Voice Feminization Surgery in McLean, VA

Voice feminization (aka Wendler glottoplasty or Vocal Fold Shortening and Retro­displacement of the Anterior Commissure (VFSRAC)) is a procedure that benefits patients who desire a higher-pitched, more feminine voice in Virginia including McLean, Falls Church, Tysons, Arlington plus the Washington DC area.

What is Voice Feminization Surgery?

During a voice feminization surgery, the doctor will shorten your vocal cords, which produces a higher-pitched and more feminine voice. In some cases, the surgeon may also shorten the pharynx, or throat, to cut off the lower range and perhaps add a few extra notes on the upper range. Voice feminization surgery works best for those who have undergone and are willing to continue to undergo, speech therapy. This procedure is usually performed alone.

Am I a Candidate for Voice Feminization?

Voice feminization is about more than simply appearance. In fact, part of transitioning involves feminizing the voice. The end result should be a natural, more feminine voice. The surgery itself is minimally invasive, has no skin incisions, and usually involves only the vocal cords. As a general rule, Dr. Mardirossian encourages his patients to start speech therapy prior to the surgery. This way, their baseline fundamental frequency, and speaking pattern can be registered, and the use of postoperative exercises can be reviewed ahead of time.

If you are already working with a speech therapist and would like your voice to have a higher pitch, then you are probably a candidate for voice feminization . However, many times speech therapy alone can improve your ability to produce a higher-pitched voice. The voiced speech of a typical adult male will have a fundamental frequency from 85 to 180 Hz, and that of a typical adult female from 165 to 255 Hz. Women’s voices are more melodic while men’s voices are more monotonous. In speech training terms, this means that women have an overall higher voice frequency, and they change the frequency of their voice much more frequently than men.

The voice feminization surgery, or Vocal Fold Shortening and Retro­displacement of the Anterior Commissure (VFSRAC), is a safe and reliable method, first described in Korea in 2017, and practiced by Dr. Mardirossian. In VFSRAC, the vocal folds are not only sutured together to create an anterior glottic web, but the entire anterior commissure of the vocal folds is moved posteriorly to create more tension and thinning of the vocal folds to increase their fundamental frequency.

No skin incisions are necessary. With this approach, the outer surface of the vocal folds is removed and they are then sutured together tightly with a very fine permanent suture material to accomplish tightening and the creation of a feminine geometry to the larynx.

How is Voice Feminization Performed?

The procedure is performed through a narrow 2-cm metal tube that is introduced in the throat through the mouth. The tube allows Dr. Mardirossian to visualize and operate on the vocal folds.  A microscope is brought into the field, which magnifies the vocal folds and allows for precision work to be performed.

The anterior third of the vocal folds and the area of the larynx immediately inferior to them is roughened to allow for healing that will retrodisplace the anterior commissure of the vocal folds. In other words, the anterior attachment of the vocal folds is moved posteriorly. To facilitate this, the third anterior of the vocal folds is sutured together with a permanent suture. This process altogether shortens the vibration length of the vocal folds and increases tension, resulting in a higher voice pitch, very similar how a guitar chord is being tuned.

Bear in mind that the surgical field for this procedure is roughly 5-7 mm in size and at 22-23 cm distance from the surgeon’s hands, so it requires exceptional surgical micro-coordination and skill. The procedure is performed under general anesthesia and takes about 1.5 to 2 hours to perform.

Why Are Permanent Sutures Used as Opposed to Absorbable Ones?

After the procedure, the brain has to get used to the new length and tension at which the vocal folds have to operate. This process of “resetting the system” takes up to six months and is the main source for a hoarse voice after the initial swelling and inflammation of the voice box have resolved.

To understand this process, just think about trying to drive your car by pressing the pedals with your left foot instead of the right one. Not having the fine motor skills, your left foot will be pressing on the pedals way too abruptly to allow a smooth ride. During the process of motor reconditioning of the brain, the permanent sutures allow for a firmer union between the vocal folds and a better chance for success of the operation.

Temporary sutures may absorb prior to the completion of the motor adjustments and therefore compromise the result of the procedure. Permanent sutures will also cause some thinning of the vocal folds in the long run, with an additional increase in voice pitch months and even years after the procedure.

What Should I Expect After Voice Feminization Surgery?

Following the procedure, the patient will spend 12-24 hrs under hospital observation, during which the blood oxygen levels will be followed and the patient’s comfortable breathing will be assured before discharge. After voice feminization, patients should remain at complete voice rest for two weeks. Coughing and sneezing should be avoided as much as possible.

After the initial period of complete voice rest, use of the voice can be resumed and increased gradually. Following the surgery, patients often find that their voices are deeper due to the swelling and inflammation of the larynx. It may get worse before it gets better, and it may take up to six months for the roughness to dissipate completely. It generally takes six weeks or so before patients are fully healed and able to reach some of their higher pitches.

Is Voice Feminization Alone Enough to Have a Natural, Feminine Voice?

Keep in mind that most voice feminization surgeries can only truly affect the pitch of the voice, and not the resonance, which can also affect the way a patient’s voice sounds. Oftentimes, results are dependent on the success of the surgery along with the patient’s effort to undergo voice retraining, much as a singer is taught to use and control higher octaves. Surgeons often plan these procedures based on individual needs, so speaking to Dr. Mardirossian before the procedure is the best way to determine expectations.

How Long Will My Voice feminization Surgery Results Last?

The results of voice feminization are permanent and cannot be reversed. Since the largest possible portion of the vocal folds has been addressed with voice feminization, no further increase of the voice pitch is surgically possible. The results from voice feminization surgery are further enhanced with the help of voice training.

Contact Mardirossian Facial Aesthetics today to schedule a consultation with Vartan Mardirossian, M.D., F.A.C.S., to see if this procedure is the right solution for you. We offer voice feminization to the patients in Virginia including McLean, Falls Church, Tysons, Arlington plus the Washington DC area.