Voice Feminization Training (MTF Voice Surgery) in Bangkok, Thailand
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 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 cord’s vibration. The size and shape of our throats, mouth, nose and sinuses render the differences of the voice. The movement of the lips, teeth and tongue transforms the voice into words and sentences that we call speech. The speech is controlled by the brain to express feelings, thoughts, emotions etc. o speech practice is very important for a successful voice surgical result and natural speaking. That is why speech
practice can only be carried out by an experienced transgender voice speech therapist.
Refrain from smoking at least two weeks before the surgery. Before any thyroplasty surgery, a careful videolaryngostroboscopic 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, including the procedure discussion, alternative treatment, risks, 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 natural speech.
|Picture 1 Crico-Thyroid||Picture 2 Vocal Tract|
Picture 3 Shows vocal cords
The goal of this operation is surgically move closer the thyroid cartilage to the cricoid one, with non-absorbable stitches, so that vocal cords are not touched but passively stretched. This procedure results are an increase vocal pitch by stimulating the contraction of cricothyroid muscle with the suture. It increases the distance between the vocal fold attachments and raise the tension of vocal fold. The cricoid and thyroid cartilages are approximated as closely as possible because post operation reversion to ward a lower pitch to some extent is inevitable. The fundamental frequency of the voice to rise to perceptively overlap the biological female one. The operation is performed under general anesthesia. Duration time 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 post operation pain, however pain may occur if the Adam’s apple surgery is accomplished. In any case the pain is mild and perfectly controllable with painkillers.
A transverse incision scar is made in an existing skin crease, if possible, at the level of vertical midpoint of the thyroid cartilage on the throat, which is a small surgical opening around 2cm, leaving an almost invisible scar.
Picture 4 Shows before and after vocal cords
- This procedure dose not interfere or create scar on the vocal cords which can 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 neck incision
- Long term results are inconsistant
- Day 1 to 7: Absolute silence until the first follow up. There are no food and drink restrictions.
- Day 3 to 7: Moisturize the vocal cords by drinking enough water, 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 performed and the speech therapy rehabilitation can start.
The speech therapist will teach to the patient how to use her new voice in the best way possible. The final result will be seen between the third to eighth month after surgery. For this reason, a follow up is recommended at the third, sixth, 12th month, after surgery.
Note: The surgical team reserves the right to assess the feasibility case by case if the upcoming patient has already undergone voice change surgery using a different technique and is not satisfied with the result of his or 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.
Patients are recommended to take one week off work to fully recover. Two weeks off from work are required if the use of voice is demanded.