Introduction: The surgical management of ankyloglossia (tongue-tie), a procedure performed by multiple specialties including ENT surgeons, oral maxillofacial surgeons, and dentists, is controversial. Previous Australian studies and widespread perception point to a rising "epidemic" in procedures over the past decade. This study aims to quantify the definitive national trends in tongue-tie procedures over the last decade to inform evidence-based practice. Methods: A retrospective analysis of Australian national datasets (AIHW and MBS) was conducted for all services from January 2013 to December 2024. Data were extracted for total lingual frenulectomy/frenotomy procedures, total Medicare (MBS) claims, ankyloglossia-related hospital admissions, patient age distribution, and state/territory-based MBS per capita service rates. Linear regression was used to analyse trends over time. Results: The data reveal a significant national decline in tongue-tie procedures over the last decade. The total number of procedures (public + private) showed a slight but significant national decline (p=0.039). This was comprised of a precipitous fall in hospital-based admissions (p<0.001) and a concurrent plateau or slight decline in private (MBS) claims. Despite this overall national de-escalation, two key issues persist. First, extreme, persistent geographic variation in private practice. In 2024, the per capita (MBS) procedure rate in the ACT was 3.2-fold higher than the national average, a pattern of extreme variation present since at least 2013. Second, the intervention remains focused on children, with a large and consistent proportion of procedures performed on those aged 1-4 years and 5+ years, in addition to infants. Conclusion: The narrative of a “rising epidemic” of tongue-tie procedures in Australia has ceased, with national data revealing a significant overall decline in interventions. However, this national de-escalation is not uniform and masks a persistent, underlying problem of practice variation.