Voice Feminization Surgery Turkey Achieve Your Ideal Voice

What is voice feminization surgery?

Voice Feminization Surgery (VFS) is a series of surgical procedures that aim to give the voice a more feminine tone and characteristics, consistent with gender identity.

What is the purpose of voice feminization surgery?

The main goal of this surgery is to change the voice of individuals to make them perceive themselves and others as female. Since hormone replacement therapy (HRT) does not feminize the voice in trans women, VFS is an important method of gender affirmation for these individuals.
VFS aims to change the physical properties of the vocal cords that affect the rate of vibration. Similar to piano strings, thicker and longer vocal cords vibrate at lower frequencies, producing a deeper sound, while thinner and shorter vocal cords vibrate faster, producing a higher sound.
Most vocal feminization surgeries aim to make the vocal cords thinner, shorter, and/or more taut.

Conditions and criteria for voice feminization surgery:

Voice-related gender dysphoria (a mental state in which a person experiences a deep sense of unease or dissatisfaction):

The main reason for VFS is to eliminate dysphoria caused by the incongruence of the voice with gender identity.
The main expectation of treatment is to achieve a more feminine voice that is gender congruent.

Inadequacy of hormone replacement therapy:

HRT has no role in feminizing the voice in trans women. Therefore, alternatives such as surgery or speech therapy are used for voice feminization.

Inadequacy of speech therapy (voice therapy):

Although speech therapy is often recommended as a first-line treatment for voice feminization, in some cases it alone may not be sufficient.
When speech therapy is ineffective: When the individual has persistent voice complaints, such as the inability to consistently maintain a fundamental frequency above 150 Hz.
The desire to prevent the male voice from coming out in spontaneous moments: Patients who wish to prevent the reappearance of a deep voice in spontaneous moments such as laughter may opt for surgery.
Reducing mental effort: Surgery may be beneficial for people who want to reduce the mental effort required to maintain the desired speech pitch.
The goal of "no masculine voice": For some individuals, success is defined as the ability to "not sound masculine," and speech therapy does not meet this goal 100% of the time.

General medical criteria and age:

Generally applied to patients 18 years of age and older. Due to decreased plasticity with age, stiffening of the cartilages, hardening of the vocal cords, and less optimal healing, older patients may have lower expectations of achieving a truly feminine voice.The criteria are:

Persistent, well-documented gender dysphoria.
Capacity to make a fully informed decision and consent for treatment.
A single referral confirmation from a qualified mental health professional who supports the requested procedures.
Regular contact with a speech-language pathologist (SLP) and no evidence of non-compliance with voice therapy techniques and recommended follow-up.
Ability and willingness to comply with regular post-operative follow-ups (e.g., 1 week, 1 month, 3 months, 6 months, 1 year, 2 years, etc.) with the surgeon and SLP.

What are the methods of voice feminization surgery?

The main methods used in voice feminization surgery are as follows:

Glottoplasty (Anterior Glottoplasty / Wendler Glottoplasty)

It is an endoscopic procedure that aims to raise the pitch by shortening the vibration length of the vocal cords. In this procedure, which is performed using a laryngoscope, the mucosa at the front of the vocal cords is peeled away and then sutured to create a synechia (tissue ligament). This reduces the length of the vibrating part of the vocal cords. Laser can also be used in this procedure to control the degree of webbing.
It usually does not involve any incision in the neck. The voice box may take 6 to 12 months to heal. Absolute vocal rest is required for 10-14 days after surgery.
With a significant increase in fundamental frequency (f0), improvements in voice-related quality of life and subjectively perceived femininity are observed. Pitch elevation can remain stable for up to 4 years.
Risks may include reducing the diameter of the airway (requiring caution in emergency intubation situations), granuloma formation (a defense reaction of the body to inflammation or a foreign substance), and dehiscence—the separation or loosening of sutures in a surgically closed wound. There may be a temporary roughness in the voice during the initial postoperative recovery period.

Cricothyroid approximation (CTA):

This is an open surgical procedure that aims to raise the voice by stretching and thinning the vocal cords. A small incision is made in the neck, and the vocal cords are stretched by bringing the thyroid and cricoid cartilages together, mimicking the tension of the singer's muscles.
Usually the incision can take 6 to 12 months to heal. In some cases, 7-10 days of absolute vocal rest is recommended.
Provides an increase in pitch. When combined with glottoplasty, it can provide an average pitch increase of 80-85 Hz (8-8.5 semitones).
Risks may include an initially successful pitch rise that diminishes over time or the development of an unnatural, overly high-pitched sound. Vocal range may be limited, especially the lower pitch range. Risks of infection and swallowing difficulties have also been reported.

Feminization laryngoplasty:

This is a comprehensive surgical approach that aims to change the structure of the larynx from male anatomy to a more feminine structure. It is performed to address possible shortcomings of existing procedures (vocal webbing, cricothyroid approximation, laser reduction).

The procedure may include the following steps:
Removal of the anterior thyroid cartilage (reduces Adam's apple),
Shortening of the anterior vocal cords (increases pitch),

2 weeks of complete voice rest is recommended. Lifting anything heavier than 10 pounds (about 4.5 kg) should be avoided for one month.

It aims to increase both the fundamental frequency and the resonant frequency of the voice.

Risks include the need for external incision, infection, postoperative airway obstruction, decreased voice volume, hoarseness, limitations in singing ability, and the need for corrective surgery.

Polypectomy:

This endoscopic procedure aims to feminize the voice by reducing the mass of the vocal cords. It can improve a lower, rougher sound by removing the inflammatory tissue that accumulates in the vocal cords, especially in people with a significant smoking history.
The procedure involves exposing the voice box with endoscopy, then making an incision on the upper surface of the vocal cord and removing the inflamed tissues. Usually only one vocal cord is treated at a time to avoid complications, which means two separate surgeries requiring general anesthesia. It is recommended to wait at least three months between operations.
The recovery process can take 6 to 12 months.

Laser reduction/stretching (LAVA, KTP, or CO2 laser)

These methods aim to raise the voice by thinning and stretching the vocal cords, resulting in a softer, more breathy sound quality.
The procedure can be performed endoscopically (through the mouth) or sometimes in combination with other procedures. The KTP laser can be used to correct postoperative asymmetries or to further raise pitch, while the CO₂ laser is used to remove larger tissue.
It may provide less increase in fundamental frequency than other surgical methods.

Who is not suitable for voice feminization surgery?

Some conditions and characteristics may indicate that individuals are not suitable or are risky candidates for voice feminization surgery (VFS). These ineligibility conditions may include

Age:

Individuals under 18 years of age: This may require parental consent, legal guardianship, and approval from a qualified mental health professional.

Advanced age: While there is no hard upper limit over 60 years of age, the prospects for achieving a successful and natural feminine voice may diminish with age due to decreased plasticity of the vocal cords, hardening of the cartilage, and decreased healing potential.

Health status and chronic diseases:

Uncontrolled diabetes: Surgery may not be appropriate for those with an HbA1c of 8.0 or higher. In general, chronic medical conditions, especially diabetes, can negatively affect recovery and final outcomes.
Unsuitability for general anesthesia: People who are medically unfit for general anesthesia for elective procedures cannot undergo surgery.
Medical diagnoses that would seriously impair wound healing.
Pre-existing conditions that significantly impair breathing or swallowing function.
Clinical or psychiatric conditions that preclude surgical treatment.
Structural laryngeal pathology.

Lifestyle habits:

Nicotine use: Use of tobacco products (cigarettes, e-cigarettes, etc.) or nicotine replacement therapy (NRT) products within 30 days prior to surgery. Smoking increases the risk of complications and may compromise voice outcomes altogether; recovery tends to be worse and voice pitch lower in former or current smokers.
Patients with a BMI of 35 or above have an increased risk of complications and may be less satisfied with the surgical results. People with a BMI of 40 or above are not operated on.
Habits such as voice abuse, neglect of speech therapy, unbalanced diet, alcohol or drug use, and physical inactivity can increase the risk of complications.
Surgery is generally not recommended for those who are not committed to living full-time with a feminine gender identity, as the effects of surgery are considered permanent.

Previous surgical interventions and laryngeal status:

Previous surgery on the vocal cords: For some procedures, especially glottoplasty, it is desirable that the vocal cords be in good condition and have not been operated on before.
Those with polyps on the vocal cords or scarring from voice abuse. People with permanent, irreversible scars from previous unsuccessful voice feminization surgery may find the voice very difficult to correct, resulting in a low, rough, and unpleasant voice.
Those who have had previous cricothyroid approximation (CTA) surgery:This can make subsequent feminization surgeries more complicated and provide more limited pitch rise, as the cricothyroid joint may have lost its function. CTA may also not be recommended, especially for singers, as it limits the lower pitch range.

What are the advantages and disadvantages of voice feminization surgery?

Voice feminization surgery (VFS) has both advantages and disadvantages. The benefits and potential risks of these procedures may vary depending on the individual patient's condition, surgical technique, and lifestyle habits.

Advantages:

VFS increases the vibration frequency of the vocal cords, making the voice more feminine.
VFS improves quality of life and increases patients' satisfaction with their voice.
By reducing the risk of falling into an unwanted "male voice," the surgery can reduce the mental effort required to maintain the desired pitch. This is especially helpful in moments of surprise or inattention.
The changes achieved after surgery tend to be more stable over time.
Feminization laryngoplasty aims to make the resonance more feminine by narrowing the diameter of the larynx and shortening the pharyngeal space.
Feminization Laryngoplasty can remove the prominence of the Adam's apple more comprehensively than tracheal shaving. CTA can be performed through the same incision as thyroid chondroplasty (Adam's apple shaving).

Disadvantages and risks:

All surgical procedures have general risks such as blood clots, pulmonary embolism, bleeding, infections, hematomas, seromas, allergies or sensitivity to products, wound dehiscence, or slow healing.
In rare cases, nerve, blood vessel, or muscle damage may occur.
There is a risk of airway obstruction due to edema (swelling) after surgery. Glottoplasty significantly reduces the diameter of the airway, and patients need to carry this information with them for emergencies or intubation for life.
Problems such as hoarseness, roughness, falsetto quality, unnatural sound, or diploeophonia (double voice) can occur.
Speech and shout volume may decrease.
Speaking may require more effort, especially in the first few months after CTA.
Surgical results may vary from person to person

What should be considered before voice feminization surgery?

There are many important things to consider before voice feminization surgery (VFS). These preparations are critical to increase the success of the surgery and minimize possible complications.

Here are the main points to consider before VFS:

Before surgery, a detailed evaluation with videostroboscopy is necessary to assess anatomical pathologies in the larynx and to detect conditions such as muscle tension dysphonia (hoarseness).
Adequate psychological support by empathic mental health specialists before, during, and after surgery is of great importance. Voice dissonance has been reported to have a negative impact on quality of life.
Speech therapy is an integral component of the voice feminization process both pre- and post-operatively and is often highly recommended as initial treatment prior to VFS because it is low risk and can address multiple gender cues in speech.
Some surgeons require patients to undergo an evaluation with a specialized speech therapist before being admitted for surgery.Even if speech therapy is successful, individuals may still have a fear of making masculine sounds in spontaneous moments (such as laughter).
It is vital that you fully disclose all past and current health problems to your surgeon and anesthesiologist before and during surgery.
It must be recognized that the effects of VFS are permanent and irreversible.

How to care after voice feminization surgery?

Recovery after voice feminization surgery (VFS) requires specialized care that is critical to ensure proper healing of the vocal cords and larynx, to reinforce desired vocal characteristics, and to prevent potential complications.

Here are the main points to consider during the recovery process:

Absolute voice rest is usually required between 7 and 14 days after surgery. In some cases, this period may extend up to 3 weeks.
Absolute voice rest includes avoiding any vocal activity such as whispering, moaning, humming, throat clearing, coughing, loud sneezing (which should be done quietly), and spitting. After this period of absolute silence, some surgeons may recommend an additional 14 days of relative voice rest.
It is advisable to avoid shouting, sneezing loudly, coughing, spitting, or clearing the throat for the first year after surgery.
Cough suppressants are usually given after surgery, as coughing can damage the healing vocal cords. Whispering is prohibited for the first month, as it is more traumatic than speaking.
Speech therapy is important both before and after the voice feminization process. After 10 days of absolute voice rest, speech therapy should be continued rigorously. For best results, it is recommended to continue speech therapy for at least one year after surgery.
It can be expected that the voice will sound much worse (due to surgical laryngitis) after surgery, especially when first starting to speak; this will improve, but the patient should be patient.
Antibiotics are usually prescribed for 5 to 7 days after surgery to reduce the risk of infection.
Painkillers (e.g., Motrin or Advil) and codeine-based cough suppressants are given to control pain and cough.
Corticosteroids (dexamethasone or prednisone) may be administered to reduce swelling.
It is important to continue anti-reflux medications and a strict anti-reflux diet, if available, for one year after surgery. Similarly, allergy or asthma treatments should be continued for one year.
The incision site in the neck should be kept clean and dry for the first week after surgery, and no showering should be done.
Stitches are usually removed on the seventh day, after which you can shower. The incision site should be gently dried rather than rubbed.
After healing is complete (after about a month), scar creams, vitamin E oils, or silicone patches can be used.
Incision scars can take 6 to 12 months to mature and heal.
Lifting objects heavier than 4.5 kilograms (10 pounds) should be avoided for one month after surgery.
Depending on the nature of the job, a report period of 4 to 8 weeks may be required for return to work. Most people can return to work on day 19 (2.5 weeks) after surgery.
Speaking may require more effort during the first few months after surgery. This feeling disappears within 3 to 12 months.
Because of the swelling of the vocal cords, there may be a feeling of catching in the throat or the need to clear the throat, but this is temporary.
Temporary roughness in voice quality or wheezing (surgical laryngitis) may occur, especially in the first 3 months.
Possible complications may include infection, blood clots, bleeding, hematoma, seroma, wound dehiscence, airway obstruction, suture separation, granuloma formation, and impaired voice quality (coarser or uneven voice).
In case of severe swelling, especially on the second postoperative day, the risk of airway obstruction may rarely occur. If the infection persists for more than 10 days, it may be necessary to remove the surgical hardware or sutures.
Subcutaneous emphysema (subcutaneous air leak) can be caused by sutures leaking air or severe coughing; it is usually managed with observation.
Regular postoperative follow-up appointments (e.g., 1 week, 1 month, 3 months, 6 months, 1 year, 2 years, etc.) should be made in coordination with the surgeon and speech therapist/SLP.
It is recommended that all patients be examined and approved for travel on the first postoperative day and international patients be examined on the first and seventh postoperative days. At 3 months, examination and voice analysis are recommended.
Smoking or exposure to secondhand smoke in the postoperative period also negatively affects recovery and can completely jeopardize voice outcomes.

Timeline for voice feminization surgery (VFS):

Stage	Duration	Key Activities & Notes
The Surgery	1-2 Hours	The surgical procedure itself is performed under general anesthesia.
Absolute Voice Rest	First 1-2 Weeks	No talking, whispering, or vocalizing is allowed. Communication is done through writing, text-to-speech apps, or gestures. This is critical for initial healing.
Gradual Return to Speech	Weeks 2-4	Under your surgeon's guidance, you begin short, soft conversations. The voice may be hoarse, weak, and unstable—this is normal.
Voice Therapy & Adaptation	1-3 Months	Voice therapy is essential. You work with a speech-language pathologist to learn how to use your new vocal instrument correctly and healthily without strain.
Final Result	3-6 Months	Swelling completely subsides and tissues mature. The voice stabilizes and reaches its final, permanent pitch and tone. This can take up to a year for some individuals.

F.A.Q:

Will I feel pain during voice feminization surgery?

No, you will not feel any pain during voice feminization surgery. The procedure is performed under general anesthesia, which means that you will be in a deep sleep during the surgery and you will not feel anything.

Will the voice change immediately after the surgery?

Answer: No. At least 1-2 weeks of complete vocal rest (not speaking at all) is required after the surgery. Then the voice gradually opens up, and the final results stabilize within 3-6 months, sometimes up to 1 year. Voice therapy is very important during this process.

Are the results of voice feminization surgery permanent?

Yes, the surgical results are permanent.

Can I change my voice without surgery?

Yes, many people can achieve the voice they want with voice therapy alone. VFS is an option when the targeted results are not achieved with therapy or when a faster/permanent pitch increase is desired. Voice therapy should always be tried first.

Which doctor performs voice feminization surgery?

This surgery is performed by surgeons who specialize in laryngology, a subspecialty of ear-nose-throat diseases, and are particularly experienced in voice surgery.

Does VFS damage the vocal cords?

When performed by an experienced surgeon, VFS does not permanently damage the vocal cords. Rather, the aim is to improve the voice. However, as with any surgery, there is a risk of complications.

Will my voice sound exactly like a woman's voice with VFS?

VFS aims to increase the pitch to the female range (180-220 Hz on average). However, the "female voice" is not just about pitch. Speech style, accents, emotional intonation, and resonance are also critical in the perception of voice as gender. This is why a combination of surgery and therapy works best.

What other surgeries can be performed together with VFS?

VFS is usually performed alone. However, it can sometimes be combined with "tracheal shave" (Adam's apple reduction) surgery. This reduces the protrusion of the throat, giving a visually more feminine appearance.

Will there be scarring after voice feminization surgery?

It depends on the surgical technique used. Usually there is no visible scarring because the procedure is mostly done by laser or through the mouth. If an external incision is needed, it will be very small and camouflaged by the necklines.