Yeson voice feminization surgery 2.0

[kwala]

I wouldn't be too concerned about the "yo-yo-ing" as you put it.  I know that numerically it seems like a lot, but the difference between 195 and 220 hertz is literally one note in a scale. G to A.  Could be the simple difference that happens with time as your larynx gradually rises during the day 

[anjaq]

My final base pitch is about 175 Hz. It was the same at 2 months as it is at 2 years. I started at about 135 Hz at Yeson, so that is "only" a gain of 40 Hz.  However 175 Hz is low female range, so its ok as long as my resonance is right and I think I am mostly ok with that, except some vocal fry. Pitch fluctations do exist for me as well, it largely depends on prosody, which depends to a degree on my mood. If you record the same passage wit a rather relaxed but monotone voice and another time with a more lively voice that uses your pitch range, that second recording can be up to 30 Hz higher in the average pitch reading in PRAAT or other software. This is also part of the voice training and female speech patterns - increasing voice melody and pitch range which in turn increases average pitch. So while my base pitch is at something like 170 Hz, my average speaking pitch will be usually anything from 180 to 200 Hz, sometimes more. I found also that it comes now natural and is eas to go really up in pitch for some words - I naturally do this when saying "hello" or "bye" to someone - or "thanks" - In these situations my pitch just goes way up. When I am talking more serious business it goes down to the 170 Hz - so it varies a lot, which is actually a good thing as this is natural for a female voice.

[Rachel]

Hello,

From pictures I have seen here Dr. Kim's work looks to have very precise mucosal skin removal and very fine sutures and organized. Also, the pictures show how the tension on the newly created wound is relieved by the Botox injection. It does not look like a laser was used. The stitches are permanent and that may be the reason the stitches are precisely located, correct? Also, from the video on the site it looks like the vocal fold is somehow detached a bit from the cartridge. Is that correct? Am I correct in what I am seeing? Is a laser used on the vocal folds?

From pictures I have seen from Dr. Haban's work it looks like the mucosal layer is jagged and the sutures are a crisscross. The sutures are resolving. Also, the vocal fold and the area sutured is very red and looks sore. Also, the vocal fold looks sore. Does Dr. Haban use a laser on the vocal fold? Why is his work look like the area is very sore and jagged? Are Doctor Haban and Doctor kim's pictures both 1 week after surgery?

Dr. Spiegel, I have not seen any pictures of his post surgical work. He told me he performs the same procedure as Dr. Kim and Haban but that he has been doing it longer. I do not know if his work looks like Dr. Kim's or like Dr. Haban's 1 week after surgery. Does anyone here know anyone that has gone to Dr. Spiegel? Has anyone spoken to anyone that has gone to Dr. Spiegel for VFS? Are there any pictures of the work he does 1 week after surgery.

I am preapproved for Dr. Spiegel in network and Dr. Haban out of network and not covered for Dr. Kim even though his surgical (not room and board and travel) are cheaper than Dr's Spiegel and Haban. Dr. Kim's surgery would cost about $10,000, Dr. Haban $2000 plus travel and room and board and Dr. Spiegel $1,000 plus room and board.

My voice therapist said she is not a fan of VFS. I think Dr. McGinn said the exact words (Dr. McGinn used the same vocal therapist). My vocal therapist said I could have a feminine voice with more practice and that my pitch is not an issue. I feel as though my pitch and timber are an issue. I am at 170 to 240 hertz on my phone app during vocal training when we are reviewing pitch. This weeks assignment is resonance.

Right now I am doing round two hair transplants Sept 25 and a vaginal procedure Nov 20th then either tackle voice or some soft tissue face work. I am going to give voice lessons 10 or 12 months for a chance to optimize the training than make a voice decision. I will get a consult with Dr. Haban prior to the decision. Is there a Skype consultation available with Dr. Kim?

I am sorry but I may post here from time to time to get some perspective and recommendations. Presently from what I have seen, read and heard Dr. Kim's work looks very precise, neat and clean. The cost of his surgery is definitely a factor in the decision process.

[Dena]

There are two major differences between Dr Haben's work and Dr Kim's work. Dr Haben uses a laser and dissolvable sutures and Dr Kim uses permanent sutures and a micro scalpel. I have heard results from both doctors and both can produce good voices. I have also heard a few that were off and I am not sure if it was the surgery that was at issue or if they didn't follow up with voice therapy. In both cases, the part of the vocal folds that needs to be joined is injured then held together with the suture. Not speaking is very important to allow the folds to be come one.

Also understand that sometimes repairs need to be made to the vocal folds because of voice abuse or natural defects. If you see an irregularity, that could be the result of a repair and might not be a direct result of the surgery.

My personal opinion is if you don't need surgery, you should avoid it and stick with therapy. In my case, I used Dr Haben because with CTA, he could produce more of a change in pitch than Dr Kim and with 130HZ for a trained voice, I knew I had a real problem on my hands. The truth is that either surgeon could have produced sufficient pitch change in my case.

Photobucket killed my surgical images however if you haven't seen them, let me know and I will email them to you.

[kwala]

Hello,

From pictures I have seen here Dr. Kim's work looks to have very precise mucosal skin removal and very fine sutures and organized. Also, the pictures show how the tension on the newly created wound is relieved by the Botox injection. It does not look like a laser was used. The stitches are permanent and that may be the reason the stitches are precisely located, correct? Also, from the video on the site it looks like the vocal fold is somehow detached a bit from the cartridge. Is that correct? Am I correct in what I am seeing? Is a laser used on the vocal folds?

From pictures I have seen from Dr. Haban's work it looks like the mucosal layer is jagged and the sutures are a crisscross. The sutures are resolving. Also, the vocal fold and the area sutured is very red and looks sore. Also, the vocal fold looks sore. Does Dr. Haban use a laser on the vocal fold? Why is his work look like the area is very sore and jagged? Are Doctor Haban and Doctor kim's pictures both 1 week after surgery?

Dr. Spiegel, I have not seen any pictures of his post surgical work. He told me he performs the same procedure as Dr. Kim and Haban but that he has been doing it longer. I do not know if his work looks like Dr. Kim's or like Dr. Haban's 1 week after surgery. Does anyone here know anyone that has gone to Dr. Spiegel? Has anyone spoken to anyone that has gone to Dr. Spiegel for VFS? Are there any pictures of the work he does 1 week after surgery.

I can't comment on Dr. Siegel, but having had procedures done by Dr. Haben and Dr. Kim I can tell you the differences are enormous, almost to the point where they aren't even performing the same procedure. As you pointed out, Dr. Kim's work is done by hand after careful stroboscopic observation to create a unique shape that will allow the vocal folds to vibrate optimally.  Dr. Haben on the other hand simply does not have the skill level to guarantee his surgery won't cause damage and freely admits that he "has no control over the way people heal."  He scrambles together some sutures, fires off a laser and hopes for the best. He will also feed you different and conflicting information before and after in regards to the actual procedure and healing process. So, I wouldn't recommend going to Dr. Haben unless you're willing to risk losing your voice forever.  Dr. Kim is infinitely more talented, more knowledgeable, more professional, and has a nearly unbeatable track record. 

[anjaq]

The observations are partly correct. Dr kim uses micro scalpels for a high precision cut of the vocal fold upper layer - I think he is the only one doing this, everyone else uses lasers, apparently. Lasers of course "burn" the upper layer, which may cause some issues, I suppose. Also Dr Kim seems to be the only one using permanent sutures. The reason for this is, that he can tighten them more than dissolving sutures because it is a different material, also I think it makes sense to have the sutures hold everything together for several weeks. We have seen some people loose their surgery result because sutures dissolved after 4 weeks and the scar was not yet formed - or there can be a widening of the scar when the sutures are not tight enough for long enough, this can cause a U shaped commissure instead of a V shaped one, which causes loss of volumen and adds breathiness.
Of course if the sutures are dissolving anyways, there is less need to make them as precise as Dr Kim does them, but I think it would not hurt to still at least try to make them perfect.
There is no detachment of the vocal folds with Dr Kim though.

One other thing Dr Kim does is a "tapered" suture - the two or three threads are not done the same way, the one near the end of the vocal fold is done much deeper into the tissue than the one near the commissure, which is done shallower. This is done to give the suture strength, but also delicacy, also it avoids formation of an air pocket under the flap that is created from the vocal chords, which again would cause breathiness and loss of volume

[OU812]

I've been studying and comparing results of the two surgeons for awhile now, including reading every post on this forum about either of them, seeing what ->-bleeped-<- has to say (Haben did a great AMA there awhile back), and just trying to be as objective as possible. It's been hours upon hours of research.

I definitely get the impression Dr. Haben's technique is evolving over time. In a post from a couple years ago when someone asked him how many of these he's done, he said 200+ VFS procedures - when Dr. Kim was starting to become known for this in 2011, he'd only done ~150. Keep in mind, both surgeons are about the same age, each with <15 years VFS experience. Yes Dr. Kim has been doing VFS longer, but we're getting close to Dr. Haben having as much iteration as Dr. Kim had when his work started taking this forum by storm 3-4 years ago.

The matter of microscalpel vs laser seems debatable. It really comes down to the amount of precision used with the laser and whether it's excising the exact same tissue layers as a microscalpel. If it does, I'd imagine laser to be slightly superior, since the cautery action would yield less blood loss. Most likely Dr. Haben uses laser because his initial "claim to fame" was treating laryngeal cancer patients using lasers. (If you've ever heard someone who had to use a robo-talker, or like Dr. Leis who had radiation treatment, you can appreciate the value of Dr. Haben's innovation.)

As far as suture technique, compare the example on his website http://professionalvoice.org/images/FIGURE%201-500.jpg to the technique used on a recent posterhttps://www.dropbox.com/sh/js9jtumq725it8b/AAABgeHOkLqXe8Jb_l2RpLLla?dl=0&preview=Before+and+After.jpg who ended up very happy with her outcome. Obviously each person's vocal folds would be a little different, but just looking at the photos, I notice a number of big differences. The newer suture material appears thinner, like it's more suited for precision work. Also, the placement of the sutures appears different - he places the long cross-suture high now, rather than across the other two. The two sutures near the 'new' commissure appear about as deep as the earlier example, but they have a new angle and placement, rather than just parallel horizontals.

Could Dr. Haben be adapting his suture technique? He did say in his ->-bleeped-<- AMA that he looks at every patient as an impetus to improve and is constantly evolving his technique. I cannot say without actually seeing immediately-post-op photos of Dr. Kim's suture work, but the "taper" principle could be working its way into the states. At the least, it looks like a night and day difference!

For my part, I'm likely booking with Dr. Haben soon. I think if you're within a day's drive from him, it's worth considering more than just raw experience - factors that could affect your healing and final outcome, like catching a cold on the plane, general travel fatigue, stress (or even risk) over N.Korea's recent saber-rattling, or just whether or not you have to go by yourself. (Two weeks overseas alone for surgery? Been there done that.) Besides, as word spreads that good VFS exists, we'll need more than one great doctor in South Korea doing it.

(I haven't really seen enough from Dr. Spiegel to feel confident in his VFS, or even that he's been doing it as long as he claims - small sample size includes one failed-but-not-botched result and one of questionable comparison - let alone to trust my voice to a general aesthetic surgeon rather than a voice specialist with proprietary surgical techniques.)

[Dena]

Welcome to Susan's Place OU812. I know that Dr Haben's procedure has evolved over the years has he as abandon some of the early procedures such as vocal cord thinning. He also had a few surgeries where the tie came lose so it's likely he has looked for a more durable suture material. On the plane home, I was in a conversation (well I was writing) with a resident who was flying out to meet her husband. She said that Dr Haben was very well known in the area. In addition the taxi driver that I used serviced the hotel regularly and he said people come in from all over the world with different problems for Dr Haben to deal with. Unfortunately all surgery carries risks but I suspect both doctor's procedures are evolving and will continue to get better.

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[OU812]

Thanks Dena! I've been crawling here for ages myself but never really had cause to post til now. I'll be sure to keep you updated with how things go.

[Dena]

If you look at my initial post, you will find that the reason I came to this site was for voice surgery. I knew a good deal before coming here but this site provided me the information I needed to decide on a surgeon. Let me know if there is anything I can help you with. By the way, when I wasn't looking they pinned this moderator badge on me so watch out. 

[Rachel]

Hello,

Does anyone know the type of laser used by Dr. Spiegel and Dr. Haban? I had a laser used on me for another procedure and a comment was made about my healing and that that surgeon some day will get  CO2 laser. This was a side comment made quietly and not directed at me.

[Paige]

By the way, when I wasn't looking they pinned this moderator badge on me so watch out. 

Dena you are a great moderator so I guess they knew what they were doing. 

Paige

[anjaq]

I personally am actually not so sure the cauterizing effect of the laser is beneficial when used on mucous tissue. The blood loss is minimal anways in a cut that is just a few millimeters long. I would be worried about the laser damaging the mucous tissue more by drying it out and maybe make it harder for the tissue to connect to each other? A very clean cut with a sharp blade will heal very well, if you ever cut your finger with a scalpel, you know

But i am happy to hear that some surgeons are able to evolve and improve. Too man trans surgeons sort of are so convinced of themselves that they stop improving unless they have some good ideas themselves.

By the way - I recently found that after now over 2.5 years since my Yeson surgey, my voice seems to have cleared up even more than at the supposed "end of healing" point of one or 1.5 years post OP. Apparently I have still learned a bit on how to use it well and also "dare" to use the higher pitch ranges more regularly - so just reading the famous text, I got between 200 and 210 Hz - which is up from 170 Hz in the months post OP and about 180-190 Hz after 1-2 years. A lot of it depends on me being relaxed and feeling well though. If I feel "feminine" and more relaxed, the voice is up, if I am tired or sad , it may go down again to the 180 range. So this surgery is really something that takes forever to show final results and the voice keeps evolving over years...

[Hanana90]

I just want to give an update on my progress.  It's been nearly 3 months since my surgery, and my average pitch is around 220Hz (pre-op pitch was around 145-150Hz).  This is absolutely perfect for me and I'm extremely happy with my result.  Remember not to freak out like I did!  It can take time to hear the results, and the healing timeline and pitch increase timeline varies from person to person!

[sweetheartelise]

I am a long time reader of this thread and felt it was time to share my experience and see if anyone had some advice. I had vocal feminisation surgery with Yeson one month and roughly one week ago. I had the surgery and everything went well, Dr Kim told me at the one week check up everything was healing fine and a few of weeks into recovery I had said a couple of words. Just to kind of test the waters and maybe see how my new voice would sound! When I did, my voice sounded the same pitch, a little hoarse but I was very disappointed, I emailed Jessie and she said to wait and see how things go, so I did. About a week ago I was able to have short conversation and my voice sounds the exact same as before the surgery, just strained and a little rough? From everyone else posting on these threads I haven't heard of anyone with the same experience, most of the time the pitch increase is almost right after surgery! My voice pre surgery was 135hz and I measured it today at 110hz. Has anyone else seen a pitch increase this long after surgery, I am very disappointed and think it was a failed surgery for me.

[Dena]

Welcome to Susan's Place. It's very difficult for Yeson's surgery to fail without a visible sign like pain or bleeding. I suspect two possible problems. The first is for some of us the swelling can go on for months after surgery resulting in a low bad sounding voice. My surgery wasn't with Yeson but the swelling went nearly 7 months and some have gone even longer. The second is you may not be using your voice properly. Often to obtain the proper resonance, the voice is adjusted to use the head voice. My chest voice after surgery is about 135HZ and my head voice is around 220HZ. Comparing that to my pre surgical head voice of about 130HZ. I asked before surgery which voice I would need to use after surgery and the answer was my head voice so there was no surprise. This is why I often say a surgical voice is half surgery and half speech therapy.

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[sweetheartelise]

Yes thats why I am concerned, I have heard of girls getting the surgery and only increasing a small amount in pitch but I still haven't noticed any changes in pitch. One thing that has changed is that my voice use to come from my chest and I could feel it rumble however now it comes from a much high place, like head voice. Maybe its due to the fact that I hadn't done much/any vocal training beforehand, I haven't had much chance to play with pitch or anything as I don't want to strain my vocal cords too much. Kind of disappointing but there isn't much I can do at the moment!

[ShannonMaher]

Hi

I've  been trying to change ny male sounding voice for what seems like a really long time. I really hate my voice and feel that it's certainly one if the reasons why I'm not passing.

I've read some of the posts and they seem to suggest age has a factor in the result. I'm 44 and I'm wondering if I've left it too late. I healed very well when i haf my FFS.

Thank you

Shannon

[Dena]

Welcome to Susan's Place Shannon. I had voice surgery at 63 years old and healing wasn't an issue. Age might affect the surgery somewhat but the biggest issue is smoking. Dr Haben combines CTA with fold shorting for voice that are really low and damaged by smoking.  I expect that Dr Yeson could produce similar results given the same voice because both doctors use procedures that produce similar results.

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[ShannonMaher]

Hi Dena

Thanks for the replay I've been lurking for a long but this is the first time I though I wanted to say something.

My transition has certainly has had its ups and downs,  I told my mum that I was a women when I was 37 and by 41 I had lost her to Cancer.  She was my best friend and for years I thought that she would leave me if I had told her.  But she accepted with out hesitation or question I only wish I could say the same thing about the rest of my so called family.

So I find myself on this journey without the support of my mum which makes everything seem harder.

Well I don't smoke so that's a good thing, some of my friends keep telling me that voice surgery is to dangerous and I might get a dalek voice or something.  Do you think its a dangerous surgery.

This isn't going to be my next surgery I'm book in with Dr Suporn on the 4th July

Thanks

Shannon