Yeson voice feminization surgery

[AmyBerlin]

Dear all,

having asked a few friends who use their voice professionally (speakers, singers), Dr. Gross appears to have a really good rep as a phoniatrist among this crowd. That's promising. In any case, I'll check him out in Feb. and have him take a look at my voice box to get an opinion on the status quo of my problem, and will try to obtain more detailed information on the surgery he's doing. Under the very restrictive German laws, he can't publicly supply before/after recordings, but he could do so on a one-on-one basis. If he doesn't, it's not a good sign, but if he does, I'll let you know how they rate up in comparison to Yeson's work. However, I feel it would take absolutely top-notch results for me to consider choosing him over Yeson.

Meanwhile my friend is on her road to recovery and I'm very curious how she'll sound. I feel that the availability of this kind of surgery, performed at Yeson's level of perfection, is truly a revolutionary life-changer for trans women, on a par with the advent of FFS 25 years ago, and it's exciting to be a part of it. Actually, I can hardly wait having the procedure, and the prospect of having to wait another half year really sucks (pardon my French).

Amy

[anjaq]

Hi Amy

That's promising. In any case, I'll check him out in Feb. and have him take a look at my voice box to get an opinion on the status quo of my problem

Did you also have a very specific problem like I do with overstraining? Do you already know what the issue there is? Or is the problem the whole issue about pitch and such?

Under the very restrictive German laws, he can't publicly supply before/after recordings, but he could do so on a one-on-one basis.

Yes - to clarify this, there is a regulation that prohibits medical professionals who offer health services that are usually covered by health insurance to do advertisement. The idea is that it would be detrimental if doctors (often at publicly funded institutions) would have to spend lots of money to participate in a advertisement battle. It makes a lot of sense, but to consider voice samples an advertisement is stretching it - I would say it is important information.

If he doesn't, it's not a good sign, but if he does, I'll let you know how they rate up in comparison to Yeson's work.

I exchanged some facebook comments with two people who had to do with Dr Gross and both told me they did not listen to voice samples - I am not sure if they did not ask for them or if he does not give them they were not provided (or his patients generally refuse to give them due to privacy reasons). So I was kind of stuck with anecdotes about the voices being often a bit hoarse or breathy. I am still trying to get someone who had the surgery there on the skypephone to get an impression. I really would like to hear some of the voices of people who had done the surgery either at Yesons or at Dr Gross to get a direct impression, which would mean more to me than a recording, which means more to me than someone writing online that it was great (very subjective!)

Meanwhile my friend is on her road to recovery and I'm very curious how she'll sound.

I am looking very much forward to it, also because it will be possible to get a recording of a german language sample then - which is easier for me to judge of course than a foreign language one!

Actually, I can hardly wait having the procedure, and the prospect of having to wait another half year really sucks (pardon my French).

Ah half a year will be over in no time. For me, if I should go for this it would be at least a year out from now. More like 1.5 years.

Greetings

[AmyBerlin]

Hi Anja,

Did you also have a very specific problem like I do with overstraining? Do you already know what the issue there is? Or is the problem the whole issue about pitch and such?

The problem is that it's an awful lot of work. Keeping my speaking voice up is work in itself, but singing takes an excruciating amount of control and diaphragm support. I suppose there won't be any voice problems per se, since I have fairly good technique, but I'd like to rule out such a case before seeing Dr. Kim.

I exchanged some facebook comments with two people who had to do with Dr Gross and both told me they did not listen to voice samples - I am not sure if they did not ask for them or if he does not give them they were not provided (or his patients generally refuse to give them due to privacy reasons). So I was kind of stuck with anecdotes about the voices being often a bit hoarse or breathy. I am still trying to get someone who had the surgery there on the skypephone to get an impression. I really would like to hear some of the voices of people who had done the surgery either at Yesons or at Dr Gross to get a direct impression, which would mean more to me than a recording, which means more to me than someone writing online that it was great (very subjective!)

Anecdotes are NOT evidence. Question is, how do we track down patients who had the procedure with him, and get a voice sample from them? Apparently there's no conclusive information floating around on the Internets.

Regards,

Amy

[anjaq]

Yes - very little Information. I am trying to collect some now. Its a hard Job and people dont like to give voice samples. I guess they are afraid that it is not as good as they think it is, just like with all our procedures...

I have interesting news. a) Dr Gross seems to almost never talk to the patients himself in the consultation but sends his co-surgeon. b) they seem to never give out voice samples and do not even give you the detailled results of your voice examination unless you request it

and the biggest one: c) I think I have a hint on what makes a glottoplasty a success or not. One of the girls who went there found out that they say the hoarseness/breathiness that some experience is coming from a wrong angle in the new V-shape. So basically if it is a wider angle (which is inevitable with this method) or if there is an assymetry, this may cause the problem. What I think as a result is that a good and experienced surgeon can better predict the angle of his results, maybe even correct assymetries, ensure that the angle is good. And then the result is a voice that is not hoarse or breathy. If the surgeon cannot do that, the angle does not work out and there is a flaw in the resulting voice, which in theory could probably be corrected surgically, but few would go through all of this again for such a minor correction. This is just my impresison now - it is not said so by the surgeons.

And Amy - if you go to Charité for the consultation - make sure you ask for voice samples, make sure you try to get the most information about this issue with the hoarseness and the angle of the vocal chords ("c.") and make sure you ask them for videos, pictures and printouts of your voice analysis. It seems they are typical german doctors who think that it is enough if the doctors know all that information and the patient just has to know the minimum information needed.

[AmyBerlin]

Dear Anja,

I am trying to collect some now. Its a hard Job and people dont like to give voice samples. I guess they are afraid that it is not as good as they think it is, just like with all our procedures...

This is an alarming sign. People who are happy with their surgery result should be pleased to readily submit an anonymous voice sample.

b) they seem to never give out voice samples and do not even give you the detailled results of your voice examination unless you request it

No sample, no surgery. For me at least. Not with him.

So basically if it is a wider angle (which is inevitable with this method) or if there is an assymetry, this may cause the problem. What I think as a result is that a good and experienced surgeon can better predict the angle of his results, maybe even correct assymetries, ensure that the angle is good.

This is likely the point, and the only sensible reason why Dr. Kim limits his glottoplasties to a 75 Hz increase. Were the angle irrelevant, the stitch could be placed in an arbitrary position and the voice retuned at will. Probably the 75 Hz are just at the limit where the arytenoid cartilages can still maintain good vocal fold closure for loud phonation. Hoarseness or even breathiness preclude loud volumes at the risk of injury, and definitely are pathologic signs for a voice.

make sure you ask for voice samples, make sure you try to get the most information about this issue with the hoarseness and the angle of the vocal chords ("c.") and make sure you ask them for videos, pictures and printouts of your voice analysis.

I'll try and squeeze as much information out of them as I possibly can. I'll be taking a detailed list of questions with me and systematically work my way down. Also, I'll take an USB drive, digital camera (to copy printouts) and notepad. It could also help (and indeed has helped me in dealing with a lot of physicians in Germany) if I state my Ph.D. on the admission form. OTOH, I've also seen cases where it seemingly backfired, though they are few and far between. Having the degree and a good background on the subject matter often help in restoring the loaded doctor-patient authority see-saw to balance and level out the playing field.

It seems they are typical german doctors who think that it is enough if the doctors know all that information and the patient just has to know the minimum information needed.

Well, I'd be happy if they gave me the information needed. I need a whole lot of information to make an informed decision, I would say!

Have a great day,

Amy

[anjaq]

This is an alarming sign. People who are happy with their surgery result should be pleased to readily submit an anonymous voice sample.
No sample, no surgery. For me at least. Not with him.

Yes indeed. I must admit however that Germans seem always a bit more privacy oriented than lets say Americans. I personally would not want my pictures or videos to be seen on the web in this context. But I think I would not mind to give an anonymous voice sample, especially if it is not publicized. But I guess the German surgeons do maybe not even ask for samples to be shown to others? I can imagine they don't...

This is likely the point, and the only sensible reason why Dr. Kim limits his glottoplasties to a 75 Hz increase.

I think this range is also the one others are aiming at but I think it is probably a crucial detail on how the stitches are done in that area, how well the surgeon can predict the post operative shapes and such.

Also it totally makes even more sense now with this information on the importance of the angle on the voice, that post operative restrictions (no speaking, no coughing etc) are kept to the letter because I can imagine that even small tears in the area of the commissure (the tip of the "V") can alter its shape enough to endanger the overall result. After all this is a delicate area post op. Imagine two strips of cloth and sewing them halfway together, then pulling at them even slightly - there may be tears in the fabric or widening of the holes of the stitches right at the commissure.

I'll try and squeeze as much information out of them as I possibly can. I'll be taking a detailed list of questions with me and systematically work my way down. Also, I'll take an USB drive, digital camera (to copy printouts) and notepad. It could also help (and indeed has helped me in dealing with a lot of physicians in Germany) if I state my Ph.D. on the admission form.

Yeah - you seem to be well equipped then - Its what one needs, it seems , to get good quality information out of some doctors. I have to try that trick with the PhD - I thought of that too - they seem to sort of treat people differently if they see one has an academic degree. I did not put it on the admission form however if I think that it could rise fees because they think I am well off because of it

[AmyBerlin]

Hi all,

I think this range is also the one others are aiming at but I think it is probably a crucial detail on how the stitches are done in that area, how well the surgeon can predict the post operative shapes and such.

Also it totally makes even more sense now with this information on the importance of the angle on the voice, that post operative restrictions (no speaking, no coughing etc) are kept to the letter because I can imagine that even small tears in the area of the commissure (the tip of the "V") can alter its shape enough to endanger the overall result.

Having thought intensely about the geometry of the glottis, I think the V's tip shape is much more important than the angle per se, because, on phonation, the arytenoid cartilages bring the posterior end of the vocal folds in line, no matter how obtuse the angle in front. But what's absolutely key to phonation is that the two vocal folds meet at a well-defined point in front. If that point takes on a rounded shape post-surgically, or is blunted or stiffened by scar tissue formation, the folds won't be able to make contact in front, thereby letting a jet of air escape in a turbulent airstream, without contributing to phonation. The unused air gives the voice a breathy quality and the turbulence of the airstream creates an irregular pull on the vocal folds at higher volumes that could potentially lead to additional vocal fold wear and hoarseness. And that's why you have to adhere to the post-op instructions so precisely, to ensure scar-free healing.

But this is just my conjecture of what could go wrong during the procedure.

Regards,

Amy

[Mx Pippa]

Hi everyone! I have been looking into this place "Yeson Voice Center" more and more. My practiced female voice is coming along but I am still finding great difficulty using it around people I already knew- which leads to difficulties across the board. I want to use it all the time but just... can't... for some reason.

Glad to know I'm not alone on this Jenny, I've tied most things to get a wonderful fem voice, Andrea James to start, even had Skype lessons from Kathe Perez, who said my voice was just where it should be, but as soon as I confront some one, in kicks my male voice. I'm sure it's just in my mind so giving the Hypnotherapy root a try now.

[anjaq]

Having thought intensely about the geometry of the glottis, I think the V's tip shape is much more important than the angle per se[...] If that point takes on a rounded shape post-surgically, or is blunted or stiffened by scar tissue formation, the folds won't be able to make contact in front, thereby letting a jet of air escape in a turbulent airstream, without contributing to phonation. The unused air gives the voice a breathy quality and the turbulence of the airstream creates an irregular pull on the vocal folds at higher volumes that could potentially lead to additional vocal fold wear and hoarseness. And that's why you have to adhere to the post-op instructions so precisely, to ensure scar-free healing.

This totally makes sense and I think that is what Dr Gross' Assistant meant actually - I think she was talking about the microstructure there (the tiny tip of the V) with the angle, not the whole vocal chord angle. It has to stay V-shaped and not U shaped or like a V with a wider angle. I guess this is in part surgical experience and good aftercare to make this happen.
My vocal chords now do something like this because of my condition - they do not close completely in that area. I guess my voice is a bit breathy as a result (which is partly desired as it makes the voioce more feminine) but also causes problems. I seem to somehow correct it or maybe it is just not as strong, as the phonetics doctor and my voice tainer both said that my voice is a lot less breathy than they would expect with that condition. So a bad shape in the Tip of the V definitely should be avoided and I can imagine this makes a whole lot of difference.
This complication does not explain a lack in the increase of average pitch though, as some have experienced it. This is a mystery to me.

[Mx Pippa]

This is a mighty big thread, so I just may have missed it, but has price been mentioned?

I seem to remember trawling thought the web site but not really getting an incing of the cost.

[sarahb]

This is a mighty big thread, so I just may have missed it, but has price been mentioned?

I seem to remember trawling thought the web site but not really getting an incing of the cost.

It was $7,380 when I was there almost a month ago. If you need the Botox it's another $400.

[Mx Pippa]

Thanks Sarah, It seems I have to bookmark you or something, until I get 50 posts (sorry another thread), then I can give you a reputation point. Anyways, thanks again, your a star, sorry to say no Yeson for me, unless my lottery numbers come up.

[AmyBerlin]

Dear all,

the following link leads to a poster that details the results of VFS performed by Miethe et al. at Katharinenhospital, Stuttgart, Germany:

http://www.egms.de/static/pdf/journals/cpo/2006-2/cpo000215.pdf

They apparently use the same basic technique as Gross and Kim. I'm not going to translate the text that only highlights the deep lack of concern many physicians have toward issues we, their trans* patients, face, but will only point out what the figures mean.

Fig. 1: Vocal folds with mucosa removed in the anterior portion. Very similar to the corresponding picture supplied by Yeson.
Fig. 2: Completed surgery. The result is worse than Yeson's in three aspects:

• Sutures are not horizontal, thus possibly leading to an uneven distribution of tension between the two vocal folds.
• The surgery created lesions on the vibrating portion of the vocal folds that may hamper phonation post-surgically. The left fold is marred by an attempt at a stitch, the right appears swollen.
• The two folds do not meet in a well-defined contact point, the re-located commissure, but instead the right one was pulled over the left, thus vertically displaced. This may possibly also negatively affect sound quality afterwards.

Fig. 3: Pre- (green) and postoperative (magenta) speaking pitch of study subjects. X axis: Pitch [Hz]
Fig. 4: Patients' self-assessment of satisfaction with their pre- (green) and postoperative (magenta) voices. X axis: Satisfaction on an ascending 10-point scale, Y axis: Number of patients.

Compared to Yeson's counterparts of Figs. 2 and 4 (Fig. 1 is indeed very similar), Yeson's procedure has a clear edge over Stuttgart's. How Gross (Berlin) compares to either is yet to be determined.

I'm looking forward to any comments and suggestions as to the comparison of the two results.

Best regards,

Amy

[anjaq]

Thanks Amy for sharing this. I would really like to see that Fig 2 without all the blood in it to get a clear picture, but the unevenness of the sutures is really striking in any case. I also would like to see a higher res picture of the results from Yesons to see how their commissure is looking like. But indeed from the comparison of these pictures to http://www.yesonvc.net/disease/feminization_surgery.asp I would say that the people in Stuttgart are doing not that great of a job. Ok, this is of course just n=1, one sample, pictures chosen for whatever illustrative purposes. Still it says something.

Maybe there is a chance to get more pictures. Have you sent this document to Dr Kim?

[Jennygirl]

For a frame of reference, here is a before/after of my vocal cords

day before surgery


7 days post-op


I would really love to see how my cords look NOW. Maybe it's time to schedule an appointment with a local ENT to have a look. Yes, I think I will do that. I'm extremely curious to see if the V shape has returned fully.

[AmyBerlin]

Dear Jenny,

thanks for posting your before/afters. As far as I can see, this is VERY good work by Dr. Kim. And please note that the large "V" only exists with the vocal folds in the breathing position, so you don't have anything to worry about. In phonation position, the folds touch along the midline. And the "V" we've been talking about is far smaller: just the little contact point of the newly formed commissure (where the green and blue lines would touch in your picture). If the procedure caused scarring, there wouldn't be a neat contact point, but more or less of a gap through which excess air would escape without contributing to phonation.

BTW, I just got off the phone with a Stuttgart patient (a decade postop with Drs. Hagen/Miethe). She sounded very convincingly feminine to my ears, although her voice was a tad duller sounding than yours that has this wonderful mezzo ring to it. But this could be because of being inexperienced in voice technique. But the main outcome of this conversation was to provide a frame of reference for the long-term effect of this surgery: it's indeed absolutely permanent, her voice reportedly hasn't changed since, which I'm more than ready to believe. She mentioned that she lost some volume with the surgery, though. Jenny, can you fill us in how volume develops after a Yeson surgery?

Plus, I heard that Gross is no longer doing most of the Berlin surgeries, apparently a colleague of his, Dr. Nawka is. Hearsay has it he's also good. But that's for me to find out in February. I wrote to them again if they could provide me with samples in advance of our meeting. Let's see how they react.

Bottom line: Kim still remains top choice for me, although sound-wise Stuttgart appears to be a viable option for people unwilling to make the trip to Korea.

Best wishes, happy holidays to all,

Amy

[Jennygirl]

I decided to do another check in video, including my before reading of rainbow passage. Haven't posted anything in quite a while!! I took analyzation graphs from Praat and animated it along with the videos to provide better frame of reference.



As far as volume, I am still gaining it back... but by no means do I feel like it is a problem. On numerous occasions I have had to yell, and I am surprised by how loud & high I can get. When I really push it, I can go much much higher and louder than I used to be able to and purely in a head voice.

Under normal speaking circumstances the volume difference is a little bit more noticeable, where I find myself having to speak up a bit more than I was used to. I also find that usually in this case I just need to focus more on bringing the pitch up instead rather than putting more air through.

I hope that makes sense. It certainly is getting better still. Being home for Christmas my mom has told me numerous times how wonderful she thinks my voice sounds, and I have been passing to everyone I've come in contact with which eases her mind soooo much. It's quite wonderful what this surgery has done

[AmyBerlin]

Dear Jenny,

thanks for all the information. I'm so glad that you have such a supportive mother. And that she, as a retired voice professional, is happy with your voice says a lot to the credit of Dr. Kim. And I'm relieved to hear that with him, volume is not an issue. Now, over half a year past the procedure, your voice just keeps sounding stronger and better. Congratulations! I can't wait until April rolls around and I have the time to go to Yeson to have the surgery. I could afford it, like, immediately, but unfortunately, my work schedule is jam-packed until mid-April.

BTW, didn't your old ticker say you'd get FFS soon? I don't think you need it, I think you're pretty the way you are, but in any case I wish you lots of success with that and that all your dreams and aspirations come true! Who you're having it with?

Love,

Amy

[barbie]

I hope that makes sense. It certainly is getting better still. Being home for Christmas my mom has told me numerous times how wonderful she thinks my voice sounds, and I have been passing to everyone I've come in contact with which eases her mind soooo much. It's quite wonderful what this surgery has done

Yes. Jenny, it seems a surprising gift for Christmas to your family.
I hope to listen you delivering a lecture or a speech next year.

barbie~~

[Jennygirl]

Dear Jenny,

thanks for all the information. I'm so glad that you have such a supportive mother. And that she, as a retired voice professional, is happy with your voice says a lot to the credit of Dr. Kim. And I'm relieved to hear that with him, volume is not an issue. Now, over half a year past the procedure, your voice just keeps sounding stronger and better. Congratulations! I can't wait until April rolls around and I have the time to go to Yeson to have the surgery. I could afford it, like, immediately, but unfortunately, my work schedule is jam-packed until mid-April.

BTW, didn't your old ticker say you'd get FFS soon? I don't think you need it, I think you're pretty the way you are, but in any case I wish you lots of success with that and that all your dreams and aspirations come true! Who you're having it with?

Love,

Amy

Thank you for your blessing, Amy And I too hope that it times out well for you in April, I am ecstatic anytime I hear that someone is going to have this surgery. The joy that it has brought me gives me a sense of compersion to know that others will be much happier with their own voices too.

You are correct, my old ticker did say that I was getting FFS. I changed it because Rowan will be coming down to take care of me for a bit right after my surgery, and to have FFS ticker in my signature felt a bit like I was bragging anyway so I changed it. Plus I am equally excited to see Rowan again!

Thank you for saying that you think I don't need it, my hope is that from the front of my face it won't change a thing besides turning back the age clock a few years for years to come (I am turning 30 in february). The only thing I really have a concern about on my face is my brow bossing, which is only visible from the side. At the same time though I am having my under eye bags corrected (a hereditary trait - thanks mom!) and nasolabial folds filled in a bit with the leftover tissue from my brow bossing/hairline reshaping procedure. All in all, they are very minor things to have done and I'm not expecting to look much different from the front... it's really only my side profile that you can see why I'm going through with it- or if I am sitting directly underneath a very strong overhead light.

Yes. Jenny, it seems a surprising gift for Christmas to your family.
I hope to listen you delivering a lecture or a speech next year.

barbie~~

Thanks for that barbie! That would be pretty neat