A frenotomy  or frenectomy procedure involves releasing or removing the restrictive frenum. The term has been used interchangeably.

An infant’s ability to breastfeed effectively is paramount. Skilled assistance with breastfeeding is an important place to start if difficulties arise. Breastfeeding issues, unresolved with skilled assistance, in the presence of a tongue tie may be treated effectively with lingual frenotomy or frenectomy. A lingual frenectomy may be performed in childhood for eating or speech issues, and in adulthood for eating, speech or breathing or neuromuscular reasons.

A labial (lip) frenectomy is the removal of the labial frenum of the upper lip. It is performed for a variety of reasons including breastfeeding problems, the prevention of gum recession where the frenum is too close to the gums, for orthodontic reasons where a large frenum causes a diastema to develop between the two front teeth and to improve the fit of a denture where the frenum interferes with its fit and function.

The tongue and floor of the mouth contain vital structures including nerves, blood vessels and salivary gland ducts and so it is extremely important that whoever performs a frenectomy procedure is very skilled and experienced and has excellent knowledge of the anatomy associated with these areas. There is NO such thing as a "simple snip" of a lingual frenum, and surgery by an inexperienced practitioner may result in scarring, excess trauma, and permanent damage to vital structures of the tongue and floor of the mouth.

A medical or dental doctor, or a midwife with specific training, performs the frenectomy procedure.  The procedure on both the upper lip and tongue are typically extremely fast and relatively painless.  However, when performed in infants, it can be a very emotional experience for parents. This is especially so for children that do not like being held or restrained, and some babies can find the lights and procedure anxiety provoking. Oral premedication of analgesic may be suggested in older infants. Local anaesthetic may be used at the discretion of the practitioner and parent and the procedure can be performed by scissor or lasers.  With older children, due to the age, co-operation or complexity of the procedure, a general anaesthetic may be necessary. For adults, the release procedure is often carried out in chair.

There is frequently a limited amount of bleeding following the procedure which is managed by compression. Some providers report a more prolonged experience of bleeding which may be attributed to an aberrant blood vessel or an undiagnosed bleeding diathesis.