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Voice Feminization Surgery (VFS), Anterior Glottoplasty

Whether on the phone or in person, it is a common and frustrating problem to have so many masculine vocal features that a person is mis-gendered.  A feminine voice is more than just a high pitched voice. Feminie voices differ from masculine voices in the way they vary their pitch, the direction of pitch variation at the end of sentences, their cadence, breath use, and many other things.  What makes a voice feminine can vary from one culture to another. Voice surgery can only elevate pitch, so it is only part of the equation. We encourage any patient considering voice surgery to work with an experienced speech therapist before and after the procedure.  Some patients will find that they may not even need surgery to get the feminine qualities in their voice that they want.  

How is voice feminizatoin surgery (VFS) performed?

There have been several procedures performed over the years to raise voice pitch and make a voice more feminine. Cricothyroid approximation is procedure that pulls the thyroid cartilage and cricoid cartilage apart and streatches the vocal cords.  This is the way we raise our own voice voluntarily – tightening our vocal cords. The advantage of this procedure is that the results are instant and you would have a clear voice with an elevated pitch right after surgery. The disadvantages include that you have a scar on the front of your neck, and, more importantly, that the vocal cords tend to loosen with time.  This makes every patient lose some of the pitch elevation that they gained, and a few even end up with a deeper voice than they started with. The lowering of pitch after surgery is the main reason the cricothyroid approximation is not as commonly performed.  

The second, more common procedure is called an anterior glottoplasty.  In this procedure the front ¼ to ⅓ of the vocal cords are fused together to make the functional part of the vocal cords shorter.  Testosterone makes the thyroid cartilage grow more prominent (creating the “adam’s apple) and make the vocal cords longer. Shortening the cords makes them closer the length most commonly seen in females.  The main disadvantage of this procedure is the healing process. There is typically a period of voice rest, and when a patient starts to use their voice their swollen vocal cords make the voice low in pitch and harsh or raspy.  The pitch will slowly elevate over the course of months. There are several advantages to this procedure, though, that make it the most common type of VFS performed. The procedure is performed entirely through the mouth, so there is no scar on the front of the neck.  While some patients don’t get quite as much pitch elevation as they would like, there is little risk of ending up with a deeper voice.  

What is recovery from voice feminization like?

Anterior glottoplasty is performed through the mouth, so there are no incisions on the neck.  There can be some throat soreness, but it is most commonly well controlled with advil and tylenol.  The most significant part of recovery is the mandatory voice rest. Patients are asked not to use their voice AT ALL for 1-3 weeks.  No talking, whispering, or making any noise. Coughing and sneezing should also be avoided to the extent possible.  

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