There are several types of voice feminization techniques, Crico-Thyroid Approximation (CTA), Laser Assisted Voice Adjustment (LAVA), Vocal Cord Shortening (Anterior Web Creation), Thyroid Cartilage and Vocal Cord Reduction and Laryngoplasty. All procedures are designed to make a genetic Male’s voice box smaller and vocal cords shorter in an attempt to raise the comfortable speaking pitch.
The characteristic pitch or fundamental frequency (F0) of the male voice ranges from about 100 to 150 Hz; for the female voice, F0 ranges from 170 to 220 Hz. By reducing the voice box, these procedures can increase the pitch of the voice.
Another distinctive characteristic of the voice is resonance. The timbre or resonance of the male voice is deeper than females, this is due to the greater length of the male upper airway.
CRT Crico-Thyroid Approximation
The most common formed operation to increase the F0 is CRT. In this technique, the thyroid cartilage (Adam’s apple) is pushed against the cricoid cartilage that lies below it. The two cartilages are then sutured together with nylon sutures, usually placed over bolsters
The approximation of the thyroid and cricoid cartilages increases the tension of the vocal cords by stretching them. This raises the pitch at which the cords will vibrate.
CTA is performed through a small incision in the neck. The incision is placed within a natural skin fold so the resulting scar will either be invisible or at least easily concealed. Either local or general anesthesia can be used and because there is no actually surgery on the vocal cords themselves, patients can have the procedure reversed if unsatisfied.
This minimally invasive technique involves removing the front of the voice box to make the voice box smaller. First an incision is made in a skin crease of your neck, over the Adam’s Apple.
The front of the voice box is removed making the voice box smaller.The vocal cords are then stretched and a third of them removed. A tiny metal plate maybe used to over the voice box to help maintain tension. This plate stays in place, even once everything is healed.
This procedure reduces the projection of the Adam’s Apple, making it unnecessary to have a separate “trach shave” procedure. CTA may also be performed to help correct a previous voice feminization procedure.
The surgery is performed in an outpatient setting under general anesthesia.
Laser Assisted Voice Adjustment
Laser Assisted Voice Adjustment is an endoscopic technique in which a CO2 laser is used to scar and stiffen the area surrounding the vocal cords. The surgery aims to alter the pitch of the voice by increasing the tension of the vocal cords. Surgery is performed under general anesthesia, and with this type of endoscopic procedure, there is no incision to the neck.
Vocal Cord Shortening
Vocal Cord Shortening is also known technically as Anterior Web Creation. It is another technique to increase F0 is to shorten the vibrating length of the cords by suturing them together. This creates what is called an anterior vocal web. Depending on the specific technique used, a piece of the thyroid cartilage maybe also be removed to aid the creation of the anterior vocal web.
This technique can produce long lasting results without the need for neck incisions and is done under general anesthetic.
Thyroid Cartilage & Vocal Cord Reduction
This procedure combines the open resection of a central strip of the thyroid cartilage, about 8 mm wide, along with resection of the anterior one-third of the vocal cords to reconstruct the anterior commissure (where the vocal cord meet anteriorly). This aggressive procedure has been proven to effectively increase the pitch of the voice (perhaps too much).
The results from six Thai patients showed the surgery to increse pitch by an average of 147hz. This can leave the voice sounding oddly high even by female standards.
Although the procedure requires a neck incision, previous result suggest long term effectiveness.
Best Candidate for Voice Surgery
Voice feminization surgery is for patients whose still conscious of their distinctive male voice. If voice training or speech therapy has not produced noticeable results, you may want to consider having surgery.
The typical patient will be a male who has or is undergoing transgender surgeries and wishes to change the voice pitch and potentially other qualities of the voice as well.
Before the surgery your surgeon will evaluate your larynx with a video-endoscopy.
They will then hold a PARQ (Procedures, Alternatives, Risks and Questions) conference with you.The evaluation and examination of your voice box is essential. You will also be shown important preparation and recovery guidelines which you must follow strictly.
A number of your vocal parameters will be recorded, and your vocal cords will be filmed in motion.
Your chosen procedure will likely take place in an outpatient ward and will be performed under local or general anesthesia. The duration of the operation varies depending on which technique is being used.
After the surgery and once you have recovered from the anesthesia, your surgeon will discuss with you the outcome of the surgery and remind you once again of the important guidelines during recovery.
Depending on the specific technique of voice feminization and the outcome of your surgery, you may be asked to stay in hospital, however in most cases and overnight stay will not be necessary.
After one or two days you will be required to go for a post-operative exam, you will also be advised to stay in the area for up to a week so the doctor can monitor your progress.
Complete voice rest is mandatory for one to two weeks after the procedure (all forms of verbal communication are not allowed, including whispering), until your body’s own scar tissue helps support the procedure. You should also refrain from strenuous activities for a at least three weeks.
Your voice will often seem quite soft, tight or requiring effort to use. It will likely get worse before it gets better
There will be initial pain or discomfort from the procedure. patients have describe symptoms such as a sore throat sensation and difficulty swallowing.
Other symptoms which are considered normal include swelling and bruising, discomfort and pain, crusting along the incision line(if any), numbness and visible scars.
After three week you may begin aerobic activity and finally after the 6th week, your voice will begin to approach its new pitch.
Voice Surgery Risks
As with any surgical procedure, voice feminization carries significant risks, these include:
- Allergic Reaction From Anesthesia
- Hematoma Inflammation and infection
- Thick, wide or depressed scars
- Wound separation or delayed healing
- Sensitivity or allergy to dressings or tape
- Injury to blood vessels, nerves or muscles