For transgender people transitioning from male to female, voice change surgery is considered as important as sex change surgery itself. The voice greatly affects our overall appearance and how we present ourselves to others just because of the fact that men and women have very different tones and characteristics. For men, the vocal cords of larynx are big and thick, so there is difference in length and size of vocal tract (pathway from the vocal cords to the lips or nostrils) and the resonance space is larger and longer than that of women. This results to a lower and deeper voice for men.Voice feminization surgery changes the vocal cords by making it thinner by pulling and fixing the vocal cords which results in a higher toned voice. Byapplying the unique technology of the laryngeal plastic specialist, notthe technique as CTA, Glottplasty or direct shortening the vocal cords ways that which is commonly known for voice feminizing surgery, surgery will be performed through an incision approximately 1.5 centimeters across the neck above the thyroid cartilage on a wrinkle on the skin and at the same time the adam’s apple cartilageare removed free of charge to maximize the change in appearance.
A laryngoscope will be used to observe laryngeal movements and record voice condition on the consultation before the surgery. Then the doctor willfigure outthe movement of vocal folds per second in hertz to determine the frequency of voice. The frequency range of the average male is 100 to 150 hertz, and the frequency range of the average female is 200 to 300 hertz.
Getting ready for voice change surgery
Take note of all instructions before the surgery during the consultation. This includes information about smoking, medications taken, tickets, what to bring during the stay, length of stay after discharged, and fasting before surgery.
Below are some things to keep in mind to prepare for surgery and what to do during recovery.
• Smokers should quit smoking for two weeks before and two weeks after surgery. Smoking increases the risk of side effects. When smoking, the chemicals in cigarettes act as free radicals and interfere with the postoperative recovery process. Long recovery periods can cause scars to form in large or strange shapes, cause inflammation due to poorly healed scars, and serious side effects that require removal of the implant. If you continue to smoke, your doctor may not proceed with the surgery.
• You should not drink alcohol one week before surgery.
• Do not consume any food or drink, including water, at least six hours before your surgery.
• Aspirin, anti-inflammatory medications that can cause bleeding, and vitamins, fish oils, and herbal supplements that can cause swelling should be stopped two weeks before surgery.
• Should be over 23 years old to be allowed to undergo the surgery.
Process of voice change surgery
1. An incision of 1.5 centimeters will be made over a wrinkled skin above the thyroid cartilage.
2. Pull out the vocal cords in the horizontal direction and trim excess tissue then fix it to the thyroid cartilage using a special medical anchor.
3. Trim the adam’s apple to make it flat and smooth and finish the sutures.
After voice change surgery
Surgery is usually performed over two or 3 hours under general anesthesia. At the end of the surgery, the bandage is fixed to the entire neck to prevent dehiscence due to neck movement. The neck bandage will be removed after about 2 days. After surgery, the patient recovers for about an hour under the observation of the anesthesiologist in the recovery room and then transferred to the room. For seven days immediately after surgery, talking or making sound will be prohibited for smooth recovery, frequent coughing or a pulling feeling of the larynx when swallowing drinks or food is apparent for 2-3 days. You will be discharged after 2 nights in hospital, and you should not speak or make any sound until the date instructed. You canstart to talk withsome light body stretching on directed date. Atfirst you might not make any sound or you might hear some trembling or dripping but this is a very normal reaction so no need to worry about it at all. You might have some difficulty speaking at first but you should practice your voice as directed. Ten days after the operation, through the follow up checkup, the doctor will check whether there is any abnormalities or infection. The bandage may me replaced or removedthen you can go back to your home if there are no abnormalities found. The very high, slight hazy voice immediately after the surgery will enter the qualitative range for about a month and a half to three months. For at least one month, you should avoid drinking alcohol and rough and sharp foods that mightbe irritate your throatsuch as crackers and should completely stop smoking.
Risks of voice change surgery
• Bleeding and hematoma formation
• Slow recovery of the incision site
• Keloid or asymmetrical scar formation
• Temporary or permanent sensory changes
• Changes in position of the larynx
• Hoarse voice
Q & A
Q: I’ve already had voice feminization operation but I’m not seeing the changes I want. Is it possible to have a reoperation?
A: The vocal cords are very flexible and can be operated on again with great care if they have already been done once. According to the existing method of feminization surgery you had already, reoperation is possible when there is little damage to the vocal cord tissue, but actually in many cases it is not.
Q: I have hadadam’s apple removal surgery. Will it affect to the outcome of voice change surgery?
A: Mostly adam’s apple removal surgery is done in plastic surgery clinic. And often, it affects to the some vocal cords if it is not accompanied with otorhinolaryngologiccal opinion. In those cases, it is reported that 20~30% of the success rate will got down comparing with those who didn’t have adam’s apple removal surgery.
Q: Do I need voice training after voice feminization?
A: Voice change surgery is a type of laryngoplasty that uses a surgical method to control the height of voice during speech. The habits of vocalization, tones and the way of talking, etc. that patients usually use cannot be controlled by surgery. We encourage patients to practice soft, rhythmic, feminine language habits in your daily life, even though it’s not through the professional vocal training.
Q: Is there a difference in the results? Some friends are so natural, but some aren’t. Why is there such a difference?
A: If everyone can have surgery with the same physical condition, they would be able to show a more consistently good result but there are various differences not only by physical condition but also by age, lifestyle and living environment. Using language is very different from using the body sothere are differences in recovery and improvement in many factors, including the patient’s personality, living environment, frequency of speech and audience.
Q: Does botox treatment help if I have hoarseness after surgery?
A: No. Botox treatment, which is applied to the vocal cords, is divided into two groups: the purpose of treating diseases and the purpose of plastic surgery. Among the purposes of the disease treatment, it is known that it can be effectively applied to the case of spasmodic dysphonia in limited treatment. Postoperative hoarseness often stabilizes and lasts longer, but gradually disappears over time.
Q: As explained, way of surgery is pulling the vocal cord to fix it. Isn’t it more effective to directly reduce the vocal cords?
A: There are many ways to perform the voice feminization surgery. Divided into two main categories, one is CTA methods that pulls limbal muscle and directly shorten the thyroid cartilage and the other one is vocal cord ablation. In the case of the CTA method which is most commonly known surgical method,it is right that you can see the result but there is disadvantages that it is difficult to predict the result as a surgeon. And also the vocal cord ablation method, shortening of the vocal cords directly without external incisions makes it impossible to remove the adam’s apple at the same time and it makes the airway rapidly narrow during breathing so it can be very dangerous in case of emergency.