Voice feminization

Voice feminization or transsexual voice surgery, depending on gender identity – is a surgical operation that aims to achieve the desired sound of the patient’s voice, most commonly the rise of the voice from the lowest to the highest, sonorous.


Examination and diagnostics methods

Executive checkup is carried out by patients with glottis incompetence. It includes video fiberoptic laryngoscopy which allows the doctors to assess the condition of the upper respiratory tract and to get the view of the vocal folds as close as possible. This procedure is fast and painless, it is done during the consultation and as a rule, it doesn’t require any special preparation. ENT specialist, a patient and his attendants can see the whole examination on the screen of the monitor that is why disclosing and interpretation of a disease (nodes, polyps and tumors) of the vocal folds are simple and clear.
In addition, executive checkup includes stroboscopy. During this procedure the vocal folds movements are slowing down, so it allows to have a thorough look at them. In usual conditions the vocal folds vibrate too quickly so it is complicated to examine them.
Stroboscopy is peculiarly important for people whose jobs are connected with voice and speech activities (singers, actors, teachers, salesmen, newsreaders), for children and grown-ups with permanent or temporary voice disorders, for any people who regardless of their professional occupations have periods of vocal activities (singing, theatre etc), as well as for early cancer detection.
If the patient has already got the voice feminization surgery, he needs to send endoscopy of the larynx (laryngoscopy) to his treating doctor in order to check if the surgery is possible. First of all it is necessary to eliminate the consequences of the previous surgeries and only then to perform a new one using the method of VFSRAC (vocal fold shortening and retrodisplacement of the anterior commissure). At this stage, our main priority is to restore the quality of the patient’s voice, rather than raising the tone. The voice tone may become higher after repeated surgery. However, the voice pitch will be limited due to the damaged vocal folds and dependent muscles. Before the surgery the patient is highly recommended to give up bad habits such as smoking and alcohol abuse. General and biochemical blood tests, clinical urinalysis need to be done. These tests allow us to identify the presence of current pathological processes in the body, which may become a contraindication to performing vocal fold aesthetic surgery. In addition, more blood tests are assigned to indicate the presence or absence of HIV infection, hepatitis B and C, syphilis, and rhesus blood factor. Moreover, coagulation test, ECG and chest X-ray examination are performed.

Methods of surgery performance

The average male vocal folds are between 100 – 150 Hz, the female vocal folds are between 200 – 250 Hz. The male vocal folds are thicker, longer, heavier than the female ones that is why the male voices are lower pitched. After the surgery the vocal folds get shorter, thinner and lighter, so the patient receives the female voice. Males and females have a significant difference between the voice pitch. Raising the voice pitch can be interesting for women who find their voices irritatingly low and for transgender groups.

Comparison of the methods

Vocal fold surgery (phonosurgery) is performed in case of inefficiency of conservative methods of treatment of vocal fold disorders. The surgery is performed under a microscope, and often with the use of a CO2 laser, which allows doctors to perform the procedure with the highest accuracy almost without bleeding and postoperative pain, with accelerated and successful healing process. At present there are several surgical methods for the voice feminization. One of the most popular ones is vocal fold shortening and retrodisplacement of the anterior commissure (VFSRAC). This method perfectly modifies the features of male vocal folds into those of female vocal folds without a necessity of a skin incision. This is achieved by endoscopically removing of 1/3 of the vocal fold membrane and internal tissue and then suturing the new structures tight with permanent suture material.

Voice feminization

Vocal folds.

Efficiency of the methods

It is implicated that VFSRAC method can achieve an average raise in the patient’s vocal fundamental frequency of 73.6 Hz in the transgender group allowing it to shift from the male range (100 Hz – 150 Hz) into the female range (200 Hz – 250 Hz). The average time period needed to gain a fully feminized voice pitch ranges from 6 to 12 months and in 92 % of cases patients are satisfied with the surgeries. Removing of the 1/3 of the vocal folds and restoring the anterior commissure is the technology of utmost importance which allows for a smooth glottic air flow resulting in a natural and clear voice. This method helps to shorten the vocal folds and achieve a higher pitch which allows the patient to get a natural female voice without damaging any of 50 larynx muscles. After the surgery, thanks to these method peculiarities, the patient’s voice has its natural tone and ability to sing.

Preparation for surgery

Voice feminization starts with the detailed discussion and patient’s examinations such as video fiberoptic laryngoscopy and stroboscopy. If it is required, additional examinations can be asked to be done, depending on the situation. It is necessary to disclose diseases of the gastrointestinal tract that may interfere with the results of the surgery. It is recommended as well to pass the thyroid function test and check the endocrine profile at thyroid specialist.

Surgery and postoperative care

During and after the surgery the patients are under experienced and highly qualified medical staff. Patients are usually discharged the day after surgery. The resting voice period for 1 month is recommended. All procedures prescribed by your doctor should be followed. Patients should stick to healthy diet, work with phonopaedists, avoid too much of physical activities.

Process of the voice changing over time

Adaptation to the new form of vocal folds takes place within a year. In order to achieve adaptation successfully, it is necessary to perform rehabilitation exercises daily for several months. Please be aware that this surgical approach requires the patient to train female resonance patterns, adapt to the new laryngeal biofeedback reflex system – the key moments of adaptation to be able to use the new vocal folds.

Possible complications

Voice feminization surgery is a very safe procedure with minimized risks. In rare cases, there could be temporary complications such as pitch instability, foreign body sensation on throat, hoarseness, neck pain, bleeding, sputum or cough. All these symptoms can be eliminated with the help of medicine prescribed by your doctor. Voice quality and clarity can be self-controlled, including regularly performing exercises for the voice repair.

To sum up

Surgical procedures on the vocal folds are orientated to the voice repair and its improvement. As a result of a timely surgery, you will completely restore your speech functions, physiologically normal breathing and will acquire a strong voice that will appeal to you.

Specialist in aesthetics voice surgery:

oncology specialist, phoniatrist Liliya Budeykina

Liliya Budeykina

ENT oncology specialist, phoniatrist, pediatric surgeon. Areas of specialization: phonosurgery, classical operative otorhinolaryngology in adults and children.

The way we work:

  1. Primary consultation. After patient’s request, the consultation is carried out as soon as possible.
  2. Assignment of the most effective therapy The surgeon is immediately provided with the results of the patient's examination, on the basis of which he makes a decision on treatment tactics.
  3. Coordinating the dates for the surgery The specialists of Impex life coordinate the dates for the surgery and hospitalization.
  4. Surgery performance. The surgery is performed under the supervision of Roberto Puxeddu on the base of the clinic “Medicina” in Moscow.
  5. Postoperative in-patient clinic. After the surgery, the patient stays in the in-patient clinic under the supervision of a doctor who is directly involved in all stages of examination and treatment.
  6. Post-hospital rehabilitation. Required consultations during the follow-up and rehabilitation period are carried out after discharge from the hospital. The doctor who is in charge of these consultations sends all the data to Roberto Puxeddu and receives recommendations from him for further patient management.