FAQs
Frequently Asked Questions
About Voice Feminisation
As is the case with musical instruments, pitch - how high or deep a voice sounds - is related to the length, bulk and tension of the vocal cords, which are dictated by the puberty that an individual goes through. A male puberty typically results in a deeper voice and a female puberty typically results in a higher, lighter voice.
Unfortunately not. The changes of the larynx position and dimensions experienced during a male puberty, as well as the testosterone-driven increase of the muscle bulk around the vocal cords, can only be altered with surgery.
Surgery aims to either shorten the cords (see Glottoplasty) or increase their tension (see Cricothyroid Approximation).
Yes. Voice, and the way in which it is perceived, is dependent on a number of factors only some of which can be influenced through surgery. The combination of surgery and therapy delivers the best results.
A full course of voice therapy is made up of around 12 sessions. If you are unable to achieve the results you are looking for, you may decide to undergo surgery. The alternative approach is to have pitch elevation surgery first, followed by voice therapy.
Once surgery is complete, we recommend follow up therapy to maximise the results.
Yes. You can focus on achieving the pitch you are hoping for with surgery first. We then recommend having a course of voice therapy post operatively, to hone the other elements, such as resonance, and intonation.
No. We recommend a couple of sessions pre surgery to prepare you for the operation, to talk about the recovery, how to look after your voice and how to avoid straining it post operatively.
We recommend that voice therapy begins three weeks post surgery. Starting with gentle exercises.
If you choose not to have voice therapy and you opt for surgery alone, you may not achieve the results you are hoping for.
We have voice therapists with whom we work closely. We can provide recommendations in this area.
No, voice feminisation therapy and surgery can start at any point during transition.
Yes. Cis women can have a naturally deep voice. The same principles apply to surgery, before and aftercare and voice therapy.
Occasionally, deep voice could be related to conditions that affect the vocal cords or general medical conditions such as underactive thyroid. We will need to examine your voice box first to exclude any treatable factors.
About Voice Feminisation Surgery
To feel our authentic selves, we need a voice that matches who we are. When someone transitions they may find that their voice no longer reflects them as an individual and this can exacerbate feelings of gender dysphoria.
The most effective and most predictable procedure for voice feminisation is the endoscopic modified Wendler Glottoplasty. This involves shortening the vibrating segment of the vocal cord by around 40 - 50 percent and stitching the front of the vocal cords together, in order to raise the pitch.
VFMR is a new technique aimed at reducing the volume of the vocal folds. The procedure requires only minimal postoperative voice rest and mild pain relief. See above for more info.
Yes. VFMR can be performed as a first line procedure. It might be more suitable for professional voice users who would like to reduce the risk of any long-term voice change.
VFMR is a better second line option as the resulting quality of voice is superior to that which can be achieved with CTA.
Patients will experience some hoarseness as part of their recovery but this will have fully settled by month six. The risk of permanent hoarseness is exceedingly rare. Other rare complications include bleeding, pain, infection, damage to the teeth and injury resulting from laser use.
VFMR requires 72 hours of post-operative voice rest.
Allow 6 months for full recovery after VFMR.
VFMR delivers consistent results with the postoperative pitch being within the range associated with someone who has not been through a male puberty.
It is possible to repeat the VFMR procedure more than once if the results are not as significant as you might have hoped.
This procedure involves making an incision in the skin on the neck and then bringing together the cricoid and the thyroid, cartilages of the voice box. This stretches the vocal cord and increases the pitch.
If there is not sufficient pitch increase with Glottoplasty we would discuss Cricothyroid Approximation.
Yes, this is possible but it is not our recommended approach. We find that the effects of the Glottoplasty are superior as well as being minimally invasive, which speeds up the recovery time. Glottoplasty also results in a more natural sounding voice, like our original voice but higher.
This involves lasering the upper surface of the vocal cord away from the vibrating edge. This tightens the cord and is suitable for minor adjustments
LAVA is a more superficial form of the procedure. With LAVA, the laser also aims to produce the same stiffening effect on the vocal folds but the laser incision is directed at the lining, rather than the vocal folds themselves. When LAVA is combined with Glottoplasty it has the added benefit of releasing the tension on the sutures.
No. Many transgender women can achieve this effect via therapy alone.
Yes. It is essential to work with an experienced speech and language therapist with an interest in working with transgender people.
The length of therapy and number of sessions needed varies from person to person.
There is no rigid criteria for voice feminisation surgery. We work with the individual to achieve the outcomes that work for them.
No, you do not need a referral letter.
Yes, the surgery is the same.
You will need to have a minimum of one-two sessions of voice therapy. If you smoke, you will need to stop smoking two to three weeks before surgery. If you suffer from reflux or asthma we would look to optimise treatment beforehand, to aid recovery and prevent damage to the Glottoplasty.
About Modified Wendler Glottoplasty
Glottoplasty is minimally invasive, this means the recovery time is faster. It also results in higher pitch increase, long lasting results and a more natural sounding voice - like the original voice, but higher.
Glottoplasty takes between 60 and 90 mins.
Our current waiting list is two-three months.
Yes it is a day case unless there is a medical background that requires overnight stay for monitoring purposes. You will be in for a couple of hours, wake, have something to eat and then you can be discharged.
As we carry out the procedure under general anesthetic, you won’t feel anything during the operation. Once the anaesthetic wears off there will be some limited discomfort for which we prescribe co-codamol, which is codeine and paracetamol. The codeine helps to suppress coughing and the paracetamol is normally more than enough to help with any pain from the surgery.
You will need one week of complete voice rest. Not a single word for a whole week (that includes talking, whispering, singing, coughing, humming, crying). You will need to be completely silent. During the second week you can increase this to two or three words at a time - still keeping voice use to a minimum. Gradually this will build over weeks three, four and five. By week six you should be back to using your voice with relative normal frequency.
We recommend that you avoid placing any unnecessary strain on your voice following the procedure until your first follow up. This is critical in the first two weeks after your operation.
Research suggests that younger patients will have better results. It is worth noting that we don’t perform voice feminisation surgery on those under 18.
If your job is voice dependent, you will need two to four weeks off work. If your job is not voice dependent or your employer can make the necessary adjustments so that you can rest your voice, you can return to work after five to seven days.
This can vary from patient to patient. Some patients start talking after the first week and their voice is as clear, no issues, the pitch is elevated straight away. For others, their voice will initially be quite weak but that will improve over time. By week six you should have a good indication of how your voice will sound.
We recommend allowing between three and four months for the voice to settle. At this point there may still be some hoarseness, with some vocal fatigue if you use your voice for a long period of time, but you will have a good idea of how your post-operative voice will sound.
The most important thing is to stay hydrated. When we narrow the vocal cords, we change the diameter of the airway so mucus clearance, especially in the first couple of days after surgery, can be quite tricky. The more hydrated you are, the thinner and looser your secretions will be, reducing the likelihood of you needing to cough and causing irritation or damage to your vocal cords. We advise steaming after the operation four times a day in week one. This can be as simple as placing your face over a bowl of hot water, with a towel over your head. You can reduce the frequency as the weeks go on.
There are no restrictions in terms of what you can eat and drink. If your throat is a bit sore because of the scope, perhaps eat softer foods in the first couple of days, but normally you can go back to normal diet pretty much from the same day.
Glottoplasty is minimally invasive, so there is less of a risk of the things you would usually associate with other surgery such as bleeding, pain and infection. There is the risk of damage to the teeth because we go with the scope through the mouth. If you have dental issues or bridges for example, we tend to put additional protection in place such as a gum guard. In theory there is an element of risk associated with the use of the laser, but we take laser safety extremely seriously.
Surgery can never be 100% guaranteed, and this is something we discuss in detail in the pre surgical consultation so that patients are fully informed. However, having said that, Glottoplasty has a 90% success rate.
If there is failure it tends to be one of two things, either the stitches prematurely break down after surgery or we fail to achieve enough pitch once the surgery has fully healed. This can happen if we’re starting with a very low, deep voice. So there is some increase, but not the amount of increase required by the patient to feel entirely comfortable.
The majority of people will recover the full use of their voice in time. However, there may be some negative effects including:
- possible reduction voice volume which might impact the ability to shout and project the voice
- long term hoarseness and strain which can be managed by speech therapy.
A good result requires a good partnership between surgeon and patient. So much of your outcome is dependent on good aftercare. That means following the surgeon’s instructions, making sure you don't strain your voice, that you don't push yourself to do too much, too soon.
Normally with general anesthetic you either put a tube through the vocal cord or a laryngeal mask airway which stays above the vocal cord. In this instance, because we're operating on the vocal cord we can't use either of these techniques. Instead, this is a tubeless surgery, we use something called jet ventilation, which provides a puff of oxygen 100 times a minute.
Yes. We perform the Adam’s apple reduction first, remove the tube and start with the Glottoplasty.
It is possible, but we don’t combine Glottoplasty with Cricothyroid Approximation, this is mainly because it can result in a monotonous, robotic- sounding voice. We recommend Glottoplasty in the first instance and if we can’t achieve what we want to achieve then we’ll have another discussion around VFMR.
This varies from person to person, but some individuals lose some of the voice pressure which can make it difficult for them to raise their voice, shout, scream and even sing. This is why the procedure is not recommended if singing is your career or an essential part of who you are. As with any surgery, the patient must weigh up the risks versus the benefits. Therapy can make a huge difference to the way your voice sounds without any of the potential risks associated with surgery but sometimes therapy isn’t enough to achieve the results you are looking for.
Glottoplasty is non invasive, there are no external incisions as the procedure is performed via the mouth. CTA and tracheal shave will involve a small incision on the neck, which will be placed in a natural skin crease to minimise visibility.
The results of glottoplasty are permanent.
The stitches will dissolve in six to eight weeks.
Consultations and surgery will take place at:
OneWelbeck Ear, Nose and Throat
1 Welbeck Street
London
W1G 0AR
For safety reasons, as with all day-surgery patients, you will need an escort to bring you home and stay with you for a minimum of 24 hours.
You can book a consultation by completing the contact form or by contacting
Mr Al Yaghchi’s secretary Olimpia Palici:
direct: 0207 205 2832
mobile: 0757 012 6245
email: secretary@lvsclinic.com
We are open Monday - Friday 09:00am - 17:30pm
About Chadwan Al Yaghchi
Mr Chadwan Al Yaghchi is our consultant ear, nose and throat surgeon. After developing a keen interest in transgender healthcare during his time working in close proximity to the Gender Identity Clinic in London, he went on to pioneer his own modification to the Wendler Glottoplasty technique, allowing him to provide better care to more people than was previously possible. (Link to full bio)
After Your Operation
No, you can’t travel on the same day. If you are from outside London then you should arrange accommodation for one or two nights after the surgery has been carried out.
In the event of stitches breaking down prematurely, or the requirement for the surgical management of complications, e.g steroid injection for excess granulation tissue, Mr Al Yaghchi will waive his surgical fee. You will, however, still need to pay the hospital charge and anaesthetist fee.
If you need further surgical intervention for enhanced pitch elevation or minor voice adjustments, such as Cricothyroid Approximation (CTA) or laser-assisted voice adjustment (LAVA) these will be charged at the normal rate, as they constitute separate surgical interventions.
Fees
Mr Al Yaghchi’s initial consultation fee is £500 including voice analysis, pitch measurement and endoscopic examination.
The cost of surgery is between £4,500 and £6,000. This includes surgical fee, two follow up appointments, anaesthetic fee and hospital charge. Please note that surgical and anaesthetic fees are fixed and you will pay these in advance. We will also provide as accurate an estimate as possible for hospital fees. This can vary based on the need for overnight hospital stay and any further tests and investigations for pre-existing medical conditions that may be needed.
Some hospital charges will be refunded if not required. Please note that you might receive three different invoices. If you require additional voice procedures, for example further pitch increase after the initial operation, revision surgery or Cricothyroid Approximation this can be provided at an additional cost.
Yes, we recommend two follow up appointments with your surgeon.
Yes, two follow up appointments are included in the fees. Hospital charges for endoscopy (£150) are not included in the fee and will be collected on the day by the hospital.
NB: All prices are correct at the time of writing. You will be given an up-to-date detailed quote prior to consultation and surgery.