises

2. Consider surgical intervention when:

   • Non-surgical interventions have failed
   • Clear functional impairment exists
   • Anatomical abnormalities are present or developing

3. Timing considerations:

   • For breastfeeding issues: Early intervention (under 60 days of age) may be beneficial 1
   • For anatomical concerns without urgent functional problems: Can be addressed between 3-5 years of age 5

Surgical Approach

When surgical intervention is indicated:

• Technique options:

  • Simple frenotomy (incision of labial frenulum) 1
  • Z-plasty for more severe cases 4

• Setting:

  • Minor cases: Can be performed in-office 1
  • Complex cases: May require operating room setting 3

Expected Outcomes

Research shows that properly selected patients may experience:

• Improved breastfeeding latch (82% of cases) 1
• Increased maternal satisfaction with breastfeeding (73%) 1
• Resolution of lip pain within 24 hours in most cases 1
• Improved infant weight gain 3
• Correction of lip contour and mobility 4

Potential Complications and Considerations

• Low recurrence rate (approximately 9%) 1
• Minimal risk of infection when properly performed 1
• Transient discomfort that typically resolves quickly 1

Important Caveats

• The evidence base for isolated upper lip tie treatment is still developing 6
• While anterior tongue ties have strong evidence supporting intervention, posterior tongue ties and upper lip ties are still being studied more intensively 6
• Surgical intervention should be considered only after proper assessment and when conservative measures have failed
• Cosmetic concerns alone rarely justify early intervention unless associated with functional problems

Special Anatomical Considerations

For lip ties in aesthetically sensitive areas like the lip, the final cosmetic result is often superior when growth of the lesion has ceased and the number of surgical interventions can be minimized 5. However, early intervention may be warranted when the lip tie is causing significant functional problems or anatomical distortion.