Open Feminization Laryngoplasty, Cricothyroid Approximation (CTA), Thyroplasty type IV.
The goal of the voice feminization surgery is to raise both the fundamental and the resonant frequency of the vocal tract in male to female transgender patients. There are some differences between pitch, voice and speech. The vocal cords are like a sound generator and the individual pitch depends on the frequency of the vocal cords vibration. The size and shape of our throats, mouth, nose and sinuses also gives the voice differences. Using an experienced transgender voice speech therapist is very important for a successful voice surgical result and comfortable speaking. In some regards being taught how to use your new voice is as important as the voice pitch itself.
Stop smoking at least 2 weeks before the surgery. Before any thyroplasty surgery, a careful videolaryngostroboscopy and spectrum-acoustic study of the voice is performed on each patient in order to better plan the surgery and evaluate the post-surgical results. The examination lasts one hour and includes a consultation about the procedure, the risks and questions and answers. After the first evaluation the patient will spend one hour, 2-3 times per week with the speech therapist to reeducate the voice to its new natural speech.
|Picture 1 Crico-Thyroid||Picture 2 Vocal Tract|
Picture 3 Shows vocal cords
The goal of this operation is to surgically move the thyroid cartilage closer to the cricoid with non-absorbable stitches. The vocal cords are not directly touched but passively stretched. This procedure results in increased vocal pitch by stimulating the contraction of cricothyroid muscle with the suture. This increases the distance between the vocal fold attachments and raises the tension of the vocal fold. The cricoid and thyroid cartilage are moved as close as possible because postoperative reversion to a slightly lower pitch to some extent is inevitable as swelling resolves and tissues relax. The fundamental frequency of the voice to rise up to perceptively overlap biological female range. The operation is performed under general anesthesia. The duration of the surgery is about 40-50 minutes and the surgical reduction of Adam’s apple can be performed at the same time. Generally the patient doesn’t feel any postoperative pain however pain may occur if the Adam’s apple surgery is done. This pain is mild and easily controllable with painkillers.
A transverse incision scar is made in an existing skin crease and if possible at the level of vertical midpoint of the thyroid cartilage on the throat which is a small surgical opening, around 2 cm, leaving an almost invisible scar
Picture 4 Shows before and after vocal cords
- This procedure does not interfere or create scar on the vocal cords which could potentially lead to permanent hoarseness.
- Theoretically reversible if the patient is dissatisfied.
- The surgical reduction of Adam’s apple can be performed at the same time.
- Requires a neck incision.
- Long Term results are not known as it's a newer procedure.
- Day 1 to 7: You must maintain absolute silence until the first follow up. There are no food and drink restrictions.
- Day 3 to 7: Keep the vocal cords lubricated by drinking lots of water and nebulize with a sterilized saline solution.
- Day 8 to 10: After the vocal rest period a new videolarygostroboscopic and spectrum-acoustic study is performed. The outer stitches are removed, the dressing is changed and the speech therapy rehabilitation can start.
The speech therapist will teach the patient how to use her new voice in the best way possible. The final result will be seen between the third month and the eighth month after surgery. For this reason a follow up is recommended at the third, sixth and twelfth month after surgery.
Note: The surgical team reserves the right to assess the feasibility case by case if the upcoming patient already underwent the voice change surgery using a different technique and is not satisfied with the result of his / her voice.
In order to prevent acid reflux it’s highly recommended to avoid caffeine, chocolate, peppermint, fatty foods, acidic foods, soda and alcoholic drinks.
One week off from work is sufficient as long as long as it’s possible to follow the voice restrictions. Two weeks off from work are required if the use of your voice is needed.
Female to male voice surgery or voice masculinization:
This type of surgery is performed if the patient is not satisfied with his voice despite the use of the male hormone therapy. Unlike the female voice a lower fundamental frequency of the voice is associated with men.
Before the surgery, an accurate videolaryngostroboscopy and spectrum-acoustic study of the voice will be performed to highlight the real and fundamental frequency and to plan the best operation to achieve the patients goals.
To achieve a deeper more masculine voice an increase in the mass of the vocal cords through an intra-cords injection of biocompatible material (from autologous fat to hydroxyl-apatite depending on the cases) is used. The increase in vocal cords mass creates a lowering of the fundamental frequency of the voice. The operation is performed under general anesthesia and its duration is about 20- 30 minutes. The patient generally does not experience any pain after surgery and there are no limitations on what you can eat.
After the surgery there is a mandatory period of silence for about two days. A new videolaryngostroboscopy and spectrum-acoustic study is then performed to evaluate the new fundamental frequency and after this the patient can start talking again with the help of a speech therapist.
Usually only one injection of biocompatible material is sufficient but the biological re-absorption of the injected material is unique to the individual and is not predictable. Although temporary the results of the surgery usually last a number of years. The operation is repeatable indefinitely in the same way as facial fillers so you can easily maintain your new masculine voice.
Voice Feminization Surgery (MTF Voice Surgery) in Bangkok, Thailand
Having a natural sounding feminine voice is important to complete the male-to-female sex reassignment surgery. After voice feminizing surgery, our speech therapists, Ms. Srinakorn Prohmtong and Ms. Sirirat Prayoonperaput will guide you to your new voice that will help define your identity.
|Ms. Srinakorn Prohmtong||Ms. Sirirat Prayoonperaputcan|
|Speech and Voice Therapist||Speech and Voice Therapist|
Male to female voice therapy is voice therapy to feminize the voice. Male to female voice training will help patients naturally communicate with a new authentic voice that is true to their gender identity. You will learn how to develop a feminine voice from the basics of frequency and tone with ease. Your posture, behavior and facial expression is important as well. The speech therapists will help you to gain control of your voice with crucial aspects such as breathing techniques. We teach you a female speech pattern where you learn how to control your resonance and intonation.
Therapy can start before surgery and will continue after surgery to achieve the best result. Only 10 minutes a day is required.
Voice feminization speech therapy
Voice feminization speech therapy is a treatment to refine your voice, making it sound more feminine. The treatment has to be done before and after the voice feminization surgery to provide your effortless control of speech. Before voice feminization surgery is performed, your voice has to be assessed and tuned to let you have a proper speech. After voice feminization surgery is performed, you would have to learn to feminize your voice and how to speak effortlessly. This program is provided by a specialized, skilled speech therapist, inclusive of multiple sessions of practice until you complete all aspects of voice feminization therapy, under the guidance of our speech therapist. Practicing without a guidance of the specialist may result in edema of your vocal cord and can cause a failure in our training program.
Voice feminization training program @ Kamol Cosmetic Hospital
Around one week before having voice feminization surgery your voice and speech will be assessed by our speech therapist who will help you tune your voice and let you speak with the least effort as preparation for talking in your new voice after the surgery.
After the voice feminization surgery you will meet with the speech therapist to assess your vocal cord function and help you speak in a healthy way. This session will be held on the second and fourth week after the surgery. You will be given daily voice exercise as homework in order to yield the best results. Monthly online follow-up meetings with our speech therapist can be arranged via Skype so no matter where you are you can continue to train and learn to speak in a female range and pattern with the correct intonation. Each meeting will be around one hour.