Voice surgery by shortening vocal cords (Yeson and others)

[anjaq]

Ok, I figures I make a new thread on this not to hijack the ones on Yeson.

There is a paper I found from a surgeon in Berlin, Germany who wrote about doing this kind of surgery:  http://www.ncbi.nlm.nih.gov/pubmed/10442755?dopt=Abstract or http://www.sciencedirect.com/science/article/pii/S0892199799800289
He describes it as

In our method the endolarynx is exposed via direct laryngoscopy. The anterior part of the vocal folds is deepithelized, and the corresponding tissue of the vocal folds is firmly sutured to obtain a V shaped anterior commissure. Thus, the vocal folds are shortened, and the vibrating mass of the vocal folds is reduced

This sounds to me what Yeson is doing as well. The technique seems to have been invented in the 1990ies and by 1999 this Dr Gross in Berlin did 20 surgeries and followed them up.
They seem to always use botox. They mentioned however that almost all of the patients were over 10 years post-op (just like me) and that as a result they had "hyperfunctional voice disorder" which apparently happens if you use your voice in a way that is too much changed from the natural and I guess it happens when you dont have proper training or such? They managed to correct that with voice training though... I guess I have that "disorder" too, as I did not have a full blown voice training and I noticed that my voice degraded over the years.

I did not like the data in the paper though:

We have operated on 20 patients using this method. The results of the first 10 patients are reviewed (Table 1). In 1 patient, who smoked immediately after surgery, coughed, and did not observe voice rest, there was a dehiscent suture. Nevertheless, in general the patients demonstrated a 9.2-semitone increase of the mean, spontaneous fundamental frequency. In the voice range profile (Figure 2) it may be seen that after surgery the voice range is reduced for the lower frequencies. This part of the result is desired and permanent. Hence, even in uncontrolled situations no deep voice is possible. Our patients have also shown a reduction in loudness over all frequencies in at least the first 3 postoperative months. Only 3 out of the first 10 transsexuals desired a louder voice. Their preoperative loudness levels were restored through voice therapy. Muscle tension dysphonia, a functional voice disorder, was present in 8 out of the first 10 patients in the early postoperative weeks. A clear female voice was accomplished when the anterior commissure became definitively V-shaped and when the hyperfunctional voice disorder was no longer present. Because some of the patients had had their genital reassignment surgery more than 10 years earlier,hyperfunctional voice disorders were a major problem but could be overcome in most cases by conservative voice training.

The pitch raise was quote high, like >9 halftones, thats more than an octave, some post-op pitches were in the 230-240 range (IMO too high) and the diagram showing the pitch vs loudness range they show looks like nothing was gained at the top end, but a lot of loudness was lost. They say they could fix the loudness with training though and I saw in the table that a few of the patients actually expanded their range to the top a bit.


Sadly I did not find a followup on this, which basically only talks about a few months post op and not long term

It seems that there are at least surgeons in Berlin, Stuttgart (both Germany) and Korea doing this method sind around the new millennium.

My question to the Yeson girls now is - what do you think of this (I can send you a PDF of the paper if you cannot access it) and do you know if Yeson is better at reaching a specific target pitch? It seems like this is a bit unpredictable. I really do consider this as an option even though I am scared to death about it, but I would not want to go to 220or 240 Hz, that would not fit me as a almost 40 year old woman of a rather stout stature, I think. Though what do I know how it would fit, really, its just a feeling.

Did anyone find any newer articles in science journals like this one that actually shows some data? I am a geek, I love data

The paper also gives a good review on why not to use any other method by summarizing the failures in them...

[big kim]

I remember Michelle Duff writing that it still left her with a gruff voice,this was the 80s so things could well have improved with better results

[anjaq]

I remember Michelle Duff writing that it still left her with a gruff voice,this was the 80s so things could well have improved with better results

Oh for sure. The paper does a decent job given its shortness to make a summary of the alternative and previous methods used and more or less says that all of them are not good, either not permanent or resulting in a hoarse or rough voice plus all being quite invasive. Jenny does a good job in describing the advanteages in her thread on her experience with Yeson too as of why she would not have done any other method.
I did not yet find a working link to the article that is free, sometimes there are some, I need to look.

[A]

A friend of mine had that surgery at Yeson shortly before we lost contact, and even though she still wasn't fully done with recovery when she disappeared, she sounded pretty good.

Now I looked up the video, and found that there are now two more videos, including one from this summer, which makes me feel quite surprised because back then I was worrying and thinking she might be dead because of how she just stopped logging in, yet she did two more videos for the Yeson Voice Center and even invited people to contact the Center for her email address, while of course ignoring my email and even letter to her address for her or her parents, asking, as her ex-girlfriend and supposed good friend who she deeply cared about, for a sign of life so I'd stop being worried sick.

That frustration aside, ahem, as for the videos themselves, I'm puzzled because in the later one, she sounds lower and less feminine than in the earlier one, but if anything her videos can show you that there is no crazy pitch difference. She's the Slovenian patient.

http://www.yesonvc.net/disease/diseaseMovie2.asp?type1=Operation&type2=VFS

[Jennygirl]

I'm super curious to see if my vocal cords have returned to the V-shape. My guess is, not quite yet. I don't feel like my voice is up to full steam yet. It's getting really close though, and I'm only 4 months post op out of the 12 they say it takes to completely recover.

And with Maja, the Slovenian patient you mentioned, I think her voice does sound female. To me, that is the point of voice surgery, to make one's natural speaking voice sound female. I was most impressed with her videos prior to my surgery and they were the main contributing examples that convinced me it was going to work for me.

As far as upper range extension, I've gained about 4 semitones higher on max pitch (from C5 to E5) and my chest/head voice crossover has nearly disappeared. I don't have a falsetto sounding voice at all anymore. Before, I could belt an E4 in chest voice, and now I can nearly belt a C5 in chest voice (where my head voice used to crap out). That is an 8 semitone improvement in chest voice range which really does feel stellar. 2 months post op, I could barely muster an A#4, and now it's gone all the way up to E5. Quite a difference for only a few months more of recovery.

As far as low range, I used to be able to go down to a D2 (73hz). Now, I can barely grunt a C#3 (138hz)... so that means I lost about 11 semitones off of the lower range which seems perfectly ideal to me.

Volume for me does not seem to be a problem anymore, but I haven't done any scientific tests on the matter. All I know is that I no longer have difficulty even speaking over a loud soundsystem. And with the more weeks that pass, my loud voice has improved in pitch as well. You see, girls tend to use much higher pitches to talk loudly. At first, my voice still sounded quite male when trying to talk loudly. Now though, the loud voice has gone up in pitch and I'm pretty sure there is rarely a moment that my voice does not pass. It's hard to say though without hearing a recording of myself.

I am really interested to see if the German surgeon's technique differs at all from Yeson- I have a feeling there is at least one minor difference. There's no way they are exactly the same.

[anjaq]

Maja sounds good indeed, I also listened to the before/after recording and I think she had quite a female voice in that before surgery as well! I assume that she did the recording using her daily voice that was already altered by herself and she did not use an uncontrolled voice as Jenny did in the before/after video? If not, she had a really good voice to start with. I wonder if she does much voice control post-op. I felt like she did not do a lot of resonance control (and IMO she did not really have to as the voice sounded fine), but maybe A can say something to that being a friend of hers?

I like it that her voice is not that high post op - it fits her well. I dont like it if post op voices are way too high, I always feel it sounds a bit false then.

It seems that loudness loss can be counteracted. Interesting that using a higher pitch actually helps there and I didnt know that you actually sounded a bit male when upping the volume there. My volume now is already not great. I get asked to spek up all the time, so I cannot afford to loose much on that. May be due to my attempts at controlling the voice though that diminishes loudness a bit as I tend to not use a full chest voice as I feel I loose control if volume is too high and then it sounds bad again - so if that would go away, it may actually improve.

I will try to send you the article, Jenny, but sadly it is not very detailled. It would be great to compare it to Yeson as if I would choose to go this route, I probably would be stuck with him and not Yeson unless I actually manage to get a lot of money together, which I might do if there is a substantial difference. Does Yeson describe this in more detail? I could of course also just write to Dr Gross and ask about a comparison, if Yesons method is somewhere described in detail.

[A]

I think the method is described in detail somewhere on their website. Just look around I guess.

As for Maja... ehm, as it stands, given that now, she completely avoids and ignores me, you probably have a better chance to know these things than I do. All I can say is that even though I think if she'd persevered a lot with her voice training, she wouldn't have needed the surgery, I can't say it was useless. I think she was using her best female-ish voice in the pre-op recording.

Now, I wouldn't say that's a daily voice she'd have honed and trained, since she started living as a girl right when she got the surgery.

[Jennygirl]

From one of her videos, she mentions that the reason she got the surgery was not because she couldn't produce the female voice- it was because her voice could not sustain the raised pitch (her voice used to give out). I will say +1 to that being one of the biggest reasons to have this procedure done, because it raises your normal speaking pitch with no added effort / strain / or pain. Having your voice already trained in some way beforehand is a HUGE positive because you can already connect the higher pitch with being your voice, and you will already know how to modify the resonance.

[anjaq]

That seems to be the #1 good reason to do this - to keep a voice you already can produce without the effort so much. So I guess I better start voice training soon now as I dont think I can do that properly now as can be seen in that thread with the voice recordings; I already sent an email to our local support group to find a good voice therapist in the area to do this and hope I can have some success, especially with the resonance thing - an ability I somehow have lost to a degree in the past 10 years it seems.

So I will try and see if I can find details on the procedure to compare with Gross. Maybe I will write him an email with that and see what he replies, though from what I got now thoughts on actually having a surgery are not the best thing for me now before I tried to at least get some voice training done first because otherwise I would probably be dissapointed by the result... I hope the doctors and voice trainers I hope to find will be open to at least the possibility of assistence by surgical means and not condemn it. I'd rather like to keep that as a very likely option for the not so far future.... as I dont think I have the discipline (and I dont even have the desire for such discipline) to do what I learn in that training 100% all the time.

[Jennygirl]

I hope the doctors and voice trainers I hope to find will be open to at least the possibility of assistence by surgical means and not condemn it. I'd rather like to keep that as a very likely option for the not so far future.... as I dont think I have the discipline (and I dont even have the desire for such discipline) to do what I learn in that training 100% all the time.

Maybe with the right data they would see the benefit, but I doubt any voice feminization therapist would recommend it. Either way, any voice feminization you do now would only be a benefit to the result.

Does the German doctor have any voice samples of patients' results? That seems about as important (if not more important) than the statistical data itself.

[A]

Yeah, very few voice therapists are going to support voice surgery. For one, it is true that most problems can be somewhat corrected without surgery. But most importantly, it's a pretty new thing to have surgeries that are effective, not excessive and low risk. Just, what, ten years ago, having a voice surgery was a huge gamble, and often ended with unnaturally high voices, for instance. Most current surgeons probably still do those "old" surgeries, actually. So I think most voice therapists either don't know about the new procedures, either are still skeptic about them because they haven't been used for a long time.

[anjaq]

Yes I doubt the voice therapist will like the idea. They like voices and a surgery removes part of the capability of a voice. We think its a benefit, but they dont. No, Jenny, I have not seen any openly accessible voice examples. I doubt he has any in the internet. It would be quite un-german I suppose. So i guess if I would be interested enough, I would have to contact him for this. I kind of hope to get more information and maybe examples and experiences at the TG group here. Gosh I need to go there after I though I never come back 13 years ago. Maybe they know some more on this any maybe they know a voice therapist that at least does not completely hate surgeries. If they have to do a lot with TS folks, they should at least be aware of current techniques, I would say, but I dont know if there are any therapists that have experience with that at all. I suspect that most TS will do voice training themselves as DIY off tapes or CDs... so maybe there is not a lot of voice specialists in the city that have proper experience with this.

I will check with the group and see what is going on there. If there is no specialist here that knows this, I will maybe choose a general one to try and get general voice stuff done and add a CD with TS specific stuff to it for homework. Aw I hate that I have to do this now. It is a lot of work I feel and it just feels wrong to do this so long after SRS... should have done this properly back then...

[alexiakk]

Wow I just saw this topic now 

There is one thing I kinda want to say about this "230-240 range (IMO too high)": This Fo is a bit higher than the western average indeed, but not so much if you're in Asia (esp. China, Japan) - if we're saying that white girls mostly speaking in 210-220 range, I will say Asian girls speak in almost 270  so it really isn't TOO high 

[anjaq]

Yes. I saw a study about pitch differences between different ethnicities. I think it probably is in part physiological, jsut as women from eastern or southeastern Europe somehow tend to have more browbossing or facial hair. But also part of it probably is cultural which is interesting as it means that these women basically trained their voices to be of a different pitch than other women elsewhere. They did so since childhood of course, but I guess it is the basis of the idea that voice training alon can actually be enough in some cases.
The US average is also about 10-20 Hz higher than the German one, so ethnicity is an important factor to take into account with a VFS.
When I wrote to Yeson for example they told me that maybe they cannot feminize my voice as the totally relaxed pitch is 110 Hz and they can shift that only ba 75 Hz which would not put me in a female range. But a plus of 75 Hz would be 185 Hz which is in this area quite a regular albeit somewhat lower pitch, in the US it would be at the lower end of the range and in Asia it might then be below the normal range. So that assessment was probably based on USA women?