Dividing a tongue tie in an awake baby is a very different scenario than carrying this out under general anaesthetic. In an awake baby the division is only a simple snip through the membrane, whilst under general anaesthetic the division is carried out down to the muscles of the tongue and the incision is closed in the opposite direction (frenuloplasty) to minimise rescarring. It is difficult to divide a tongue tie in a baby over 2 months of age.
In our clinic the tongue tie division is carried out by a Consultant Surgeon assisted by a Paediatric nurse using good illumination and sterile instruments.
The Paediatric nurse swaddles the baby in a sheet keeping the head still. The surgeon exposes the tongue tie using a specially designed retracter and then divides the tongue using special blunt tip scissors that crush the tissue, as it is being cut, to minimise bleeding. Despite what is reported, the procedure is uncomfortable for the baby but the discomfort settles fairly quickly once the baby is breastfed. Breast feeding itself appears to help with pain control and babies settle within a few minutes.