Lip Tie - Definition, Symptoms and Treatment

Labial Frenulum and Lip Tie

Lip Tie Release Surgery, Labial Frenulum, Frenum,Frenectomy,Labial Frenectomy

What is Lip Tie?

The piece of tissue behind your upper lip is called the frenum. This structure extends between the inner surface of the upper lip and the gingiva, and limits lip movement. Sometimes it is possible for this structure to pass between the upper teeth and extend to the hard palate and cause an effect on the jaw and tooth structure depending on the tension it has made. When these membranes are too thick or too rigid, they can prevent the upper lip from moving freely. This condition is called lip tie.

Lip ties are not as scientifically researched as tongue ties, but treatments for lip ties and tongue ties are very similar. Lip ties and tongue ties can make breastfeeding difficult in infants and in some cases may cause babies to have difficulty gaining weight. Especially short, tight and thick ones have more symptoms. A lip tie is not a major physical abnormality in a baby. But if left untreated, it can cause problems in the long run.

What does lip tie do?

The lip tie restricts the forward and upward movement of the upper lip. It acts as a fixing band between the gingiva and the inner surface of the lip. Although tongue ties have the task of fixing the tongue to the floor of the mouth in case of unconsciousness or coma, it seems that lip ties do not have a vital and health-important task.

What Causes Lip Ties in Babies?

There is no special reason for the formation of lip tie in babies. Simply put, some babies are born with a lip tie, while in others this structure is tense and non-restrictive. A lip tie condition can develop in the womb. While most experts think that it can only be attributed to genetics, there are not enough scientific studies for this theory.

A lip tie may be caused by an abnormal attached tissue due to an underlying cause. A defect in the MTHFR gene, which is also responsible for the development of a cleft lip, is assumed to be responsible for lip tie in babies. Because the condition is genetic, there is no known way to prevent it.

Is Tongue Tie Necessary For Babies With Lip Tie?

There is no evidence to suggest that a baby with a lip tie will also have a tongue tie. In fact, both areas of the baby develop in the womb at different times and with different processes. When both are present, especially breastfeeding and feeding problems (breast rejection, insufficient weight gain ...) are more likely to occur.

The maxillary labial frenulum is the membrane that connects the upper lip to the upper gums or palate. This is not an unusual situation. Having a labial frenulum connecting your lips to your gums doesn't always mean you have a lip tie. The upper labial frenulum is the soft tissue that connects the upper lip to the anterior surface of the maxillary gingiva. Also known as the maxillary labial frenulum, this fold of connective tissue originates from the midline of the lower surface of the lip. Here, the expression "lip tie" is used to mean that a membrane or band-shaped structure, which should normally be, is short or tight.

To summarize simply to avoid confusion in terminology:

Normally, the thin layer of tissue (medically called the labial frenulum) between the midline of the upper lip and the gingiva extends from behind the upper lip in front of the maxillary gums. You can see this tissue texture when the upper lip is lifted.

However, when a "lip tie" is used, the frenulum is usually thicker and may extend to the ridge of the upper gums where teeth appear. Some extreme conditions cause tissue to extend beyond the back and into the upper palate. In such cases, it can create a gap between the teeth.

In the presence of a lip tie, it is difficult to lift the upper lip. A lip tie is also known as a "tight labial frenulum" because of the stiffness of the upper lip. The term "lip tie" describes a membrane that restricts the normal movements of the upper lip. Confusingly, one can use "lip tie" to refer to the normal presence of a membrane in this area.

Lip Tie Symptoms in Babies

If the lip tie is tight and tight in babies, the baby's upper lip is usually fixed towards the gingiva, the baby's upper lip cannot be turned outwards and upwards sufficiently during breastfeeding, and the following signs and symptoms may occur. (you can see a few signs that the baby may have lip tie while breastfeeding):

Lip Tie Labial Fenulum

The signs and symptoms of lip tie in babies can be summarized as follows:
  • A weak latch during breastfeeding is often the leading sign of a lip tie because the baby's lips cannot be fixed by inserting the skin into the mouth around the nipple.
  • The baby is unable to maintain the suction on the nipple and may come out of the breast earlier than it should
  • Baby may make clicking noises due to poor latching which causes air to pass through the lips
  • More air intake leads to gas swallowing in the baby (gas swallowing and reflux are more pronounced in those with tongue-tie)
  • The baby may become fussy. This is due to constant hunger and frustration at being unable to maintain a latch.
  • When the frenulum is too tight, the baby's upper lip curls inward
  • Poor weight and height gain due to insufficient breast milk intake can slow the baby's physical growth
  • Other common symptoms that can be seen in babies with lip ties are breathing frequently and falling asleep while breastfeeding.

Symptoms that can be seen in mothers of babies with lip ties

Mothers of infants with a tight and short upper lip frenulum may experience the following symptoms:

Nipple pain: Improper latching can cause discomfort and pain in the nipple. The baby may also try to bite for nipple attachment, causing more pain
Flattened nipples: Fixed false latch can distort the shape of the nipples (take the shape of a lipstick).
Swelling of the breasts and mastitis: Since the baby cannot feed properly, milk remains in the breast. It can lead to breast enlargement, which can lead to problems such as mastitis, infection of the milk ducts
If you think that your baby cannot maintain the latching motion for a long time while sucking and cannot protect it by moving towards the nipple, you can check the lip tie.

It means that the labial frenulum, the piece of tissue that connects the upper lip to the gingiva, is too tight. Upper lip tie refer to the band of tissue or "frenulum" that connects the upper lip to the maxillary gingival tissue (upper gums) in the midline. This can make it difficult for the upper lip to move.

In babies, lip tie can cause breastfeeding problems, such as difficulty getting enough milk. It can also cause pain in breastfeeding women. The frequency of diagnosis of lip tie by doctors and other healthcare providers has increased in recent years, according to the Triological Society (source >> The Dramatic Rise in Tongue Tie and Lip Tie Treatment).

Gently lift the baby's upper lip to see a thin layer of frenulum tissue underneath. If it's attached to or beyond the back of the upper gums, the baby likely has a lip tie. If you notice other symptoms or are unsure whether it is a lip tie, be sure to have your baby examined by a doctor.

How Does Upper Lip Ties Negatively Affect Breastfeeding in Babies?

Does lip tie prevent sucking?

The baby's upper lip rests against the breast in a neutral or very light position during breastfeeding and makes a seal or latch around the breast (up to the areola area, the baby inserts the nipple into the mouth). The upper lip does not need to run away from the nipple or take shape like the lips of a fish. The baby's upper lip does not need to move up and down, hold tightly to the chest or curl.

When the upper lip is turned into the mouth (when it cannot move up and out) due to the lip tie, the baby takes a position on the nipple and places the breast area with the ducts towards the nipple instead of the milk sacs in the areola area into the mouth. Generally, in this way, only milk can be dripped into the mouth and large amounts of milk cannot be vacuumed. When he gets tired, he can pause and suckle again in the same way. In other words, lip ties can make breastfeeding difficult for babies. There are discussions on this subject. In babies with lip ties, it may be appropriate to decide on surgical treatment after breastfeeding counseling training.

"Callus" Caused by Lip Ties in Babies

In babies with unstable breast positioning and lip ties, when the upper lip and breast compression is performed, a lentil-like swelling that is more puffy than normal, located in the middle of the upper lip and sometimes covered with epithelium as if irritated, is referred to as "callus". Names such as "Callus on the upper lip - Breastfeeding calluses - Sucking pads - Sucking pads - Sucking callus - Sucking calluses - Sucking pads" are also used. It will usually disappear once your child starts cup feeding.

How Does Lip Tie Cause Teeth Separation (Diastema)?

How Does Lip Tie Cause Teeth Separation (Diastema)?

A lip tie can cause a gap between the upper central incisors, the two front teeth of the upper jaw. This is because the frenulum passes between the teeth, causing the incisors to naturally change their position. A change in the position of the incisors can further affect the location of the other teeth on the upper jaw.

Lip tie nothcing

Teeth separation with "elevator door model" in lip ties

The "automatic elevator door model", which can be simply said about the lip ties causing separation in the upper teeth, can be defined as follows:

- If you put your foot or an object between the doors while an automatic elevator door is closing, the door will open again before closing and the door will remain open for the thickness of the object you put in. In other words, the thicker the lip tie that sits between the teeth, the more likely the teeth will come out apart.

- The more force you apply while trying to open the elevator door with both hands, the more you can open the door.

Can you tell if your baby will have split teeth by looking at the lip tie?

With that, I would like to present some information below:

- when you lift the upper lip and look, the upper lip hardly moves forward and up
- if the lip tie has reached between the teeth (if it has reached the hard palate)
- If the lip tie is rather thick instead of the thin membrane structure and it is seen as thick between the teeth like this
- If there is notching in the gum line (perhaps this is a more objective finding than the ones above ...) it is possible that your baby will have separation in the upper teeth that will emerge (see the photo below).

Notching at the upper gum line

In patients with a tight upper lip tie, when there is pitting or notching in the bone structure between the upper incisors, it is a sign that there will be a gap between the upper incisors that will come out and the teeth will come out apart.

Does Cutting the Lip Ties Prevent Separation of Teeth?

If the lip tie is too tight, if it has caused notching in the bone structure on the upper gum line, tooth separation may occur after cutting, but even if the milk teeth are separated; There are children whose permanent teeth erupt normally. Although cutting the lip tie does not provide a guaranteed result to prevent separation of the teeth; There are physicians who excise the tissue between the upper incisors, especially. Simple triangular tissue removal or a simple lip tie incision is usually made for the breast sucking problem.

Does Lip Tie Affect Speech?

Can a baby with a lip tie have speech problems?

There is no significant risk in terms of speech problems due to lip tie. Also, most babies are treated before they develop speech skills. A lip tie is unlikely to affect a baby's speech development. While tongue ties can cause articulation disorders, that is, they can cause problems in the shaping of speech; This is not very likely in lip ties.

On this subject, there are resources that argue that there may be an effect in speech in children with severe lip tie as "opposite opinion". There are sources that emphasize "In some severe cases, if the lip tie is causing some discomfort to the child due to mouth opening (due to tension), it may change the oral anatomy to minimize pain, which may affect speech" ("Ankyloglossia (Tounge Tie) and Lip-Tie Issues") in Speech ..." link). 

How Can Lip Tie Cause Tooth Decay?

The most important article on lip tie and early tooth decay is by Dr. Published by Larry Kotlow. In this study, he associates the presence of a prominent maxillary labial frenulum with early caries of two teeth on either side of the frenulum (central and lateral maxillary incisors). The most likely mechanism for this early deterioration is that a prominent frenulum allows uncleaned food residues to enter the pocket between the gingiva and tooth, providing a reservoir of material for the bacteria to use. Apart from this, as a result of fixing the lip to the gingiva, there is also the formation of an insufficiently ventilated pocket between the lip and the gingiva. It has also been emphasized that lip tie makes brushing difficult in older children. Source article >> The Influence of the Maxillary Frenum on the Development and Pattern of Dental Caries on Anterior Teeth in Breastfeeding Infants: Prevention, Diagnosis, and Treatment

Breastfeeding Problems in Babies with Tight and Short Lip Ties

To breastfeed properly, the baby must be able to close their lips around the nipple. The nipple should fit fully into the baby's mouth so that the baby can move the upper lip enough to fit the nipple and create a secure latch. Some infants' labial frenulum is very short and tight, or attached lower on the gums than is typical. This can make it difficult for the baby to move their upper lip. In some babies, this interferes with the ability to breastfeed. Parents and caregivers may notice that the baby has a more prominent labial frenulum or that the baby has trouble moving their upper lip.

A lip tie is a difference in anatomy. This is not a sign of a disease or a serious problem. When a baby has no difficulty breastfeeding and breastfeeding is not painful for the breastfeeding woman, there is no reason to treat a lip tie.

Pay attention to your baby's upper lip movements!

A lip tie affects the upper lip. Look at the middle of the lip and when you lift it, you can see the lip tie as a band of tissue between the upper lip and the gums. If the upper lip is difficult to lift or the baby seems unable to move the upper lip, it may be a lip tie.

Lip Tie Symptoms in Babies

Although lip tie can affect breastfeeding, breastfeeding experts disagree about what counts as a lip tie and when or when a lip tie should be treated.

Many lactation consultants and other breastfeeding experts, Dr. It uses the classification system developed by Lawrence Kotlow (>> Diagnosing and Understanding the Maxillary Lip-tie (Superior Labial, the Maxillary Labial Frenum) as it Relates to Breastfeeding). You can also find related information when you search for lip tie classification in the search section of this website.

However, a 2019 systematic review found that this system did not reliably produce the same diagnosis among different specialists. Multiple healthcare providers may disagree about whether a baby has a lip tie (source >> Upper Lip Tie and Breastfeeding: A Systematic Review).

Some babies have symptoms while others do not. However, just because a baby has difficulty breastfeeding does not mean they have a lip tie. Also, even if a baby has a lip tie, it may not cause feeding difficulties, and fixing the tie does not always solve breastfeeding problems.

Some symptoms that parents and caregivers may notice in babies with lip ties include:

labial frenulum that looks too tight
pain during breastfeeding
poor weight gain in baby
a baby who seems fussy or irritable while breastfeeding
a baby who wants to breastfeed too often (because they are not getting enough food)
a baby who looks happier when drinking from a bottle
difficulty latching or latching the baby to the breast

However, it is important to note that many of these symptoms can also occur due to a number of other breastfeeding difficulties.

These symptoms can also occur with tongue-tie. Many babies with lip tie also have tongue tie. A doctor will usually evaluate these together.

Complications Due to Short and Tight Lip Ties

Lip tie should not be a cause for concern, except possibly for babies who are breastfeeding. When the baby does not grasp well, it can disrupt breastfeeding. It is not clear which lip ties interfere with breastfeeding, but if they do, some complications may occur. These include:
  • sore, itchy or cracked nipples in a nursing woman
  • pain during breastfeeding even after the initial adjustment period
  • increased risk of breastfeeding-related infections in women, such as mastitis or yeast infections
  • baby not gaining weight fast enough
  • dehydration or malnutrition in the infant
  • shorter breastfeeding time
  • jaw and tooth structure changes in the future
Some studies emphasize that lip tie causes dental health problems. This is because milk and food build up on the teeth, increasing the risk of tooth decay, gum disease, and other oral health problems. As a result, the lip tie causes the upper lip to remain adhered to the gingiva, resulting in a dead space (air transfer restricted areas) in that area (source >> Just Flip the Lip! The Upper Lip-tie and Feeding Challenges). However, some studies have not been able to fully prove this.

Treatment in Babies with Short and Tight Upper Lip Ties

Before seeking a medical procedure, it may be best to start working with a lactation consultant on some ways to resolve breastfeeding issues. They can help address any issue more generally, including the potential effects of lip tie.

In babies with lip tie, it is important not to offer the bottle as a feeding option to the babies as much as possible and not to feed the bottle in terms of breast rejection.

Others may prefer lip tie revision. During this procedure, a doctor will cut a small piece of tissue from the labial frenulum to help relax it. While the lip tie is cut, simple appendix (frenotomy) or triangular tissue removal (frenectomy) can be performed. During the incision, devices such as scissors, laser, thermal welding, electrocautery, radiofrequency, coblation device can be used. However, the use of devices such as laser, cautery and electrocautery that can cause heat damage can cause burns. I generally prefer to perform frenectomy with scissors and clamps in office conditions for babies younger than 5-6 months, and to perform the same procedure in older babies under sedation anesthesia with the help of a thermal welding device in hospitals.

It is important to note that laser frenectomy can cause burns and experts do not recommend this procedure for newborns. Also, while laser treatment for lip ties is becoming more common, it is expensive and not without risk. There is little evidence that it improves breastfeeding outcomes, and lip tie can sometimes reappear after treatment.

Older babies who have been lip-tied for several months may have learned compensatory strategies that no longer work after a surgery. Parents and caregivers should work with a pediatrician or lactation consultant to assist the baby nurse effectively and comfortably.

Lip Tie Release Surgery One Week After

People who do not want a lip tie revision or who want to try less invasive methods may want to make changes in the way they breastfeed the baby.

Breastfeeding Techniques for Babies with Lip Ties

A very detailed page on this subject >>

Trying different breastfeeding techniques can make it easier for a baby to breastfeed. For example, moms can try these tips:

Breastfeed the baby more often. This ensures that they get enough food. It also prevents the breasts from getting clogged and hard. It is more difficult for a baby to breastfeed from firm breasts.

Lower the baby's chin. This can help them gain a deeper grasp.

Try making a dimple under the areola by squeezing the area around the nipple just before baby latches on. Place their chin in this recess under the nipple.

Express milk by hand or with a pump. This ensures adequate milk supply if the baby cannot breastfeed effectively. It also provides another option for feeding the baby.

An upper lip tie can affect a baby's ability to flank in a number of ways. The first is the most obvious – the shorter and tighter the frenulum, the more uncomfortable it is for the baby to bend that lip outward, even if the mother opens it by hand. After a few minutes, the baby will relax enough to either completely remove the breast or very briefly loosen the latch on the skin to allow the upper lip to return, this is a more comfortable position. The mother often complains that she has to turn her lip upwards in frustration. The second way a tight upper lip tie affects breastfeeding is based solely on muscle flexibility. To open their mouth wide, a baby without an upper lip tie pushes the upper lip towards the nose. When the upper lip tie is present and the lip naturally rolls inward, the muscle around the lip (orbicularis oris muscle) cannot be pushed towards the nose. This puts an unnatural amount of tension on the lip muscle. Try this yourself. First, open your mouth naturally as wide as possible. Compare this feeling with an attempt to forcefully squeeze your upper lip and then open your mouth wide. In the upper lip, you will feel tension in the middle part (not the entire upper lip). If the lip is tight, the baby cannot open their mouth wide (source >> How Does An Upper Lip Tie Affect Breastfeeding?).

Lip Ties Examination

In infants, lifting the upper lip upwards with two fingers is sufficient to see and diagnose the lip tie. Whether the lip tie reaches the interdental, hard palate area, its tension and thickness should be evaluated.

How is Short and Tight Lip Tie Diagnosed?

Lip ties are one of the least diagnosed conditions. Lip ties can often be delayed in diagnosing because they are rare (in fact, due to insufficient diagnostic and screening studies) and many of their symptoms are similar to other conditions. In babies with lip tie, the upper lip can be simply lifted after the mother notices the symptoms such as "callus formation" that looks like a lentil grain in the middle of the upper lip, superficially latching on to the breast, malnutrition, lip not turning outward and upward while breastfeeding. Diagnosis is made after it is seen. When making the diagnosis, apart from the anatomical location and classification of the lip tie, the tension force felt when lifting the upper lip, the presence of notching in the bone in the hard palate and gingival region, and the presence of callus in the midline of the upper lip should be evaluated.

You Can Easily See Lip Ties By Lifting The Upper Lip While Your Baby Is Sleeping!

Just lift the upper lip upwards and you can easily see the lip tie while your baby is sleeping

Anatomical Classification of Lip Ties in Infants

What are the different lip ties in babies?

Depending on the degree of attachment of the frenulum to the upper gum, there may be differences in the type of lip tie.

Below is the lip tie classification system created by Dr.Kotlow:

Class 1: Attachment of the frenulum to the upper gum is minimal and not significant enough to cause any problems.
Class 2: The frenulum extends further into the upper jaw, but is mostly attached to the outer gums.
Class 3: The frenulum tissue adheres to the back of the maxillary gingiva and fills the space between the two anterior teeth of the maxilla.
Class 4: It is a case of lip tie that can reach beyond the hard palate of the frenulum tissue and severely restricts upper lip movements.

The lip tie classification here is made "anatomically". In other words, it is not considered whether the lip tie is elastic or stretched.

Does Lip Tie In Babies Heal By Itself?

When there is lip tie in babies, surgery is usually performed in the early period due to breastfeeding problems and feeding problems. Although there is a possibility of tooth decay and disjointed teeth in advancing ages; It is also argued that lip ties can become more elastic on their own and do not cause serious health problems. In other words, an emergency treatment is usually planned for babies who do not have breastfeeding problems and who have lip ties.

When Should Lip Ties be Cut in Babies?

In babies with lip tie, if there are breastfeeding problems and the limitation of movement in the lip tie is observed by a mother, lactation consultant and pediatrician, the baby's superficial positioning at the breast while breastfeeding despite breastfeeding counseling, nipple biting, intermittent and short-term sucking period, nipple in the mother In case of problems, surgical procedure can be planned in the early period. Immediate cutting of labial ties that do not cause any problems is not necessary.

Lip Ties Damages in Babies

Babies with severe tongue-tie or severe lip-tie may have trouble gaining weight. You may need to supplement breastfeeding with formula or bottle-fed breast milk if it makes it easier for your baby to feed. According to the American Speech-Language Hearing Association, babies with severe lip or tongue tie may have trouble eating from a spoon or eating finger foods.

Lip ties do not have many complications later in life. In babies with tight and short lip ties, the upper jaw structure may be affected in the following period, the upper teeth can be separated, and dental caries may occur.

Who Performs Lip Ties Surgery?

In babies, lip tie operation can be performed by an ear, nose and throat specialist, dentist and pediatric surgeon.

A lactation consultant can offer additional strategies based on the specific needs of the mother and baby.

Some people also get help from joining support groups. Experienced group members can provide advice on managing lip ties or recommend healthcare providers with experience in treating them.

There are many breastfeeding consultants in Turkey who are very conscious and follow up-to-date information.

How is Lip Ties Surgery Performed?

Normally, lip tie surgery can be performed in office conditions and under local anesthesia. Simple labial incision frenetomy and removal of labial connective tissue can be performed as frenectomy. Since the margins of the incision wound are less in contact with each other after frenectomy, they are less likely to reattach. Stitching is not necessary after the procedure. Sutures can also be placed to control bleeding.

Lip Ties Surgery Video

Lip Tie Reelase Surgery - Before Frenectomy, After 10 Days and After 25 Days

In the video above, there are images before, 10 days after and 25 days after lip tie release (frenectomy) surgery performed in office conditions. Details of the surgical procedure performed here:

"After the lidocaine gel was applied, a very small amount of lidocaine / adrenaline solution was injected into the lip tie with an insulin injector. The triangular lip tie area to be removed with the help of a clamp" was marked. With the help of scissors, the triangular tissue was removed and a diamond-shaped rhombic wound area was exposed. Pressure was applied with sterile gauze to control bleeding. Process terminated".

Upper Lip Tie Removal Surgery in Babies (Frenectomy)

For the upper lip tie operation in babies, it can be performed in the office after the application of gel containing local anesthetic (local anesthetic can be injected in limited amounts). Generally, lip tie surgery can be performed under office conditions for babies younger than 6 months, under hospital conditions and under sedation anesthesia for older ones.

During the procedure, the triangular area to be removed in the lip tie is marked with a clamp and can be cut with scissors. Apart from this, laser, electrocautery, thermal welding, plasma knife can also be used. As the heat damage increases, the recovery time may be longer and the pain felt after the procedure may increase. In babies older than 6 months, the procedure can be performed under simple sedation anesthesia in the hospital. In the hospital, I usually prefer to perform frenectomy with a thermal welding device, which reduces heat damage.

Things to Do After Cutting the Lip Tie in Babies

To help the baby recover better after lip tie surgery for babies, you can:

Breastfeeding immediately after the operation: Since the baby is in the mother's lap during the operation, the doctor will recommend breastfeeding immediately after the operation. It soothes the baby and the baby's sucking can be controlled. Some babies may take a few days to get the right latch. Therefore, observe and note that the baby latches onto the breast.

Soothe the pain: Baby can't take painkillers. Therefore, parents will need to use other methods to soothe the baby's pain. You can swaddle the baby, cuddle with them, take a warm bath, read a book or sing a lullaby to get away from the pain and make it more comfortable.

Be alert for any complications, watch out for signs of swelling or bleeding on the lips. If you notice that the lips or the baby still have a problem with the latch, see the doctor.

You may not be able to use a pacifier or teething toy for a certain period of time after surgery. Postoperative visits to the doctor are necessary to check if the tissue has healed and the baby can latch on to the nipple correctly. In general, the healing of the lips after a frenectomy is fast and the results are generally good.

Performing a lip tie massage after the lip tie surgery can prevent the wound from healing on itself in the horizontal plane by closing again, and heal it in the vertical plane.

Is Lip Ties Surgery Painful in Babies?

The pain felt after lip tie surgery is generally less than the pain felt after tongue tie surgery. In infants, applying cold breast milk to the wound site and frequent breastfeeding may be beneficial in reducing the pain felt and accelerating the wound healing. Usually, the pain is felt more in the first week. It is appropriate to use low-dose syrups containing simple paracetamol. After the procedure, there is usually not much change in breast sucking performance in babies due to pain in the first week.

Does Upper Lip Tie Cut Cause Breast Rejection?

After the lip tie is cut in babies, pain is usually felt in the first week. The pain felt may increase when the procedure is performed with electrocautery, laser and radiofrequency devices. Cutting the lip tie can rarely cause breast rejection in the first weeks in young babies. In infants 6 months and older who are already alive and bottle fed, breast rejection may increase the likelihood of permanent breast rejection due to pain felt in the first week.

Lip Tie Bleeding in Babies

Lip tie bleeding in babies is rarely seen after lip tie surgery. External pressure on the upper lip and cold application is usually sufficient, and a pressure of 5 minutes is sufficient to stop the bleeding. Bleeding may also occur in infants and children after trauma to the rupture of the upper lumbar tie.

Lip Ties Surgery Price for Babies in Istanbul

Upper lip tie operation can be performed under office conditions in babies younger than 6 months. In office conditions, the cost of lip tie surgery in Turkey is around 500 - 700 Us Dollars, according to the materials used for 2021.

Lip tie surgery can be performed in babies older than 6 months, usually in operating room conditions. The cost of cutting the lip tie in this way in the hospital is around 1000 - 1500 Us Dollars in affordable hospitals when it is done with the bloodless bladeless thermal welding method. Laser lip tie surgery may be more expensive and I do not prefer it because of the mucosal damage. In luxury hospitals, the transaction fee can be up to 2 times this price.

How Can You Feed a Baby with Lip Tie?

If the baby has a low lip tie, the doctor can teach you ways to gently stretch the frenulum with your finger and increase the mobility of the upper lip. You can then adjust the baby's lip on the nipple for a better latching. Babies with a lip tie can suckle more easily from a bottle. However, as I wrote before, you can think of the bottle as a faucet flowing into the mouth. There are many negative effects of bottle feeding instead of breast sucking, which is a motor coordinated movement. So you can feed formula or expressed breast milk from a bottle.

Does Lip Ties Recur?

The recurrence rate of lip tie is very low. In most babies, normal frenulum and upper lip movement occur after a frenectomy. The baby may need to be checked periodically by a doctor, even after the tissue has healed. It will help to detect any recurrence early. Generally, when a simple incision is made, partial adhesion may occur in the lip tie.

Lip ties are treated in infants because they interfere with breastfeeding, which is essential for the baby's growth. Although it is a congenital problem, there is treatment for lip tie and it usually produces excellent results. Post-treatment care and follow-up are all that is needed to treat lip tie in babies.

Newly Published Scientific Articles on Lip Ties Treatment and Health Effects in Infants

Below are a few studies and links that I would like to share with you, showing the upper lip tie surgery, its effect on breastfeeding in babies and its results. I wanted to add summaries of the studies to you. It seems to be emphasized that the positive effects of surgical treatment, the lower probability of re-adhesion compared to tongue-tie, less pain and breast rejection than in tongue-tie surgeries, especially in babies with lip ties, whose tense and restrictive effects are evident.

Upper lip frenotomy for neonatal breastfeeding problems

Without the accompanying tongue tie, the upper lip tie can prevent the upper lip from curling properly during breastfeeding, resulting in poor sealing and sucking for the baby with breast pain and maternal dissatisfaction. Due to the lack of published studies on this subject, we report our technique and results for in-office release of the isolated upper lip tie.

In properly selected infants, upper lip frenotomy has positive short-term results with mild temporary discomfort and low recurrence rate. As our study was of short duration and did not include a control group, we cannot comment on the efficacy or long-term effect of the procedure.

The Effect of Tongue-Tie and Lip-Tie on Breastfeeding

Babies with oral soft tissue abnormalities may experience breastfeeding difficulties, which may lead to discontinuation of breastfeeding. Lingual ankyloglossia (tongue tie) is well described in the literature. Upper lip ties have recently been recognized for their role in breastfeeding difficulties. Frenotomy (tongue or lip release) is a well tolerated procedure that can provide objective and subjective benefits in breastfeeding. This report discusses the effect of tongue tie and lip tie on breastfeeding and the role of frenotomy based on current recommendations and scientific literature. This information will assist the clinician in making informed decisions when evaluating a baby with breastfeeding difficulties.


• Timely recognition of tongue tie and lip tie may affect the success of breastfeeding.
• Frenotomy is a well tolerated procedure that can be performed in an outpatient setting.
• Clinicians should be instructed to give appropriate advice to nursing mothers.
• High-quality studies are needed to further evaluate its effect on breastfeeding.

Anatomic Distribution of the Morphologic Variation of the Upper Lip Frenulum Among Healthy Newborns

To our knowledge, this cross-sectional study was the first to objectively measure numerous morphological components of upper lip anatomy in healthy neonates. Variations in maxillary labial frenulum morphology have been identified, and some combination of the indicated measures can be used to establish a more robust classification system to advance quality research in the association between breastfeeding difficulty and lip tie.

In fact, there are studies that highlight the unclear results regarding the effect of lip tie on breastfeeding. It is very important that the lip tie has a restrictive effect in babies with lip tie. In babies who do not have feeding and breastfeeding problems, it may not be necessary to cut the lip ties in the early period.

How to Feed a Baby With Lip Tie?

Breast milk is the main source of nutrition for infants. For the first 6 months, exclusive breastfeeding is ideal. If there is a breastfeeding problem in babies with lip tie or tongue tie, a pediatrician and lactation consultant should evaluate the baby first.

A baby with a lip tie may find it easier to drink from a bottle. Breast-pumped milk or store-bought formula are both acceptable forms of nutrition.

If you want to continue breastfeeding, you should consider the recommendations of your lactation consultant to maintain your child's milk supply.

You may need to be a little strategic to breastfeed a baby with a lip tie. Before latching on, try to soften your breast with your baby's saliva and practice proper latching technique so that your baby can bond better with your breast. There are therapy techniques that try to loosen a lip tie and make it easier for babies to breastfeed. Sliding your finger over your baby's lip and loosening the space between the lip and the gumline can gradually (albeit slightly!) increase the mobility of your child's lip.

A lactation consultant and lactation nurse can help you brainstorm more ways to make nursing more comfortable and productive for you and your baby. If your baby cannot breastfeed and feed enough, you should consult a specialist doctor for tongue tie and lip tie surgery.

How should babies with lip ties be breastfed?

I would like to quote the information I quoted from foreign sources below:

Breastfeed the baby more often. This ensures that he gets enough food. It also prevents the breasts from getting clogged and hard. It is more difficult for a baby to look at from firm breasts.

Place baby's chin down. This can help them get a deeper peg.

Try pinching the area around the nipple to make a notch under the areola just before baby latches. Place their chin on this nipple under the nipple.

Express milk by hand or with a pump. This ensures adequate milk supply if the baby is not able to vacuum effectively. It also provides another option for feeding the baby.

Any mother with breastfeeding concerns can consult a lactation consultant or a pediatrician with breastfeeding knowledge. A lactation consultant can offer additional strategies based on the specific needs of the woman and the baby.

Lip ties are common and do not have to be a problem for all babies who have it. A lip tie doesn't always need treatment. However, especially in patients with severe limitation of movement in the upper lip and related feeding and breastfeeding problems, if the baby does not benefit from breastfeeding counseling, a surgical procedure can be decided.

How is Lip Ties Surgery Performed in Babies?

In patients with tight and short lip tie, if there are feeding - breastfeeding problems, if they do not benefit from breastfeeding counseling, a lip tie surgery decision can be made. In Type 3 and Type 4 upper lip ties (they are attached to a larger area anatomically), a "frenectomy" operation, in which the lip connective tissue is removed, can be performed. After the local anesthetic injection, the triangular connective tissue is marked and can be easily cut with the help of scissors. The triangular frenulum is removed. Also, laser and thermal welding device can be used in office conditions.

Before resorting to a medical procedure, it may be best to start working with a lactation consultant on some ways to resolve breastfeeding problems. They can help address any issue more generally, including the potential effects of lip tie.

Does Lip Tie Prevent Sucking?

For proper breastfeeding, babies should be able to lift their lips around the nipple and insert the breast into the mouth up to the areaola. The nipple should be fully inserted into the baby's mouth, so the baby should be able to move the upper lip to pick up the nipple and create a secure latch.

Some babies have a labial frenulum that is very short and tight or attaches lower than normal on the gums (short and tight lip tie). This can make it difficult for the baby to move their upper lip. The baby has difficulty in moving his upper lip upwards and outwards. Parents and caregivers may notice that the baby has a more prominent lip tie or has trouble moving the baby's upper lip. Lip tie is a difference in anatomy. It is not a sign of a disease or a serious problem. Unless a baby has difficulty breastfeeding and nursing is not painful for the nursing mother, there is no reason to treat a lip tie urgently.

A lip tie can complicate breastfeeding nursing and cause problems with weight gain in newborn babies. This condition is not difficult to spot and is easy to treat with the help of your pediatrician and lactation consultant.

Not All Babies With Breastfeeding Problems Have To Have A Lip Ties And Lip Ties Surgery Can't Always Normalize Breastfeeding!

In a 2019 systematic scientific review, Dr. He stressed that a classification system developed by Lawrence Kotlow does not reliably produce the same diagnosis among different specialists. More than one healthcare provider may disagree on whether a baby has a lip tie. Unfortunately, I think that the information presented in medical education on the subject is not sufficient.

Some babies have lip tie symptoms, while others do not. However, just because a baby has breastfeeding difficulties does not mean they have a lip tie. Also, even if a baby has a lip tie, it may not cause feeding difficulties, and correcting a lip tie does not always solve breastfeeding problems. Perhaps more important than the anatomical classification here is the amount of functional limitation of the existing lip tie. In other words, if the lip tie is very tight and short, the symptoms may appear more clearly. It should not be forgotten that the lip and tongue movements normally work in a motor coordinated way while the baby is sucking, and the restricted lip and tongue movements may not become normal all of a sudden. Especially in bottle-fed babies, this feeding style, which needs much less intraoral muscle activity, may be preferred, and even if the procedure is performed, breast sucking may not become normal. 

How Long Does it Take for Full Recovery After Lip Ties Surgery in Babies?

It is a great advantage in terms of recovery that the baby is fed with breast milk after lip tie surgery. Frequent breastfeeding of the baby provides frequent contact of mother's milk to the wound; it also acts as a precaution to cause the wound to move and not to re-adhesion. However, a lip tie massage should be done for 3 to 6 weeks after the procedure. Cold or frozen breast milk can be used before and after the lip tie massage. Generally, full recovery after lip tie operation occurs after 3 weeks.

In Babies with Lip Ties, Protrusion or Bulbul Appearance in the Middle of the Upper Lip May Occur!

In babies who are normally breastfed, the lips must be able to completely absorb the brown breast area into the mouth in order for the breast to be sucked properly. For "correct latch-on" or "correct closure to the breast", the lips should function normally and should not be restricted.

In cases where the upper lip cannot be pulled out or folded upwards properly due to the upper lip tie, "callus" or "round protrusion" may occur due to prolonged friction on the baby's upper lips. As seen in the photo above, the puffy image that appears as a result of friction in the middle part of the upper lip may strongly suggest the presence of a lip. The absence of this puffiness in the middle of the lip does not prove that there is no lip tie.

When babies have a sucking problem, they should get support from a lactation consultant and their babies should be examined in terms of lip tie and tongue tie.

According to the classification of lip tie, it is inevitable that the symptoms will increase as the lip restriction increases.

How Can You Evaluate Your Baby's Sucking Pattern With Your Finger?

First, point to his mouth with the thumb and feel the roof of your mouth. Towards the back, you will notice a point where the hard palate meets the soft palate. Now, using your index finger, you find the same spot in your baby's mouth. You can understand that the tongue and lip tie are vacuuming in the form of massage along the entire length of your finger.

If most of the compression is at the front of the mouth, this is an indication that your baby is just grabbing the nipple instead of squeezing the whole breast. Such latch-like closure is often uncomfortable and weakens milk stimulation.

In babies with a tight upper lip tie, when there is pitting or notching in the bone structure between the upper incisors, it is a sign that there will be a gap between the upper incisors that will come out and the teeth will come out apart (diastema).

A Beautiful Video for Tongue Tie Massage and Lip Tie Massage in Babies!

I have published articles on the importance of stretching the wound site after cutting lip tie and tongue tie in babies, and the healing properties of intraoral mucosal damaged areas. Lip tie massage and tongue tie massage, which should be done after lip tie surgery and tongue tie surgery in babies, are roughly the same.

In a video, while lifting the upper lip from the inside with the index finger; in the other, the upper lip is pulled forward from the outside and then lifted from the inside with the index finger. Cutting the lip tie in babies can cause a serious increase in breast sucking performance.

The main problem after tongue tie surgery and lip tie surgery is re-healing of the wound sites and insufficient release of the tongue and upper lip.

After lip tie surgery and tongue tie surgery, training is given abroad to families, breastfeeding counselors and intraoral muscle function therapists.

If lip tie massage and tongue tie massage are performed from behind by going to the head of the patient, adhesions in the lip tie incision area and tongue tie incision area can be evaluated more easily.

After tongue-tie surgery, tongue-tie massage and frequent breastfeeding can be recommended to prevent re-adhesion of the tongue-tie. In the facebook group named "Ankyloglossia Professional Support Group", you can find the posts of doctors and families from different countries about babies with tongue tie. In this group, physicians specializing in this procedure recommend tongue-tie massage with olive oil, St. John's Wort oil and various herbal tissue-healing products for babies whose tongue-tie has been cut. I usually recommend tongue tie massage with breast milk to my infant patients. I think that it is more appropriate to use it during massage, as breast milk is natural and the most ideal food source for the baby, contains antibacterial products, has tissue healing properties, has a low risk of allergy and does not cause microbe contact. After the tongue tie is cut, it is beneficial to breastfeed frequently for the first 3 days and to massage with breast milk in the first week.

After tongue tie cutting and lip tie cutting, tongue tie exercise, tongue tie massage and lip tie massage should be done in order to prevent partial adhesion of tongue tie and lip tie in the horizontal plane.

Upper Lip Tie Classification

Upper lip ties are divided into 4 subclasses. In this system, which is an anatomical classification system and prepared by Dr. Kotlow, lip ties are classified according to the place of attachment of the lip tie, varying between 1 and 4.

Much of the information regarding tongue-tie and lip-tie has been highlighted in recent and recently published studies. The most accepted and most used classification system for the classification of upper lip ties was defined by Dr.Kotlow. In the upper lip tie classification system defined by Dr.Kotlow, upper lip ties are examined in 4 different classes, just like tongue ties. In this anatomical classification system, Class 1 labial ties are perhaps the least anatomically severe visible, thin mucosal fold located in the midline between the lip and gingiva, on the inner surface of the lip. Class 2 labial ties extend to the gums and are easier to see. Class 3 labial ties extend to the papilla. The papilla here is the part of the gum located between the teeth. Class 4 lip ties are a type of lip tie that reaches the hard palate by passing between the teeth from the gingiva to the back. Anatomically, it is the most severe type of lip tie. The classification system here is a purely anatomical classification system. The classification system here is an anatomical classification system, different from the staging systems that show the severity of the disease in cancer diseases. The extent of limitation of the lip ties can be evaluated during the examination. For example, a baby with a class 3 upper lip tie may have more upper lip restriction than a baby with a class 4 upper lip tie.

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon

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