Feminization laryngoplasty, also known as voice feminization surgery is a procedure designed to make a voice box smaller and vocal cords shorter in an attempt to raise the comfortable speaking pitch. This should allow the voice to sound more feminine.
Some surgeons also try to alter the resonance as well by adding in a thyrohyoid elevation at the same time. The thyrohyoid elevation shortens the pharynx (throat) to improve the resonance of the higher pitches.
Who This Surgery is For:
The surgery is intended for patients whose voice pitch is consistently interpreted as male, despite concerted efforts at altering pitch such as speech therapy and training.
For example, a woman might have no problem being identified as female in person, but is still typically perceived as male when on the phone.
The typical patient will be a male who has or is, or may yet be undergoing transgender surgeries and wishes to change the voice to sound more feminine. Many genetic females or intersex individuals could benefit from the procedure as well.
Having a previous voice surgery such as a cricothyroid approximation (CTA) does not preclude performing this procedure. Feminization laryngoplasty might be successful, even if the CTA procedure failed. It also can be used to correct complications from a tracheal shave where the pitch was inadvertently lowered.
This surgery doesn’t always work and the results aren't always perfect. It is a new procedure that is still being improved upon. It carries with it some significant risks. A more common and traditional surgery would be a CTA. Another alternative is to reduce the size of the vocal cord with a laser. A thinner vocal cord will vibrate at a higher pitch. Women’s vocal cords are both thinner and shorter than men's vocal cords. The surgery might also increase the tension of the cords from some pulling and retraction after the surgery and reduce the vocal quality.
Pitch elevation in both males and females involves changes in the diameter and length of the throat during speech, so there may be a way to surgically reduce the diameter or length of the throat (or pharynx) that would change the resonance of the voice.
Most surgeons will evaluate your larynx with a videoendoscopy and have a PARQ conference with you.
An evaluation and examination of your voice box is essential. During the typical examination your vocal parameters are recorded and your vocal chords may be filmed. The complete examination of your voice usually takes about an hour.
PARQ is an acronym for Procedures, Alternatives, Risks and Questions. It means that your surgeon has discussed with you in full detail the reasons for the procedure, the alternative treatments to the procedure, the risks of the procedure and that you have been given ample time to ask questions and are satisfied with those reasons and answers.
The general risks of surgery will be discussed on the informed consent page. The risks specific to this procedure are similar to those for a cricothyroid approximation though there are some additional ones as well. Granulomas can form on the inside of your voice box. Granulomas can cause a soft whispery voice, depending on where it is located inside the voice box. They might be able to be coughed out, but the surgeon might need to inject them with steroids to make them fall off.
Infections are common after vocal feminization surgery. The infections can range from mild redness, to more prolonged infections that will require surgical removal of the infected area. If your throat swells too much, then you might need a tracheotomy to breathe for a few days.
The feminization laryngoplasty surgery is performed in an outpatient setting under general anesthesia. Once you are asleep, an incision is made parallel to or in a skin crease of your neck over the Adam’s apple. The front of the voice box is removed which will make the voice box smaller. This also removes the Adam's apple at the same time so it will not be necessary to have a separate tracheal shave procedure.
The vocal cords are then stretched and the front third to half of the cords are removed to shorten them. A tiny metal plate may be placed over the voice box to maintain tension on the vocal cords and also to hold the cartilage together during the healing period. It is a small plate that will remain in place even after everything is healed.
Some surgeons use a thyrohyoid elevation to try raising the voice box in the neck. This shortens the pharynx to feminize a portion of the resonance chamber (pharynx). A thyrohyoid elevation consists of passing sutures around the hyoid bone to hold the voice box in place in a higher position of the neck.
Voice feminization surgery is usually an outpatient procedure, so you should not have to stay in a hospital over night.I have not kept anyone in the hospital overnight. If you have a complication, it is usually an infection or swelling 3 days after surgery. It is recommended for you to stay in the area for a week to make sure that you don't have any problems.
Immediately after vocal surgery, your voice might be deeper than prior to surgery. This is caused by swelling of your voice box. Swollen vocal cords will vibrate at a lower pitch. Your voice might sound quiet, tight or effortful to use. It will usually get worse before it gets better and you may have a roughness that changes over several months. There will be initial pain and discomfort from the procedure. It is common to have a sore throat and to have difficulty with swallowing. Do not expect your voice to be approaching it's new pitch for at least 6 weeks.
You can't use your vocal chords for two weeks after surgery, not even to whisper. There are only a few sutures holding the vocal cords in place and until your body's own scar tissue helps support the procedure, the sutures could pull out.
Sedentary work can be resumed about 3 days after surgery. Speaking can begin gradually after two weeks,but should sill be avoided until after 3 weeks.
Aerobic activity may be resumed after three weeks. You shouldn't lift anything heavy until after one month.
Feminization laryngoplasty has more benefits than a criothryoid axproximation, but it also has more risks. It has the potential for a much more female sounding voice. However, with some complications the outcomes have been poor.
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