The enlarged tongue, or macroglossia, may compromise vital function to the point that surgical correction is necessary. Although earlier procedures simply aimed at reducing tongue bulk, contemporary techniques attempt to decrease lingual dimension yet preserve critical neurosensory function. Still, modern approaches advise a broad variety of differing incisions and propose excision of various anterior, lateral, central, or circumferential lingual tissues. The keyhole technique allows direct excision of midline musculomucosal tissue along the tongue’s length. With this central tongue-reduction procedure, significant lingual resection is possible and crucial tongue function and neurovascular structure are maintained. In this article, as a supplement to our video demonstration, we describe a modified keyhole technique for macroglossia correction.