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Voice Feminization Surgery

What is Voice Feminization Surgery?

Voice feminization surgery is the procedure which changes the voice to a higher pitched tone. It is appropriate for the patients who have hormonal abnormalities, androphobia or androgenital syndrome, etc.

There are great anatomical variation between men and women.  Many men have lower voices and larger Adam’s Apples than women. Sometimes even with consistent practice and effective speech therapy assistance, the voice may still not be transformed in to a good match.  In such circumstances, voice surgery may be recommended.

Voice Feminization Surgery (VFS) is changing one’s voice to a higher voice tone. It is for the patients who have experienced abnormal hormone functions that were affected by adrogenital syndrome or androphonia, or through the side effect of the hormone treatment for aplastic anemia. However, VFS is mainly performed to the GID (Gender Identity Disorder) patients, which is for male to female transgender.

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Male to Female Voice Phonoplasty is a procedure that changes the voice of a male into a female voice in order to help establish the sexual identity.

Females usually differ greatly from males in the fundamental frequency and resonance. The fundamental frequency of male voices typically ranges from 100-150 Hz while ranging from 170-220 Hz in females. Men produce low voices because they have bigger chambers of the throat and mouth. Thus, by altering the larynx, pharynx, and the chambers which produce the sound, a male sounding voice can be changed to a female-sounding voice.

 

Vocal Fold Shortening and Advancement of Anterior Commisure (VFS AAC)

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The new method of voice feminization surgery, called “Vocal Fold Shortening and Advancement of Anterior Commissure,” is the world’s first treatment that does not incise the skin and get the same result of modifying the vocal cord to a female shape using an endoscope. This procedure which was developed by Yeson Voice Center was presented at the Voice Foundation Association in the United States on May 29, 2007.

 

Voice feminization surgery in Gender Identity Disorder (GID):

Most of the voice feminization surgery is preferred by those patients who want to change their gender from male to female and thereby, help to establish sexual identity.

The voice of females varies fundamentally from males in measurable parameters of waves such as frequency and resonance. The frequency of female voice being higher which 170-220 Hz has made the feminization of voice possible. The frequency of male voice has lower frequency of 100-150 Hz. Men’s voices are also different due to the size of the mouth cavity and bigger chambers of the throat. Therefore, changing the size and certain regions of larynx and mouth cavity can alter the voice tremendously transforming it to more feminine voice.

 

Vocal fold shortening and advancement Anterior Commisure (VFS AAC)

It is the latest technology developed in Korea to change the voice without any incision of skin and the modification can be done by the usage of endoscope. The result is as satisfactory as the conventional voice surgery procedure but less invasive. At present, the procedure is preferred by specialized surgeons to increase the patient satisfaction and optimal outcome.

 

Candidates for the Voice Feminization Surgery:

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.
Surgical principle & process

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Voice pitch determines by the size and the length of vocal fold. To help you understand better, it is the same logic with a musical instrument, guitar. Thick and long string makes a low pitch, thin and short makes a high pitch. Male and female vocal fold sizes are different; male’s is thick and long, but female’s is thin and short. VFS AAC (Vocal Fold Shortening and Advancement of Anterior Commissure) was developed by Yeson Voice Center. The surgical procedure is dissecting the anterior 1/3 portion of vocal fold membrane, then it makes the high voice tone.

 

Outcome of operation of Voice Feminization Surgery

The average vocal frequency increased from 137.3Hz to 211.5Hz, showing 74.2Hz increase in one’s voice frequency. It is different from the surgery methods that were introduced earlier; this treatment makes it possible for maintenance of natural phonation and even singing after the surgery. VFSAAS was presented at the Voice Foundation Association in the United States in 2007. It is different from the previous methods which it leaves less damage on the vocal cord tissue and incision is not required proving this is the best physiological method increasing one’s vocal pitch.

 

Frequency (Hz) Increasing Fo
Pre-operation 137.3
Post-operation 3 months 200 62.7Hz increased
Post-operation 6 months 211.5 74.2Hz increased

 

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The vocal fold AP shortening and advancement of ant. Comm for feminization of the voice
: The Voice Foundation’s 36th Annual Symposium, May 28-June 3,2007, Philadelphia, Pennsylvania, USA

 

Complications of the Vocal Fold Shortening and Advancement of Anterior Commissure

There are no particular complications after the surgery, but there might be some foreign body sensations in the vocal cord and rough voice, pain in the neck, sputum and cough; but these are all temporary and with proper medication and time it will resolve. Phonoplasty surgery should be operated through the most suitable method for each individual patient, and for this to occur, the vocal status after surgery must be predicted before-hand in order to increase a better result. Also, the tone quality of the voice and resonance of the sound can be changed into a more female voice by changing the shape of the pharyngeal cavity through the patients’ motivation, and by attending voice clinics and voice rehabilitations. The most important thing about this process is that each patient should get voice feminization surgery from and experienced voice clinic, and a clinic which can provide voice rehabilitations; otherwise one cannot expect any voice improvement. Therefore, patients must get voice feminization surgery by an experienced voice specialist profession.

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