Voice Feminization Surgery

Human beings have amazing skills at perception.  We are able to look at a person and in a fraction of a second know if we recognize them, their approximate age, their gender, and much more.  Similarly, our ears are very attuned to the voices we hear.  Even after masterful facial surgery to provide a beautiful, natural, enviable feminine appearance a person may still not be perceived as a woman if they have a very masculine voice.  Thus, the voice can be one of the most important parts of correct gender presentation.

While there is no amount of exercise or practice that could change your facial appearance from masculine to feminine, many people are able to adjust their voices with speech therapy.  Talented speech therapists are available in many communities, and through the internet (call us if you need a recommendation) that can help you make the most of your natural voice.  It’s somewhat like learning to play an instrument or speak a foreign language – practice, practice, practice.

However, there are true anatomic differences between men and women.  Many men have lower voices and larger Adam’s Apples than women do. Sometimes even with diligent practice and good speech therapy assistance, the voice is still not a good match.  In these situations Voice Surgery may be recommended.


In this next example we have a voice surgery procedure followed by 3 weeks post-op voice. As you can hear there has been much improvement which will only continue to improve over time.

Pre-op Before Voice

 Post-op 3 Weeks Voice

Voice Before

Voice After

Several procedures have been described in the past and Dr. Spiegel (who is board certified in voice surgery as well as in facial plastic surgery) has written a book chapter describing these techniques for other surgeons.  Most of the time today we recommend shortening the length of the vocal cords.  This procedure has been popularized recently in Korea, though Dr. Spiegel has been doing similar voice surgery since 1995.

Using a microscope we look carefully through your mouth at the vocal cords.  The chords are then surgically prepared and shortened with dissolvable stitches, making them up to a third shorter. Dr. Spiegel may sometimes recommend that botulinum toxin (e.g. Botox) be injected at the same time in order to relax the vocal chords for the next several weeks after surgery.  This procedure can be done before or after you have had a “tracheal shave” procedure to reduce the adam’s apple if desired.

Once the surgery is over it is important to be at total voice rest while healing, about 2 weeks.  This is the hardest part!  This period of not speaking, shouting, or whispering allows the delicate stitches we place to dissolve and permits the vocal cords to heal precisely where we put them.  Afterwards you may begin speaking but it will be several more weeks before you should consider shouting, singing, loud speaking, or karaoke!

Additional voice therapy is typically necessary afterwards.  Adjusting your vocal cords gives you a new instrument but you still need to learn how to use it beautifully!

To learn more about voice feminization (pitch elevation) surgery, or other ways that we can help you to look and feel your most beautiful, contact Dr. Spiegel today.