Dr. Michael C. Haben's triple VFS procedure

[Roni]

Yes, the feminine color of the voice is much more than just Fo. Remember your voice isn't producing a pure sine wave. It is producing harmonics and undertones as well. Truth be told I can talk below 200Hz if I wanted to. I have a few times but it has never ever clocked me. In fact being a bit more mature in age I tend to not talk with a high voice.

I think that is what I am slowly realizing as well. I noticed I'd get more looks/smiles from people when I am talking in the 240-250 Hz range, probably because I've just been clocked? I don't know. Whenever I used to talk in a more relaxed voice during my lazy days, my voice almost never turned heads. I would put a lot of strain on my cartilage and vocal chords to achieve my trained voice and it would almost come out unnatural sounding. I am so glad I will be able to simply relax my chords AND cartilage now, and I will take whatever pitch increase I can get. I will probably be happy with a 40Hz pitch increase at this point.. to lock my natural voice at 200Hz. Of course 75 Hz would still be ideal!

[Brooke33]

I'm really intrigued about this whole procedure, but worried I would ruin it involuntarily.  I snore.  A LOT.  Considering the fragility of the voice and throat after, would it be safe to assume snoring would be even worse than coughing?

[Dena]

Snoring isn't the best thing in the world for the voice and I do it sometimes. My solution to the problem is to sleep on my side and use the pillow to hold my mouth closed forcing me to breath through my nose. I think snoring originates higher up in the throat with the tongue and it doesn't use the vocal cords so the surgery may be safe from snoring. The other issue would be the dry air on the surgical site might cause more coughing.

[iKate]

I'm really intrigued about this whole procedure, but worried I would ruin it involuntarily.  I snore.  A LOT.  Considering the fragility of the voice and throat after, would it be safe to assume snoring would be even worse than coughing?

I snored a ton after my surgery on the day of. I asked the nurses at Yeson and they said snoring won't affect it since it's primarily your nose not your mouth.

[Brooke33]

Phew, that's a relief, thanks Kate and Dena

[anjaq]

I am very sorry to hear that someone lost the suture at such a late time and I hope it can be fixed. Its the first time I heard of such a thing that long after VFS. The others who have ripped the suture were all just 1-2 weeks post OP and something happened to them that made them shout, so it was sort of a misuse - even if it was unintentional.

Maybe someone follows her progress and possibly what Dr Haben says about this issue wherever she is active in posting her progress?

It would also be interesting if Elaines report about that one stitch continues. Did the suture also change or was it just the thread coming out? The threads always have to come out in those sutures with most surgeons. The key then is, that the tissue should at that point hold by itself.

Regarding this, I still think that Dr Kims approach makes a lot of sense. He uses permanent threads, that will stay in place forever. This may sound odd, but the CTA methods always use permanent hreads that sty in the body as well. The permanent sutures with glottoplasty make sense in my opinion because
* the healing period is up to 8 weeks until the suture is really stable and dissolvable threads can dissolve as early as 3 weeks post op.
* In addition to that, the knots of dissolvable threads can come loose. I had this happen during a GRS revision after only a couple of days!
* Also one has to ensure to not have reflux issues when using dissolvable threads (take lots of medication if needed!) because the acid makes the threads dissolve faster (Prof Remarcle always gives patients anti reflux medication).

In any case, I would pick the most conservative and cautious procedures any doctors with similar surgeries will recommend. Even if Dr Haben or Prof Remarcle allow you to talk after 2 weeks, I would still use the 4 weeks total rest and additional 4 weeks of restricted usage that Dr Kim recommends. If it is at all avoidable, I would do this when it comes to something like having a job that requires a lot of talking and returning to the job after anything less than 6 weeks - maybe 4 weeks.

[anjaq]

While only one person has reported busting the suture with Dr Kim, I would hardly say the results are 100% consistent. I know and hear a number of women who were dissatisfied with their surgeries and a few who sounded androgynous rather than feminine. I had my VFS from Dr Kim but I think I got lucky in that I got a passable voice after 1 month. Some people don't after 4 months. Look at anjaq, she is struggling with all sorts of issues now... her voice passes but she has issues with it.

Yes -I am ok with how it turned out, as it is basically what I expected originally, before I kind of increased my expectations after the pre OP consultation and after hearing some exceptional results. But my own estimate was that I started out at 110-120 Hz and now am at 170-180, sometimes 190 - so that is about the 70 Hz increase to be expected.

I am still very happy about it - I don't worry about talking anymore at all - no worries about being misgendered or thought of as trans and it feels much more like "my voice" now - even if I wake up and don't control my voice at all, it is sounding right, it also sounds right "in my own head" which is such a big relief. So while I do have some struggles - overall it is still a big success - the issues I have are in many ways "first world problems" that people getting voice surgery 10 years ago would not even have dared to mention

Anyways - this surgery is not perfectly predictable - there is a variation in the pitch increase happening. In addition to that, other voice parameters always will still play a role, which is why I called it a "voice supporting surgery". It makes it easier to use a higher pitch but to really make good use of that and to make the higher pitched voice sound feminine is up to others, not the surgeon.

That said, I have not yet heard of a really bad voice from Dr Kim - the ones I heard all are good or have the potential to be good with some training. Also I heard of only one case of physiological isses with the surgery - one time a suture ruptured but that was because for reasons beyond that persons control she was driven to disregard the restrictions very early in the healing period. So, I still think the chances for a good or acceptable results are very high with Dr Kim and I still am glad I went to him and not to some surgeon in Germany - I cannot say anything about Dr Haben, but he seems to have more patients that post here nowadays than Dr Kim, so I think we possibly may soon get a much better picture about his surgical results soon.

[Elaine S]

I am very sorry to hear that someone lost the suture at such a late time and I hope it can be fixed. Its the first time I heard of such a thing that long after VFS. The others who have ripped the suture were all just 1-2 weeks post OP and something happened to them that made them shout, so it was sort of a misuse - even if it was unintentional.

Maybe someone follows her progress and possibly what Dr Haben says about this issue wherever she is active in posting her progress?

It would also be interesting if Elaines report about that one stitch continues. Did the suture also change or was it just the thread coming out? The threads always have to come out in those sutures with most surgeons. The key then is, that the tissue should at that point hold by itself.

Regarding this, I still think that Dr Kims approach makes a lot of sense. He uses permanent threads, that will stay in place forever. This may sound odd, but the CTA methods always use permanent hreads that sty in the body as well. The permanent sutures with glottoplasty make sense in my opinion because
* the healing period is up to 8 weeks until the suture is really stable and dissolvable threads can dissolve as early as 3 weeks post op.
* In addition to that, the knots of dissolvable threads can come loose. I had this happen during a GRS revision after only a couple of days!
* Also one has to ensure to not have reflux issues when using dissolvable threads (take lots of medication if needed!) because the acid makes the threads dissolve faster (Prof Remarcle always gives patients anti reflux medication).

In any case, I would pick the most conservative and cautious procedures any doctors with similar surgeries will recommend. Even if Dr Haben or Prof Remarcle allow you to talk after 2 weeks, I would still use the 4 weeks total rest and additional 4 weeks of restricted usage that Dr Kim recommends. If it is at all avoidable, I would do this when it comes to something like having a job that requires a lot of talking and returning to the job after anything less than 6 weeks - maybe 4 weeks.

I echo pretty much of all of anjaq's thoughtful comments, both in the post quoted and the next one in the thread. A lot of very ideas and information that will only increase the likelihood of ones VFS being successful to the highest degree.

To avoid thread drift here, I will start a new one or revive my original thread on my revision trying to will update more frequently. Also reiterating my "laundry list of recommendations as well as thoughts and ideas others have posted. We have a vested interested interest, those of us interested or planning on VFS, to do our part to try and do everything possible to "assist" our surgeons by taking the best of care with their efforts.

Be safe
Elaine 

[iKate]

That said, I have not yet heard of a really bad voice from Dr Kim - the ones I heard all are good or have the potential to be good with some training.

I have heard one or two. That said their voice doesn't really sound terrible, it just isn't "instant female" as some others are. But they likely have other issues like resonance going on. There was one here who got a really high pitch but said she sounded male (and reluctantly I agree).

[kwala]

I am very sorry to hear that someone lost the suture at such a late time and I hope it can be fixed. Its the first time I heard of such a thing that long after VFS. The others who have ripped the suture were all just 1-2 weeks post OP and something happened to them that made them shout, so it was sort of a misuse - even if it was unintentional.

Maybe someone follows her progress and possibly what Dr Haben says about this issue wherever she is active in posting her progress?

It would also be interesting if Elaines report about that one stitch continues. Did the suture also change or was it just the thread coming out? The threads always have to come out in those sutures with most surgeons. The key then is, that the tissue should at that point hold by itself.

Regarding this, I still think that Dr Kims approach makes a lot of sense. He uses permanent threads, that will stay in place forever. This may sound odd, but the CTA methods always use permanent hreads that sty in the body as well. The permanent sutures with glottoplasty make sense in my opinion because
* the healing period is up to 8 weeks until the suture is really stable and dissolvable threads can dissolve as early as 3 weeks post op.
* In addition to that, the knots of dissolvable threads can come loose. I had this happen during a GRS revision after only a couple of days!
* Also one has to ensure to not have reflux issues when using dissolvable threads (take lots of medication if needed!) because the acid makes the threads dissolve faster (Prof Remarcle always gives patients anti reflux medication).

In any case, I would pick the most conservative and cautious procedures any doctors with similar surgeries will recommend. Even if Dr Haben or Prof Remarcle allow you to talk after 2 weeks, I would still use the 4 weeks total rest and additional 4 weeks of restricted usage that Dr Kim recommends. If it is at all avoidable, I would do this when it comes to something like having a job that requires a lot of talking and returning to the job after anything less than 6 weeks - maybe 4 weeks.

There really are a lot of questions regarding this technique.  As Dr. Haben explained to me, in some patients the scar forms quickly and the cords are fused together after only a week or two and in some it takes much more time for the site to become stable.  Age, thickness of cords, etc could all be factors.   One would think that by 4-5 weeks the healing would be complete and the stitches coming out would not be an issue but apparently it was for at least two girls.  Dr. Haben also gives anti-reflux meds to help ensure that stomach acids will not diminish the stitches prematurely.  What's most troubling is that it seems that these girls followed the instructions and still had this happen.  All I can do for myself is keep doing what I'm doing and hope that the stitches hold long enough for the cords to fuse.  So far so good but I'm only 5 days in.  So far no coughing incidents and no accidental speaking.  I have gently cleared phlegm a few times to avoid a cough but that's it.  Fingers crossed!

[Roni]

There really are a lot of questions regarding this technique.  As Dr. Haben explained to me, in some patients the scar forms quickly and the cords are fused together after only a week or two and in some it takes much more time for the site to become stable.  Age, thickness of cords, etc could all be factors.   One would think that by 4-5 weeks the healing would be complete and the stitches coming out would not be an issue but apparently it was for at least two girls.  Dr. Haben also gives anti-reflux meds to help ensure that stomach acids will not diminish the stitches prematurely.  What's most troubling is that it seems that these girls followed the instructions and still had this happen.  All I can do for myself is keep doing what I'm doing and hope that the stitches hold long enough for the cords to fuse.  So far so good but I'm only 5 days in.  So far no coughing incidents and no accidental speaking.  I have gently cleared phlegm a few times to avoid a cough but that's it.  Fingers crossed!

Good on you for not having coughed yet! That seems like such a feat compared to what I went through.  My first week of recovery all I did was cough every hour. I'm on my second week now and the coughing is almost gone.

[kwala]

Good on you for not having coughed yet! That seems like such a feat compared to what I went through.  My first week of recovery all I did was cough every hour. I'm on my second week now and the coughing is almost gone.

It wasn't easy!  But I've just been taking really slow breaths through my nose and sometimes hold my breath for a bit and let the feeling pass.  Then, when I'm calm and the coughing feeling passes I try to swallow or very gently remove the phlegm.  Sounds gross, but it's been working so far.  I was at the checkout line today and a cashier asked, "Credit or debit?" and I opened my mouth to answer and remembered at the last possible second not to speak.  She gave me a funny look and then I explained on a notepad app on my phone that I'm not supposed to speak and she understood lol.  As difficult as this is, it is in many ways a lesson in communication and another reason to be grateful for our voices no matter how they sound.  Not trying to sound like a Hallmark card, but I guess a little positive thinking can go a long way

[Elaine S]

It wasn't easy!  But I've just been taking really slow breaths through my nose and sometimes hold my breath for a bit and let the feeling pass.  Then, when I'm calm and the coughing feeling passes I try to swallow or very gently remove the phlegm.  Sounds gross, but it's been working so far.  I was at the checkout line today and a cashier asked, "Credit or debit?" and I opened my mouth to answer and remembered at the last possible second not to speak.  She gave me a funny look and then I explained on a notepad app on my phone that I'm not supposed to speak and she understood lol.  As difficult as this is, it is in many ways a lesson in communication and another reason to be grateful for our voices no matter how they sound.  Not trying to sound like a Hallmark card, but I guess a little positive thinking can go a long way

kwala:

Your closing thought is really appropriate and not "Hallmarkey" at all.

Well put!

Be safe and warmest wishes
Elaine

[anjaq]

I have heard one or two. That said their voice doesn't really sound terrible, it just isn't "instant female" as some others are. But they likely have other issues like resonance going on. There was one here who got a really high pitch but said she sounded male (and reluctantly I agree).

That's true, but in my opinion that is what I would call a voice with increased potential to be good. Pitch changed, timbre probably also changed, but there are other factors paying a big role in the gendering of a voice. That potential needs to be used and no surgeon can really force that. This is why voice surgery will never be a perfect thing

[Dena]

It wasn't easy!  But I've just been taking really slow breaths through my nose and sometimes hold my breath for a bit and let the feeling pass.  Then, when I'm calm and the coughing feeling passes I try to swallow or very gently remove the phlegm.  Sounds gross, but it's been working so far.  I was at the checkout line today and a cashier asked, "Credit or debit?" and I opened my mouth to answer and remembered at the last possible second not to speak.  She gave me a funny look and then I explained on a notepad app on my phone that I'm not supposed to speak and she understood lol.  As difficult as this is, it is in many ways a lesson in communication and another reason to be grateful for our voices no matter how they sound.  Not trying to sound like a Hallmark card, but I guess a little positive thinking can go a long way

What was really fun for me was I developed a UTI most likely before I went to visit Dr Haben but it peaked out at the tail end of of my voice rest. I went to the emergency room for treatment. I had to explain to the reception desk, the triage doctor and the doctor treating me what was gong on. Because I am post surgical they also needed to know about my gender status because antibiotics are given for a longer period of time when you still have the male plumbing inside. I had put away everything I would need while in voice rest so I wouldn't have to go out except for that!!! I didn't say a word but I was sure tempted.

[Lyndsey]

After the surgery when I went to his office for my check up before going home he told me that because I was a fireman for many years that i had scaring on my vocal cords and he was not sure how it would work. Well he was right it didn't work and so he had me come back in April of this year and we tried again. this time he took some of the scare tissue out and the results were much better. My voice is a lot better but my range is very limited. I hope by exercising it it will help me out. But i will never have a singing voice. At least that will save everyone ears from the toucher. LOL

[jollyjoy]

I just heard a singing clip from Isleeplikeacat, it sounds amazing and super feminine! She sent me a voice clip too but the link was broken. She told me she passes on the phone 100%, I'm soooo happy for her!! Maybe she will post an update here herself. I'm assuming her sutures never broke in the first place and the deeper sounds were all part of the healing process since I also heard deep sounds during my recovery.

[kwala]

I just heard a singing slip from Isleeplikeacat, it sounds amazing and super feminine! She sent me a voice clip too but the link was broken. She told me she passes on the phone 100%, I'm soooo happy for her!! Maybe she will post an update here herself. I'm assuming her sutures never broke in the first place and the deeper sounds were all part of the healing process since I also heard deep sounds during my recovery.

That's great news.  So maybe she just overused her voice, felt a little pain and panicked?  I'm glad things are working out for her, thanks for sharing!

ETA: I was able to find her update elsewhere with a Google search and it turned out wonderfully.  Glad everything worked out the way it did!

[Lara1969]

I would be Interesse to learn more about shouting and yelling after healing is finished. My concern that my voice will stay very thin after surgery. What are your experiences?

[Dena]

I would be Interesse to learn more about shouting and yelling after healing is finished. My concern that my voice will stay very thin after surgery. What are your experiences?

That I can answer. Yes you are supposed to be able to do it but even without surgery it's not a good thing to do very much. Anything that cause pain and done for an extended period of time will damage the voice. We have a girl on here who's past time involves a good deal of yelling. It took extra healing time because Dr Haben needed to remove some of the damage from years of abuse.

Dr Haben said no yelling before the voice is completely healed and even at four months, I am not comfortable with using any more volume than a normal speaking voice.