How is voice feminization 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 a procedure that pulls the thyroid cartilage and cricoid cartilage apart and stretches 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 to 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 makes 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.