Surgical Options for Pitch Raising Surgery
In spite of attaining feasibility in the 1970’s, pitch-raising surgery — often referred to as “Voice Feminization Surgery” — had broadly remained unpopular amongst speech pathologists up until only a decade ago. Today however — thanks to growing advancements in technology, education and gender-awareness — the practice has started to gain traction among experts as a viable, gender-affirming procedure for those seeking extra support inhabiting their target voice.
While pitch-raising surgeries can take many forms, it is worth noting that they all can only target a singular component of the patient’s voiceprint: pitch. All other parameters, such as resonance (the most important factor of voice alternation), articulation, and intonation remain unchanged by the procedure. In order to develop the voice thoroughly and lastingly, voice therapy (or gender-affirming voice coaching) continues to be recommended as standard practice after the surgery.
If you are considering pitch-raising surgery and want to know more about your options, you may find below a digestible overview of what each of the available procedures entails.
Cricothyroid Approximation
Overview of Procedure
One of the first surgeries for voice feminization, born around the 1970’s.
Cricoid cartilage and thyroid cartilage are pulled together, tightening and lengthening the vocal cords and thus creating a higher pitch.
Cons
Resultant voice has a falsetto quality to it.
Pitch eventually drops back to its original baseline for 1 out of 3 patients.
Makes the cricothyroid muscle nonfunctional, in rare cases rendering the voice of patients physiologically monotone.
*In my opinion this is an outdated procedure. If a voice surgeon is still offering this, I would consider it a red flag.
Anterior Glottal Web Formation (a.k.a. Wendler Glottoplasty)
Overview of Procedure
Performed endoscopically (through the mouth) under general anaesthesia
Duration: around 1 hour
Akin to tuning the strings of a guitar, the procedure consists of shortening or “tightening” the anterior portion of the vocal cords, causing an increase in tension and thus a higher pitch.
Cons
Webs can gradually pull apart over several years
Can potentially create a gap between vocal folds creating a breathy/weak sound
Can negatively impact volume, making it difficult to get loud
* Considering one’s use of their voice in their profession might be particularly important for those exploring this procedure as an option.
Feminization Laryngoplasty
Overview of Procedure
Performed under general anaesthesia
Duration: around 2 hours
Horizontal incision is created at the neck
Makes the thyroid cartilage smaller by removing the anterior and superior thyroid cartilages
Creates shorter vocal cords by removing anterior false vocal folds and anterior true vocal folds
Lifts larynx higher in the neck and shortens pharynx to potentially alter resonance
Cons
Most invasive
Leaves a scar on neck
Potential for diplophonia (a double pitch or roughness in the voice) due to vocal folds not being able to vibrate symmetrically
Limited follow-up research on patients
Video Explaining Procedure
***Warning this video contains graphic content**
https://www.youtube.com/watch?v=VSad61GB-tk
Laser Reduction
Overview of Procedure
This procedure is a supplement to vocal cord webbing and feminization laryngoplasty
Laser is used to remove mass/muscle from the vocal cords, making them thinner
Also makes the edge of the vocal cord tighter, reducing some mass
Cons
Using laser alone will not make much change to the voice
Though I truly believe that finding an authentic and affirming voice is possible for most without surgical intervention, it is also incredibly important that people have access to all the necessary information they need in order to make the decision that’s best for them.
References
Casado JC, Rodríguez-Parra MJ, Adrián JA. Voice feminiza- tion in male-to-female transgendered clients after Wendler’s glottoplasty with vs. without voice therapy support. Eur Arch Otorhinolaryngol. 2017;274:2049-58.
Mora E, Cobeta I, Becerra A, Lucio MJ. Comparison of cricothyroid approximation and glottoplasty for surgical voice feminization in male-to-female transsexuals. Laryngoscope. 2018;128:2101-9.
Thomas JP, Macmillan C. Feminization laryngoplasty: assess- ment of surgical pitch elevation. Eur Arch Otorhinolaryngol. 2013;270:2695-2700.
https://my.clevelandclinic.org/health/treatments/21779-voice-feminization-surgery
