Need advice about which VFS doctor

[Roni]

Hey ladies!

There is a lot of information on this forum.. thank you to the wonderful women who have shared their VFS journeys here! Certainly been extremely helpful for me, but I had specific questions and figured I could maybe turn this into a VFS journey thread of my own once I decide on a surgeon.

The backstory: I have a decent trained voice, but need a lot of focus and energy to firstly reach the desired pitch, and then more energy to maintain it. Needless to say it becomes really draining, especially since I work at one of the busiest fast food joints in San Diego, quite literally talking non-stop the entirety of my shifts.  Recently I have become really dysphoric, stressed, and anxious about the passability of my voice and want this fixed once and for all.

As it stands I have enough money for Dr. Haben, but need to spend another 12 months saving if I wanted to go with Dr. Kim. I do not make a lot of money and do not know if I can wait any longer.

What I am looking for, in order of importance:
- Ultimately I want it to be a lot easier for myself, if not effortless, to talk in trained voice
- Pitch increase would be AMAZING, but is it safe to assume my decent trained voice is as good as it's going to get?
- Lower range reduced/eliminated would be nice, but not as important as other two.

What do you ladies think? Are the results between Haben and Kim close enough that I should just go for VFS right now? Would I want to spend another year saving and go with Yeson?

[Qrachel]

Hi Roni:

I am sort in the same inquiry.  I don't think there's a huge statistical difference between the top FVS doc's.  It comes down to intangibles and personal chemistry I think.

If I do this and I'm on the fence, I'll do it here in the States and possibly here in LA where I live.

Rachel

[iKate]

As much as I like Dr Kim, and would go to him again, the glottoplasty procedure is more or less the same between the two except for some slightly different methods and different recovery instructions. Dr Kim also uses a permanent suture. Dr Haben does not.

But based on what I see here most of the results are similar for the glottoplasty.

Dr Kim does not do CTA or trach shave anymore but you probably don't need either.

Ultimately I want it to be a lot easier for myself, if not effortless, to talk in trained voice

Varies. No surgery fixes resonance. If you have resonance issues you will have them post op. However since you don't have to worry about pitch it should be easier to control resonance. I am lucky in that I don't talk any special way at all. I just talk. I don't have much resonance issues. Some do have them and they require training and have to consciously think about it, until it just becomes second nature.

You will most likely have to do training afterwards but it will be much less effort than training a male voice.

Pitch increase would be AMAZING, but is it safe to assume my decent trained voice is as good as it's going to get?

It depends. No surgeon wants to give you a mickey mouse voice. During your consult you can discuss but you will most likely end up with a voice that matches your physical appearance, which is as best as I can put it. For example a tall, large woman will not have a high pitched voice.

Some women come out with a voice sounding about the same as their trained voice. Some come out sounding much better. A few come out sounding forced and overly falsetto. There's no real way to predict it but nearly all seems to be fixed by training.

I will go against the trend here and say that it is better if your voice is not trained in the first place because you won't have to un-learn old habits.

Lower range reduced/eliminated would be nice, but not as important as other two.

Most should be gone. Mine is totally gone. I cannot make any lower pitches anymore, even if I try. If I try to talk like a dude I sound like a woman trying to talk like a dude.

[anjaq]

As much as I like Dr Kim, and would go to him again, the glottoplasty procedure is more or less the same between the two except for some slightly different methods and different recovery instructions. Dr Kim also uses a permanent suture. Dr Haben does not.

I believe there are other differences - in the way the stitches are done and such - the permanent sutures have different effects - one is that they can be tightened better, giving the suture a stronger bonding in the first weeks, the other is that the suture is held in place longer, which is why others who do not use permanent sutures give anti reflux medications to keep the sutures in place as long as possible...
How much of a difference this makes - who knows. What is the key to a good voice post op is probably that the surgeon is skilled, does a good and clean, symmetric suture that leaves no scars exposed to the airflow. Also to follow rigid post op intructions and rather be overly careful than not. And of course post op voice training is important for most.

Some women come out with a voice sounding about the same as their trained voice. Some come out sounding much better. A few come out sounding forced and overly falsetto. There's no real way to predict it but nearly all seems to be fixed by training.

I think the latter mostly comes from those women not having unlearned the old habits of voice training or because they are trying to push the voice higher than the surgery provided them with and use bad technique to do so.

I will go against the trend here and say that it is better if your voice is not trained in the first place because you won't have to un-learn old habits.

Having my experience as it stands, I think you are right there. I guess some things are good about pre op voice training, some things are counterproductive , especially after long times. I totally struggle with unlearning old voice control habits now that they harm my voice instead of making it sound more feminine.

Most should be gone. Mine is totally gone. I cannot make any lower pitches anymore, even if I try. If I try to talk like a dude I sound like a woman trying to talk like a dude.

I can go pretty low - useable lowest pitch is C3, but up to now the feedback was that even in that range i sound female and either those pitches just occur for short moments in conversations, or if I try to speak in that range it also sounds like a woman trying to sound like a guy. I can make sounds down to A2 though, which is really low, but this is rather unusual for being post VFS and that pitch range is very weak and I could not really sing or speak at a normal volume in that area - its the low end of my voice, pretty much working similar to the low end of the voice pre-VFS which was the same - I could make sounds down to 80 Hz, but it was very weak.

CTA seems to be a sure way to get rid of the lows, but from what I know about it I still will not recommend it to anyone, although it does have some advantages if one can live with the disadvantages. Doing CTA only requires a much shorter healing period, will eliminate the lows, is safe in terms of post OP further surgeries with intubations. But it only simulates your pitch gain during voice training, no other changes to the voice happen, you loose more vocal range, especially singing seems to be limited in ability, there is a scar on the neck and the amount of pitch gain depends highly on your physiology (distance of two cartilages near the adams apple).

[Dena]

Both doctors have turned out some pretty impressive work and I am a Dr Haben fan. The voices on his website are typical results and many of the voices posted here are better.

What you need to do is understand what your current voice is like and how it should be changed. I made a map like this Lowest usable note 80Hz, male speaking voice was above that.
Mouth voice 130-196Hz
Falsetto voice 155-237Hz
Whistler voice 250-490Hz
and included it with other information to Dr Haben's office. Within a couple of days I received his recommendation based on my weigh and hight as to what he could do. I suspect provided with the same information, Dr Kim could do the same for you. Should you need help mapping out your voice, let me know.

Which ever doctor you go to there will be down time. Dr Kim want a month without speaking and Dr Haben only wants 8 days. Dr Haben also wants 2 1/2 weeks of limited use. I am out at the 8 week mark and I think have some healing issues but the voice can't withstand heavy use without losing pitch. For me, final healing might run past 3 months. I can use the voice in normal conversation but the pitch where be below where I want it in a long conversation. You should be able to work 5 days or sooner out of surgery if you don't use your voice. It took me several days to get the drugs they gave me in surgery out of my system but most people don't react that way.

Most important is ask many detailed questions. Feel free to post here or message me and I will answer what I know about Dr Haben. Anja and Ikate are very knowledgable about Dr Kim. Make use of us because you only get one shot at this surgery.

[anjaq]

I am not sure about these 4 voice types you describe - I never realized that there can be 4. For me it always seemed that I can do a chest voice and a head voice and maybe a low pitched harsh more male voice within the chest voice range.... how did you measure those ranges?

[Dena]

I am not sure about these 4 voice types you describe - I never realized that there can be 4. For me it always seemed that I can do a chest voice and a head voice and maybe a low pitched harsh more male voice within the chest voice range.... how did you measure those ranges?

The whistler is pretty useless and Falsetto was listed because attempted to hit the range I needed using it. It wasn't needed for surgery. To hit the two higher voice you need very light air pressure and light tension on the vocal cords. I could easily crank out the volume in the upper ranges but not everybody can. I did my measuring with the PitchLab app on my phone and playing with the limits of my voice. I don't know if the upper two voices will work in my surgical voice and I am not going to play with them until I am sure I am healed.

My lowest chest number was just my male voice at a comfortable level. I didn't attempt any super low pitches or play with Fry. I didn't measure it but I think my male speaking voice was about 90 to 100Hz. NOT very feminine.

[Roni]

Thank you Qrachel, Ikate, Dena, and Anjaq for the replies!

I am headed to work right now and will reply when I get home tonight. you've all helped me a ton!

[Dena]

I am not sure how we helped you. Rereading the thread it sounds like we told you to flip a coin 

[Qrachel]

Sooo, all said and done it's personal, there's risk, and best case for each individual varies . . . yes, that's about how I see it: A crap shoot with decent odds!   

R

[Roni]

I believe there are other differences - in the way the stitches are done and such - the permanent sutures have different effects - one is that they can be tightened better, giving the suture a stronger bonding in the first weeks, the other is that the suture is held in place longer, which is why others who do not use permanent sutures give anti reflux medications to keep the sutures in place as long as possible...
How much of a difference this makes - who knows. What is the key to a good voice post op is probably that the surgeon is skilled, does a good and clean, symmetric suture that leaves no scars exposed to the airflow. Also to follow rigid post op intructions and rather be overly careful than not. And of course post op voice training is important for most.


CTA seems to be a sure way to get rid of the lows, but from what I know about it I still will not recommend it to anyone, although it does have some advantages if one can live with the disadvantages. Doing CTA only requires a much shorter healing period, will eliminate the lows, is safe in terms of post OP further surgeries with intubations. But it only simulates your pitch gain during voice training, no other changes to the voice happen, you loose more vocal range, especially singing seems to be limited in ability, there is a scar on the neck and the amount of pitch gain depends highly on your physiology (distance of two cartilages near the adams apple).

Thanks Anjaq! So the two surgeons use different types of sutures, but it is not entirely known how much this affects the post-op voice, correct? So it seems to be a toss-up that I probably won't be too concerned about.

CTA reduces the lows, but you do not recommend it. In addition, I do not have as much interest getting rid of my low ranges as I do increasing my pitch. If this is the case I might end up just going with Dr Haben, however Dena's post does concern me a little bit.

Which ever doctor you go to there will be down time. Dr Kim want a month without speaking and Dr Haben only wants 8 days. Dr Haben also wants 2 1/2 weeks of limited use. I am out at the 8 week mark and I think have some healing issues but the voice can't withstand heavy use without losing pitch. For me, final healing might run past 3 months. I can use the voice in normal conversation but the pitch where be below where I want it in a long conversation. You should be able to work 5 days or sooner out of surgery if you don't use your voice. It took me several days to get the drugs they gave me in surgery out of my system but most people don't react that way.

Was it much easier to talk long periods and maintain your pitch prior to the surgery? My worst fear is going through with this surgery only to sound worse than I did before, and finding it much more difficult to maintain my pitch! That is the problem I am currently facing in the first place. I have a, as far as I am aware, passing trained voice, but am having difficulties maintaining the pitch throughout long periods. I was kind of hoping getting the surgery would make it easier for me to speak. I talk non-stop for 6 hours at work.

[Roni]

Varies. No surgery fixes resonance. If you have resonance issues you will have them post op. However since you don't have to worry about pitch it should be easier to control resonance. I am lucky in that I don't talk any special way at all. I just talk. I don't have much resonance issues. Some do have them and they require training and have to consciously think about it, until it just becomes second nature.

You will most likely have to do training afterwards but it will be much less effort than training a male voice.

It depends. No surgeon wants to give you a mickey mouse voice. During your consult you can discuss but you will most likely end up with a voice that matches your physical appearance, which is as best as I can put it. For example a tall, large woman will not have a high pitched voice.

Some women come out with a voice sounding about the same as their trained voice. Some come out sounding much better. A few come out sounding forced and overly falsetto. There's no real way to predict it but nearly all seems to be fixed by training.

I will go against the trend here and say that it is better if your voice is not trained in the first place because you won't have to un-learn old habits.

Most should be gone. Mine is totally gone. I cannot make any lower pitches anymore, even if I try. If I try to talk like a dude I sound like a woman trying to talk like a dude.

Thank you! They cannot possibly screw up that big and give me a mickey mouse voice, can they? Is this still a possibility with these types of surgeries? I am also a short, 5'4 Asian woman, so if I did end up with a very high pitched voice it would probably suit my height and ethnicity.

[iKate]

Thank you! They cannot possibly screw up that big and give me a mickey mouse voice, can they? Is this still a possibility with these types of surgeries? I am also a short, 5'4 Asian woman, so if I did end up with a very high pitched voice it would probably suit my height and ethnicity.

They can but I think they have good judgment.

I'm 5'6" Indian ethnicity, size 8-10. They gave me 1/3 suture and my voice is around 220-260Hz. It matches me pretty well.

There have been a couple of cases where people sound like a bad impression of a man trying to sound like a woman but those are rare. And usually they can get better with training.

I think you'll be fine tbh

[Roni]

They can but I think they have good judgment.

I'm 5'6" Indian ethnicity, size 8-10. They gave me 1/3 suture and my voice is around 220-260Hz. It matches me pretty well.

There have been a couple of cases where people sound like a bad impression of a man trying to sound like a woman but those are rare. And usually they can get better with training.

I think you'll be fine tbh

Thanks girl. I am this close to sending Dr. Haben an email but will wait for Dena's response.

[Dena]

Was it much easier to talk long periods and maintain your pitch prior to the surgery? My worst fear is going through with this surgery only to sound worse than I did before, and finding it much more difficult to maintain my pitch! That is the problem I am currently facing in the first place. I have a, as far as I am aware, passing trained voice, but am having difficulties maintaining the pitch throughout long periods. I was kind of hoping getting the surgery would make it easier for me to speak. I talk non-stop for 6 hours at work.

No matter which doctor you pick, there are healing issues. When I had SRS, I spent months trying to pee on the wall because I had swelling that was slow to go down. I now have the proper angle and the wall are safe. I am two months out and if I don't attempt to compete with other noise or a dead battery in my mom's hearing aid, I can maintain my voice longer. If I need to push the volume up the voice fades and I lose pitch. Post surgically I was starting the 3rd week before my voice sounded like something other than a whisper. You will find a girl in the voice section that still hasn't fully regained her voice at 3 months and there are voice samples where she sounds overly breathy. Others have posted clean voices at 6 weeks.
I can feel the fact my voice hasn't fully healed but when it does, I see no reason I couldn't uses it for 6 to 8 hours. Even now I lose the pitch, but the volume is still there. I had to come up so far off the Bass voice that I still need to use my trained voice but I now am able to reach a range I couldn't before and I don't need to push the voice for additional pitch. Remember my male speaking voice was 90-100Hz. Trained I could comfortably work 130-140Hz. A falsetto would push me to 170Hz. Post surgical my chest voice would be 140-150Hz and trained seems to have a sweet spot of around 200-210Hz. I can drop the trained to around 170Hz and am comfortable with inflection over 300Hz. Not bad for a voice that couldn't work 190Hz before surgery.

One other issue Ikate mentioned. I was sutured at 40% but this is a little miss leading. One of my vocal cords is long that the other and the suture is based on the longer cord. Where it based on the shorter cord, I would have a 50% suture.
My pitch improvement is based off the longer cord and sadly, nothing could be done to correct the cord length as a nerve runs through the cord. To cut the cord would have damaged my voice .

The real question is we don't know what your pre surgical voice look like. I had to use a trained voice but Ikate said she didn't need to and her voice sound great. She also didn't have to come up nearly as far as I did.

[iKate]

Was it much easier to talk long periods and maintain your pitch prior to the surgery? My worst fear is going through with this surgery only to sound worse than I did before, and finding it much more difficult to maintain my pitch! That is the problem I am currently facing in the first place. I have a, as far as I am aware, passing trained voice, but am having difficulties maintaining the pitch throughout long periods. I was kind of hoping getting the surgery would make it easier for me to speak. I talk non-stop for 6 hours at work.

I could not maintain my "trained" pitch, the little  that I tried. It just did not work.

Post op I make zero effort at all. I just talk.

I also talk a lot at work on conference calls, meetings and such. I used to get a little tired initially but now not at all, and i'm 2 months almost 3 months post op.

But everyone's mileage varies. Some do get tired even after months post op, but it almost always gets easier, just how much is up in the air. That said if you can maintain your voice pre op you can do it post op.

[Cadence Jean]

Hi, Roni. I absolutely loved working with Dr. Haben and his staff, and love my results so far. If you need the CTA and the trach shave, you can't beat Haben 's pricing. If you don' T want to wait to accumulate more money to go to Dr.  Kim, you could go to Haben. Results seem to be terrific from both sides, so in your case, I'm thinking it comes down to money and time frame? You wouldn't need a passport for Haben either. If you don't have a passport and want to see Dr. Kim, that's another 150 to 200 on top. Also, if days off or days out of the country is a deal for you, Haben only needs you a couple days whereas Dr.  Kim keeps you like ten, I think? Really, I think it's these ancillary considerations that will make or break one of these surgeon's fit for you, not really the quality of their work. They are both top notch professionals.

[Qrachel]

I recently visited Dr. Toby Mayer about FVS. He was pretty candid: He said he can do the op with almost no down side risk. Getting a 'great' voice is something he can't predict. "I can give you significant improvement and once in a while it's a home run. It's your call and I'll support you all the way.  Just be realistic about where we are with surgery."

I was impressed with his candor.  I've listened to maybe 150+ voices now from Drs. on the Internet and here's my unscientific opinion:  <5% not improved, <20% barely improved, >70% somewhat to decent improvement,>30% excellent improvement, <10% completely feminine (does not add up to 100%).  I think in over 65-75% of the cases with follow-up training the voice would be considered feme. NOTE: THIS IS NOT PROVIDED AS ADVICE OR SCIENTIFICALLY VERIFIABLE DATA.  THIS IS MY OPINION ONLY!

It's still iffy as I see it but I'm inclined to seriously consider it.  For people like me with lots of professional voice training pre-op I consider it worthy of serious consideration.  YMMV

Rachel

[Roni]

All righty Dena and Ikate! I'm convinced I will be going with Dr. Haben now and just sent him an email asking about the soonest available surgery dates. Thanks ladies! Gah! I'm so nervous and excited haha. I will also try and get up a few samples of my "different" pre-op voices and trained speaking voice in the next couple of days.

Hi, Roni. I absolutely loved working with Dr. Haben and his staff, and love my results so far. If you need the CTA and the trach shave, you can't beat Haben 's pricing. If you don' T want to wait to accumulate more money to go to Dr.  Kim, you could go to Haben. Results seem to be terrific from both sides, so in your case, I'm thinking it comes down to money and time frame? You wouldn't need a passport for Haben either. If you don't have a passport and want to see Dr. Kim, that's another 150 to 200 on top. Also, if days off or days out of the country is a deal for you, Haben only needs you a couple days whereas Dr.  Kim keeps you like ten, I think? Really, I think it's these ancillary considerations that will make or break one of these surgeon's fit for you, not really the quality of their work. They are both top notch professionals.

Hi Cadence!

My adam's apple is unnoticeable if not non-existent, so I lucked out in that department. I have decided I will only be going for Dr. Haben's Feminization Laryngoplasty surgery.

And yes! The fact that I do not have to travel out of the country has been a huge factor in my decision.

[Qrachel]

Great and good luck . . . key us posted on your progress.

R