Feminizing voice surgery

Human voice is golden because we use it every single day to communicate with others, create beautiful music and a way to understanding one’s emotions or feelings. We laugh, scream, shout or cry using our voice. The voice does not only serve as a channel to connect with people, it is also a unique way of determining a person’s age or gender. This makes the human voice so complex, but how does it works?

Your voice is a product of these three main sources: A power source (your lungs) where the air coming in and out of the lungs gives energy to the vocal chords in the voice box to create a sound.

A sound generator (our vocal chords) consisting of two vocal folds that vibrates (moving back and forth) with the passing airstream creating a sound.

A resonator (throat, nose, mouth, nasal passages) amplifies the voice and make it distinct and recognizable from one person to another.

By merely hearing someone speak, you can immediately distinguish if that person is a man or a woman thus making the voice a significant gender marker and equally important to gender reassignment surgery and facial feminization for a male to female Transgender.

Differences in a man and a woman's voice

Men Woman
Larynx Large Small
Pitch Low High
Vocal Folds Length 17-25 mm 13-17 mm
Vocal Tracts Large Small

In general, men have larger larynx and vocal tract result in lower pitch while women have smaller larynx result in higher pitch. Since female hormone replacement and voice therapies can only do little in feminizing the voice, most male to female transgenders seek surgical remedy to complete their transition.

There are many surgeons all over the world who operate feminizing voice surgery but finding for a specialist and deciding on what technique to choose can be very crucial. This is why Chettawut Plastic Surgery Center developed a partnership with Dr. Premsuda Sombuntham MD, a board-certified ENT laryngologist who specialized in feminizing voice surgery (Feminization laryngoplasty).

Dr. Premsuda utilizes anterior web formation technique which involves the dissection of the anterior portion of vocal fold membrane and suturing out vocal fold muscles to shorten vocal fold’s size.

According to recent studies, this procedure provides satisfied result to change a low pitch (Male voice) into a higher pitch pattern with natural voice quality.

The anterior web formation technique is not affected the integrity of voice box framework so singing with stable and natural pitch is possible after surgery.

During general anesthesia with special technique of intubation, the anterior web formation is done precisely under ENT microscope for permanent thinning the vocal folds.

Since the vocal folds are approached intra-orally with special instruments, there will be no scar or incision on the neck skin.

Dr. Premsuda recommends the patients to stay in Thailand for 1 month in order to complete the whole processes which are:

- Pre-operative assessment by strobolaryngoscopy at outpatient clinic

- Feminizing voice surgery done approximately 1-1.5 hour under GA (general anesthesia) as inpatient basis with one-night admission.

- Recovery at our affiliated hotels where the nurse team will come to visit and provide necessary care/advise in daily basis.

- Post-operative evaluation by strobolaryngoscopy at outpatient clinic.

Speech Progress after Voice Surgery

One Week Post-op = Absolute voice rest (no talking, whispering, coughing) to help the vocal cords heal properly. Producing a sound during this crucial first week of recovery may damage the vocal cords or delay the healing. Communication with the medical team and your significant others will be mainly done through writing.

Two Weeks Post-op = You are allowed to talk and whisper for strictly 5 minutes per hour only. Do not strain to talk but do it effortlessly.

Three Weeks Post-op = Talking time is increased to 15 minutes per hour.

Four Weeks Post-op = You can talk normally but no screaming or shouting.

Six Weeks Post-op = You are allowed to shout and sing.

You will experience a cracking voice until 10 weeks post-op but improvement on your pitch will be noticeable after 6 weeks post-op.

Before leaving Thailand, you will undergo a thorough post-operative evaluation and further instructions will be given during this time.

Tentative plan for those who plan to come for SRS / FFS with Dr. Chettawut and Feminizing voice surgery with Dr. Premsuda

Day 1- Arrival at the airport

Day 2- Consultation with Dr. Chettawut

Day 3- Consultation with Dr. Premsuda + Preop Strobolaryngoscopy at Private ENT clinic

Day 4- SRS or facial feminization surgery with Dr. Chettawut

Day (5-14)- Recovery from surgery

Day 15 or 16 Voice surgery with Dr. Premsuda

Day 26- Follow up with Dr. Chettawut

Day 27- Follow up with Dr. Premsuda + Postop Strobolaryngoscopy at Private ENT clinic

Day 29 or 30- Departure from Thailand