As i understand it the principle of the procedure dates back to the 1980ies (Wendler glottoplasty) when it was still performed via a neck incision. There is a study from Dr Gross in Berlin from 1999, who performed it on several "transgender patients" and reports the results, which ware somwhat mixed (great variation in the pitch increase, in all cases a loss in volume and a higher dysphonia index). AFAIK they use scalpes and dissolving thread. Later the method was improved more, they then used lasers and stitches with dissolving threads. One thing that seems to persist is the higher dysphonia index (hoarseness, breathiness) and the loss of volume as well as an unpredictability of the pitch increase. I contacted the Clinic in Stuttgart who do the procedure but they said something like a pitch increase of maybe 4 semitones with a 40% closure of the vocal fold opening would be possible. The doctors following Dr Gross in Berlin (he himself does not seem to do this now) apparently tell patients that there is a 1:1:1 chance that it get better:same:worse than before. Amy_Berlin from this forum was at Yeson and showed the doctirs in Berlin her result and apparently they were so impressed that they see little scarring that they want to learn this technique. This apparently sets Dr Kim at Yeson apart from the others. He uses scalpels again and not laser, which seems to be more reliable, especially if he has as Jenny said, done some development on them. He uses permanent sutures which probably allow the sutures to be more stable during the long healing phase (dissolving sutures are gone afte a few weeks when the healing still is not finished completely) and may also just help along in the later times. He also places the sutures differently than other surgeons, not touching the active part of the vocal folds. The rest seems to be mainly experience and precision. With 350+ procedures done he is able to make the sutures very precisely parallel and avoid scarring. The scarring is what makes the dysphonia, uneven sutures make the voice unstable or cause diplophonia. Also he amazingly is able to estimate very well the increase in pitch for each patient and also he seem to manage to increase pitch by 75 Hz, that is about 7 semitones with a 33% suture, which is a higher rate than I read from any of the others.
So I believe that others can learn from him and his long experience. Sadly many ENTs seem to operate on the voice just 3 times a year and then claim it is easy but it is not a good option. I met one of them recently for a consultation. I was horrified at the idea that someone does a procedure 3 times a year - he can never have the experience needed. You would not go to a GRS surgeon who has done this 10 times over the past 5 years or so.
However I agree that the costs clearly are not a matter of how much time is needed. $7000 for a 30 minute surgery plus examination is quite a lot in terms of hourly costs, but you are not paying for the time but for the precision and experience. A FFS or GRS may take only 4-5 hours but you also pay 20k for it.
Quote from: Jennygirl on November 02, 2014, 12:57:43 AM
Your best bet would be to email Jessie at Yeson and ask her directly what sets Yeson apart from other ENT surgeons familiar with the anterior web creation procedure.
If there is a reply to that, I would love to read it and would hope it can be shared here, as this would really be good to have - we are just puzzling stuff together , but a clear statement of Dr Kim about what he is doing differently would be a really good thing to have.
Greetings
