A common thing I see online in conversations amongst parents about tongue tie, is that parents are often unaware of how challenging the aftercare will be.

Much of the overwhelm in the day/weeks after the tongue tie release revolves around the stretches. No parents want to make their baby cry, and stretches usually lead to crying (for parent & baby), especially in the first few days.

Some parents go into the procedure unaware that they may have to do stretches every couple of hours for weeks. Others know they may need to do them but have questions about why stretches are required for so long.

This post will cover the healing process that occurs after a tongue tie release and the healing timeline for a functional release so you can have a better idea of what to expect.

Tongue Tie Release Wound Healing Process

Oral wounds heal much more quickly than those of the skin. Inflammation is a crucial player in the healing process, but prolonged inflammation can mean that injuries take longer to heal. For oral wounds, the inflammation response is strong and rapid, which is very good for quick healing but poses a few challenges in the case of tongue tie releases.

Before I dive into that, let's first cover the major stages of healing that occur very soon after the procedure.

Clotting
Inflammation
Granulation
Remodeling
Contraction

Wound Healing: Clotting

Whether your baby has a laser, scissor, or diode release, the surgery process often leads to bleeding. The clotting process begins immediately to stop excessive bleeding and continues until all the tiny blood vessels the release provider cute during the procedure are plugged.

Wound Healing: Inflammation

The clotting process triggers the inflammation phase & conversely, inflammation also aids in clotting. As mentioned above, inflammation is a beneficial, necessary response to help heal the wound.

During the inflammation stage, various cell types spring into action, notably the accumulation of neutrophils & macrophages.

Neutrophils continue to fill the wound site for several days after the surgery to prevent infection. Macrophages arrive soon after neutrophils, and they aid in helping resolve the initial inflammatory response & speed up wound healing.

Wound Healing: Granulation

Granulation is the term to denote new connective tissue formation, and it begins roughly 1-4 days after your baby's tongue tie release. During this phase, collagen is laid down at the wound site & joins the other healing cells, forming a flexible yellow or white "scab" over the wound.

Wound Healing: Remodeling

Remodeling begins roughly 7-10 days post-release, though I should mention that the shift from granulation to remodeling occurs gradually. Granulation continues as the remodeling stage is underway.

Tissue remodeling is a slow, significant step in tongue tie wound healing as it's the stage that restores the structure & function of the oral mucosa, including the new frenulum that develops.

Note: Many parents are concerned when they notice a new frenulum under their baby's tongue; however, it's normal for a new frenulum to form and doesn't necessarily mean reattachment.

Wound Healing: Contraction

The next stage, contraction, occurs concurrently with the granulation and remodeling phases and is marked by the edges of the wound site beginning to move closer together. Depending on one's healing pattern, it may start as late as day seven but typically starts around day three post-release.

There are differing opinions on whether the contraction phase ends once the wound is closed up or if it continues after, but what is known is that remodeling continues for months after the apparent wound is gone. During the remodeling process, new fibers continue to form and move closer together, and continued contraction of the site may explain the regression parents often note around week 3.

Active Wound Management Post Tongue Tie Release

Despite differing stretching philosophies, there is logical reasoning for the frequent stretching recommendations parents often receive.

The healing process takes place very quickly & the body's natural response is to heal the wound to its previous state. In most cases, this is desired; however, we need to interrupt the process a bit and encourage vertical healing for a longer frenulum to grow in.

When done correctly, the stretches create distance between the top and bottom wound edges, creating the space needed for vertical healing.

Vertical Vs. Horizontal Wound Healing

Though it's possible to tell how tall the wound is healing before the contraction phase, it typically becomes more evident whether or not the diamond-shaped wound is healing long and tall (vertical) or short and flat (horizontal) as the wound begins to become smaller.

When the wound heals slow, long & tall, there is more time & space for a longer frenulum to form. Compare that to a wound that heals short & flat with the edges of the diamond healing downward toward each other in the same orientation as before the release.

In the slides below, you can see two healing progression photos, one from Infant Laser Dentistry which I consider an excellent example of horizontal healing, and one from Tongue Tie Life which I believe is a perfect example of vertical healing.

While vertical healing is ideal, many babies have marked improvement and resolution of tongue tie symptoms even if their wound heals in a horizontal pattern. Many factors contribute to the healing pattern, and how your baby's wound heals after a tongue tie release is not an indication of the quality of the release or the provider.

Tongue Tie Release Healing Timeline:

Time Since Tongue Tie Release	Wound Appearance	How Your Baby May Act	Feeding Ease
0- Day of Release	Redness, possible bleeding	Fussier Than Usual	The same or better than before the release
Day 1	Yellow or white coating may begin to develop	Normal	The same or better than before the release
Days 2-3	Yellow or white coating may begin to develop, wound contraction begins	Cranky, Grumpy, Feeding a lot	More challenging, especially if feding got better after the release
Day 5	Yellow or White Diamond	Normal	Some feeds may be easier than others
Day 7	Diamond may begin to appear smaller, coating less thick	Normal	Some feeds may be easier than others
Week 2	Diamond continues to shrink in size, no coating	Normal	Better feedings become more frequent
Week 3	Diamond may continue to shrink or not be visible	Normal	Some feedings may become a challenge again, tongue tie symptoms may reappear
Week 4	New frenelum may be visible with white translucent scar	Normal	Better feedings become more frequent
Week 5+	New frenelum may be visible with white translucent scar	Normal	Feeding becomes easy & painless, transfer at breast or bottle is good, tongue tie symptoms resolve

Note: This chart shows a typical progression of what you may expect. Babies heal at different rates & some babies still struggle with feeding challenges weeks post release. This chart assumes oral prehab was done prior to the tongue tie release and that parent & baby are working with an oral function savvy IBCLC.

Major Healing Milestones

Day 0-1 Post Tongue Tie Release

Your baby may experience pain at the surgery site, and they may be more fussy than usual. Typically skin to skin, natural remedies or OTC pain medication can help manage the initial discomfort that arises after the topical numbing medication provided at the procedure wears off.

Your release provider may advise you to begin stretches the day following the procedure.

Day 2-3 Post Tongue Tie Release

Typically by day 3, site pain from the tongue tie procedure has resolved, but your baby may experience muscle soreness or discomfort. Their tongue & oral muscles are working in new ways, and every feed is essentially a workout. You may notice that the symptoms that lead you to the release, worsen.

Between days 2-5 is the perfect time to meet with an oral function savvy IBCLC either in person or virtually. They can assess your stretches, offer oral activities to improve your baby's oral function, and provide emotional support, as this is often a very trying phase in the recovery process.

Week 2-3

You may notice that your baby's symptoms may return or get slightly more noticeable, which can be very alarming. While it may be due to reattachment, it's not uncommon for symptoms to re-emerge due to the scar tissue formation at the frenulum, which initially is more stiff & inelastic than a "the final" frenulum your baby will have. Your baby's release provider may still suggest frequent stretches.

There are activities you can do under the guidance of your release provide and/or IBCLC that can help overcome the week three frenulum stiffness, but many parents notice an improvement with time as the tissues become more supple and mobile due to continued remodeling.

With that said, it can be helpful to again reach out to a tie-savvy IBCLC during this stage to help manage any symptoms you or your baby are experiencing.

Week 5

By week 5, feeding your baby should be easier than before the release, though the occasional challenging feed may still occur. If your baby continued to need supplementation post-release, the odds are high that supplementation is not necessary by this time, assuming they can drain the breast well. Also, it's likely that you will no longer have to do stretches, as the wound should be completely healed by now.