Voice Feminization Surgery at WIH Hospital

The voice is an integral part of the identity. For many transgender women, aligning their voice with their gender is a crucial and deeply personal step in their transition journey. At WIH Hospital, we specialize in Male to Female Voice Feminization Surgery (VFS), a sophisticated procedure designed to raise the pitch of the voice for a more feminine quality. WIH Hospital has over 20 years of expertise in this specialized field.

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 understand 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 cords in the voice box to create a sound.

A sound generator (our vocal cords) 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.

Understanding Voice Feminization Surgery (VFS)

Voice Feminization Surgery (Feminization Laryngoplasty) is a surgical procedure that involves modifying the vocal folds—shortening, thinning, or tightening them to raise pitch and achieve a more feminine voice that aligns with a female vocal profile.

Types of Voice Feminization Surgery Offered at WIH

  • Feminization Laryngoplasty (Anterior Web Formation): This is a highly preferred technique. It involves precisely suturing the anterior (front) part of the vocal cords together. This effectively shortens the vibrating length of the cords, leading to a significant and permanent increase in pitch
  • Cricothyroid Approximation (CTA): This procedure involves tilting the thyroid and cricoid cartilages of the larynx closer together, which increases the tension on the vocal cords to produce a higher note.
  • Wendler Glottoplasty: A technique that also involves suturing the vocal cords together at the front to shorten their vibrating length, often combined with laser treatments to reduce vocal cord mass.

The Whole Process for Voice Feminization Surgery

A month-long stay in Thailand is recommended by Dr. Premsuda to complete the entire voice feminization process. This includes

  • A pre-operative assessment using strobolaryngoscopy,
  • The feminizing voice surgery itself (performed under general anesthesia with one night’s hospital stay)
  • Recovery at one of three affiliated hotels where a nursing team provides daily care and advice (excluding Sundays).
  • A post-operative evaluation by strobolaryngoscopy is also part of the process.

If you’re planning multiple procedures, Dr. Premsuda prefers to schedule feminizing voice surgery separately from any procedures performed by Dr. Chettasak. This is due to differences in intubation techniques required for general anesthesia. The medical team will determine suitable surgery dates based on your total duration of stay in Thailand.

Who is a Candidate for Voice Feminization Surgery?

  • Transgender Women (Male-to-Female): Those who feel that voice therapy alone hasn’t helped them reach a comfortable pitch.
  • Gender Non-Conforming Individuals: Those who desire a higher-pitched voice that aligns with their gender expression.
  • Cisgender Women: Women who may have a naturally deep voice and wish to raise their pitch.

Pre-operative and post-operative Care

Pre-operative Care

  • Our team will provide instructions on which medications to stop or continue.
  • Follow specific instructions about eating and drinking before the procedure.
  • Stop smoking 1-2 weeks before the surgery.

 Post-operative Care

  • Our experienced nurses will monitor the patient in the recovery room.
  • The surgeon will prescribe medication for pain and discomfort.
  • Attend all follow-ups at the WIH hospital with the surgeon.

Differences in a man and a woman’s voice


Larynx


Pitch


Vocal Folds Length


Vocal Tracts


Men


Large


Low


17-25 mm


Large


Woman


Small


High


13-17 mm


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 the most reliable result to change a low pitch (masculine voice) into a higher pitch pattern (feminine voice) with natural quality.

The anterior web formation technique does not affect 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 of 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.


Larynx


Pitch


Vocal Folds Length


Vocal Tracts


Men


Large


Low


17-25 m


Large


Woman


Small


High


13-17 mm


Small


Dr. Premsuda recommends 1 full month stay in Thailand in order to complete the whole process which includes:

– Pre-operative assessment by strobolaryngoscopy

– Feminizing voice surgery done under GA (general anesthesia) as inpatient basis with one night admission at the hospital

– Recovery in one of our three affiliated hotels where the nurse team will come to visit and provide necessary care/advise daily (except Sundays)

– Post-operative evaluation by strobolaryngoscopy

For patients who plan to have multiple procedures in addition to feminizing voice surgery in one trip, Dr. Premsuda prefers to perform the feminizing voice surgery separately from the other procedure/s done by Dr. Chettawut due to the difference in intubation technique during general anesthesia. The suitable surgery dates will be decided by the medical team based on the patient’s total stay in Thailand.

Speech Progress after Voice Surgery

  • First 7 Days: Absolute and complete voice rest is mandatory. This means no talking, no whispering, and no coughing or clearing the throat if possible. This allows the delicate tissues to heal without disturbance.
  • Week 2: The patient may begin to use their voice sparingly. The patients are allowed to talk for a strict maximum of 5 minutes per hour. Do not strain; speak effortlessly.
  • Week 3: The voice use can increase to 15 minutes per hour.
  • Week 4: The patient can return to normal conversational talking, but avoid yelling, screaming, or shouting.
  • After 6 Weeks: With the surgeon’s clearance, the patient can typically begin to shout and sing again.

Before leaving Thailand, you will undergo a thorough post-operative evaluation by strobolaryngoscopy.

Further instructions will be given during this time, including the plan to attend a voice training with a speech therapist in your area. Voice therapy is a significant step to practice and enhance the results of voice feminization surgery.

Recovery Timeline

  • Noticeable Pitch Change: The patient will notice a higher pitch after the initial 4-6 weeks of healing.
  • Voice Cracking: It is normal to experience some voice cracking and instability for up to 10-12 weeks as vocal cords settle.
  • Final Result: The final, stable pitch is typically achieved between 3 to 6 months post-surgery. Voice therapy during this period is essential to learn how to use the new voice effectively for feminine intonation and resonance.

The Transformative Benefits of Voice Feminization

  • Alignment of Identity
  • Increased Confidence
  • Improved Safety
  • Enhanced Mental Well-being
  • Natural Results

Important Guidance after Voice Feminization Journey

  • Adhere strictly to Voice Rest Protocols: This is the single most important factor in the recovery period.
  • Stay Hydrated: Drink plenty of water to keep the vocal tissues moist.
  • Avoid Irritants: Refrain from smoking and avoid secondhand smoke.
  • Commit to Voice Therapy: A qualified speech therapist will help the patient with pitch, resonance, and intonation to achieve the most natural-sounding feminine voice.

FAQ

We recommend a stay of 1 full month in Thailand. This allows for the pre-operative assessment, the surgery, a one-night hospital stay, a supervised recovery period, and a final post-operative evaluation before you travel home.

You will be under general anesthesia during the procedure. Post-operatively, patients typically experience a sore throat, which is well-managed with medication. The discomfort is generally mild.

Yes, voice therapy is a highly significant step. We strongly recommend it. Surgery raises the pitch, but a speech therapist will teach you how to control intonation, resonance, and articulation to achieve a comprehensively feminine voice.

As with any surgery, there are risks, though they are minimal in the hands of a specialist. Potential risks include infection, breathiness, or dissatisfaction with the pitch. Your surgeon will discuss these with you in detail during your consultation.

Example result of Feminizing

voice surgery

Pre-operative voice pitch

Post-operative voice pitch