VOICE

With voice aesthetics, it is possible to change the voice frequency and obtain a deeper or a higher voice tone. It is also possible to change male voice to female and vice versa. Some other problems such as harshness, strain and vocal fatigue can also be eliminated. But medical technology has not come to a point to make voice, sound like someone else's voice. With voice aesthetics we are able to make changes on the vocal cords, however, voice production is very complex and requires many organs such as larynx, pharynx, trachea, teeth, tongue to work together. We can not modify those organs and tissues and so far It is not possible to change one's voice to another.

The methods used in voice aesthetic surgeries generally have low-risk with relatively comfortable healing processes. Patients can usually be discharged from hospital the same day of surgery several hours after operation.

Some men have a feeling that their voices are too high pitched and women have voices that they feel are too high and have not responded to therapy. Generally as we age through puberty our larynx changes its shape, so the vocal cords become thicker and longer, and the pitch becomes lower. If that fails to occur, one can have a higher voice than he or she would like, which can cause problems in work and social interactions. Voice deepening surgeries are often performed on male who need a deep/masculine voice in order to gain authority and persuasiveness in their social or work life such as; executive candidates, political individuals, announcers, presenters etc… There are also some diseases in men causing high-pitched vocal tone. For example; Mutational falsetto (puberphonia) is characterized with high pitch voice in young adolescents. This voice disease is believed to be functional, voice therapy is the first choice for treatment and usually one or two sessions of voice therapy is enough for treatment. If therapy does not help, surgery is indicated. Other than mutational falsetto, high pitch voice related with some organic factors (short, stretched, thin, atrophic vocal cords) is more common than it is thought. Voice deepening surgery is also an effective way of reducing vocal cord tension, leading to a more deep and masculine voice in those diseases.

Patients are first welcomed to Voicest Clinic for an initial consultation with Prof. Dr. Kursat Yelken. Expectations from surgery and potential benefits of postoperative voice therapy are discussed in detail. He provides you with information about treatment options and explains all possible surgical procedures. Subsequently, vocal cord videostroboscopic examination, Acoustic Voice analysis and Perceptual voice assessment including Voice Handicap Index is performed. In case of surgery, a consent form is handed out explaining in detail the procedure.

Patients are first welcomed to Voicest Clinic for an initial consultation with Prof. Dr. Kursat Yelken. Expectations from surgery and potential benefits of postoperative voice therapy are discussed in detail. He provides you with information about treatment options and explains all possible surgical procedures. Subsequently, vocal cord videostroboscopic examination, Acoustic Voice analysis, Perceptual voice assessment including Voice Handicap Index and Transsexual Voice Questionnaire are performed. In case of surgery, patients are strongly encouraged to quit smoking as smoking deepens the fundamental frequency and compromises satisfactory vocal outcome. A consent form is handed out explaining in detail the procedure.

There are several different surgical techniques applied to decrease the pitch. We use a modification of Type 3 Thyroplasty in Voicest Clinic. This surgery is applied with an incision made from the anterior lower part of the neck under local anesthesia. The incision is approximately 2-3 cm long. A diamond shaped cartilage island is made on the thyroid cartilage and pushed back. This allows the vocal cords to become relaxed, and the relaxed vocal cords produce a deeper voice. The amount of relaxation of the cartilage is direct proportionally related to the decrease in the voice pitch. Surgery is almost painless and very well tolerated by the patients. The whole procedure lasts approximately 45 minutes. During surgery the voice of the patient is listened and both patient and the doctor hear the deepening on the patient’s voice and the procedure is terminated when a certain tone is decided upon. Therefore, patients are able to experience the change in their voices and talk to their surgeons during surgery.

A number of procedures are available to elevate the pitch of voice. These surgeries are primarily designed for male-to-female transgender patients or for genetic males with vocal pitch and vocal resonance that are often too low to be perceived as a female. In our clinic, we perform three types of voice pitch raise surgeries. The first one is a modification of Wendler Glottoplasty, which is also called as “webbing procedure”. This is the most commonly used technique and we believe has the best voice outcomes. This surgery is an outpatient operating room procedure. We suture the anterior 1/3 front part of the vocal cords together. This effectively shortens the vibratory length of the vocal cords and elevates the comfortable speaking pitch. The vibration length of the vocal cords determines the fundamental frequency of voice. You can imagine like this, voice feminization surgery is somewhat similar to the way the pitch of a guitar string goes up when you shorten its length by putting your finger on a fret. It adds about 70 Hz to the fundamental frequency. This surgery is made under the microscope with general anesthesia through the mouth. Second technique we perform to obtain a more feminine voice is laser glottoplasty. This is also an outpatient operating room procedure, a laser is used to thinner the vocal cords and reduce their mass. This surgery is done under general anesthesia and is performed through the mouth. Laser beams reduce the thickness of the vocal cord layers (epithelium, ligament and muscle tissue) that results in a raise in the pitch. The technique adds 40-45 Hz to fundamental frequency. This surgery also changes the masculine rectangular shape of the vocal cords to a feminine triangular shape; thereby obtain a more feminine voice quality. The third technique we use is a procedure called cricothyroid approximation. This surgery is for increasing the tension of the vocal cords. It is made under local anesthesia with a small (about 2-3 cm long) incision on the neck. We speak with the patient during the operation and decide the new tone of the voice together. Cricothyroid Approximation is based on approximating the two cartilages (thyroid and cricoid) of voice box with permanent sutures or plating. It elongates and tenses the vocal cords and provides approximately about 40-45 Hz of increase in pitch. In the past this surgery was the most popular technique used to raise the pitch of voice. The problems with this technique are; makes the Adam’s apple look larger and voice outcomes are not as effective or long lasting as desired, sutures we applied on the laryngeal cartilages may loosen which results in a decrease in voice pitch over a period 6 months or more after the surgery. So we tend to use cricothyroid approximation as a complementary procedure.

This surgery is an out patient surgical procedure. About 2 hours after, we conduct the follow-up examination and 4-5 hours after surgery we discharge the patient from hospital. Post-surgical pain is not expected following the procedure and most of patients do not need to use painkillers afterwards. Voice will usually be quite tight or effortful after the surgery and will possibly become worse for a few days to a week then swelling starts to subside. Voice rest is not necessary and patients are able to use their new voices just after surgery, but it takes a few months for the actual voice to adjust. Discomfort will last for a few days and include difficulty with swallowing and a feeling like you have a sore throat. Just remember to prevent the wound from getting wet for 1 week. We use absorbable sutures, which will go themselves by time, so there is no need to take these sutures out. Non-active work can be resumed in a few days. You may resume aerobic activity after two weeks. Weight lifting should be deferred for a month. Note that, healing process is considerably individual and numerous factors affects this recovery process including; age, accompanying medical diseases and most importantly patients care and attention to closely follow voice hygiene instructions. Postoperative voice therapy is scheduled according to personal needs. We offer up to 10 sessions, starting in the first month.

After the surgery in general anesthesia, the postoperative monitoring follows in the recovery room. About 2 hours later, we conduct the follow-up examination and 4-5 hours after surgery we discharge the patient from hospital. The postoperative pain is usually tolerable and most of patients do not need to use painkillers afterwards. A complete voice rest period for 10 days is mandatory after surgery. In this period patients are not allowed to speak. Then a relative voice rest period for 20 days is required and during this period patients are advised to speak as less as possible. After 1 month, it is possible to return to daily talking routine. The average time period needed to gain a fully feminized voice pitch ranges from 6 to 12 months. Note that, healing process is considerably individual and numerous factors affects this recovery process including; age, accompanying medical diseases and most importantly patients care and attention to closely follow voice hygiene instructions. Postoperative voice therapy is scheduled according to personal needs, voice therapy is needed and required to retrain the patient‘s phonatory pattern. We offer up to 10 sessions, starting in the first month.