We are aware that the cost of tongue tie treatment at the National Tongue Tie Centre is higher than other services available in Ireland. We have never tried to obscure that. We publish our fees openly, explain clearly what each component involves, and make a payment plan available for families for whom the cost is a barrier.

But we are also aware that comparisons circulate - sometimes directly, and sometimes by implication - that position a lower-cost single-appointment frenotomy as equivalent care at a lower price. We want to address this directly, because we think families deserve an honest account of what they are comparing when they compare costs.

This is not a defensive piece. It is an attempt to explain, as clearly and honestly as we can, what the cost of our pathway reflects - and what a lower-cost alternative typically does and does not include.

What a single-appointment frenotomy includes

A single-appointment frenotomy, available in Ireland at various price points from a few hundred euro, typically includes a brief clinical consultation and a scissor or laser division of the frenulum. In some cases it includes a lactation consultation at the same visit. In most cases it does not include:

• Pre-operative feeding therapy or physiotherapy
• Pre-operative bodywork to reduce jaw and neck tension
• Post-operative feeding therapy to retrain movement patterns
• Wound review and Diamond Care protocol guidance
• Medical follow-up with a Consultant Paediatrician
• Ongoing myofunctional rehabilitation
• A written clinical report

In many cases, practitioners who offer single-appointment frenotomy are aware of the value of these additional elements and refer families to lactation consultants, physiotherapists, and osteopaths in the community to provide them. That is a reasonable model. But the cost of those additional practitioners, and the coordination burden on the family, is not included in the fee comparison.

Why preparation and rehabilitation are not optional extras

This is the clinical point that matters most. A tongue tie creates compensatory movement and tension patterns throughout the body. A baby with a tongue tie has been feeding, or attempting to feed, since birth with a restricted tongue. Over weeks and months, the jaw, neck, cheeks, and body have adapted. The restriction is not isolated to the frenulum.

Releasing the frenulum without preparing the tongue and surrounding structures first means the surgery encounters tissue that is not ready to function differently. The compensatory patterns persist. Outcomes are less predictable, and the risk of functional improvement being limited is higher.

Post-operative rehabilitation addresses the same problem from the other side. The surgery creates the structural possibility of normal tongue function. The therapy builds it. A tongue that has been restricted since birth does not automatically know how to rest against the palate, create an effective seal, or coordinate correctly in swallowing and speech. That has to be learned, systematically, with support, over time.

This is not a theoretical position. It is what 17 years of treating over 1,000 patients annually has shown us. Patients who complete preparation and rehabilitation consistently achieve better outcomes than those who proceed directly to surgery alone. This is why preparation and rehabilitation are not optional extras in our pathway; they are the pathway.

The cost of revision is higher than the cost of preparation

We see a significant number of patients who have had a tongue tie release elsewhere and have not achieved the functional improvement expected. In some cases the release was technically incomplete. In others it was adequate, but without preparation and rehabilitation the compensatory patterns were never addressed and the functional ceiling was hit before the functional gain was built.

Revision is more complex than primary release. Scar tissue is present. The anatomy is altered. The cost of revisionary frenuloplasty, in financial terms and in the clinical and emotional burden on the family, is substantially higher than the cost of a thorough preparation phase before primary surgery.

We are not saying that every child who has a frenotomy elsewhere will need revision. Many do not. But the families who come to us having already been through one procedure elsewhere are often exhausted, financially stretched, and frustrated. The cost comparison looks different when the full journey is considered.

What our pathway specifically includes

The pathway cost at the National Tongue Tie Centre covers, depending on age group:

• A comprehensive evaluation appointment with a written report: the same regardless of whether you proceed
• Pre-operative feeding therapy or myofunctional therapy sessions
• Pre-operative physiotherapy and bodywork
• CO₂ laser frenectomy or functional frenuloplasty with suture closure, performed by Dr. Justin Roche, Consultant Paediatrician
• Post-operative feeding support and wound review including the Diamond Care protocol
• Post-operative physiotherapy and myofunctional rehabilitation
• A medical follow-up consultation at six weeks with Dr. Roche
• For infants 12 weeks to children up to 12 years where indicated: Functional Frenuloplasty under conscious sedation, available nowhere else in Ireland

For older infants and children, preparation typically requires more sessions because the compensatory patterns are more established. For adults, the pre-operative and post-operative rehabilitation phase is the most extensive — decades of compensation take time to retrain. The pathway cost reflects this.

An honest position on cost

We understand that cost matters. We make a payment plan available precisely because we do not want financial barriers to prevent families from accessing appropriate care. And we acknowledge that the NTTC pathway is not the right fit for every situation — some infants have straightforward anterior ties where a well-performed simple frenotomy, with good lactation support, achieves an excellent result.

What we ask is that the comparison be made honestly. If you are comparing costs, compare what is included. Ask what preparation is provided before surgery. Ask what rehabilitation is structured after it. Ask what follow-up is included and who provides it. Ask whether the practitioner you are seeing has the team to deliver those elements, or whether you will need to source them separately.

Our fees reflect a team of seven IBCLCs across medicine, physiotherapy, nursing, and midwifery, working in an integrated clinic under the medical leadership of a Consultant Paediatrician who has been treating tongue tie since 2007. That is what the cost reflects. We believe it is the right model. We also believe families deserve to make their own informed decision  and this page is our attempt to give them what they need to do that.