VFS should be done last?

[Ellement_of_Freedom]

So I remember reading on another thread that VFS should be the final surgery if you're planning on having others (such as SRS/FFS). What is the reason behind this?

Would the best order of surgeries be: FFS first, SRS second (possibly BA third) and VFS last?

Thank you for your knowledge and expertise. <3

[Virginia Hall]

So I remember reading on another thread that VFS should be the final surgery if you're planning on having others (such as SRS/FFS). What is the reason behind this?

Would the best order of surgeries be: FFS first, SRS second (possibly BA third) and VFS last?

Thank you for your knowledge and expertise. <3

Somewhere along the line I said a similar thing in one of the forums. Probably others have said similar things too.

Personally I would chose FFS first because most people will gender me by sight more than anything else, and few if any surgeons require a doctor's note to get it. I got mine from Ousterhout. A majority of passing issues are swept aside and a lot of dysphoria. Once you look female people will want to help you. A transman gave me that advice many years ago and was he ever right.

Second, personally I wound then do SRS, because it dealt with my major dysphoria and I felt normal afterwards. Dating issues are eased.

Voice is inexpensive relative to the other two surgeries. With less dysphoria, sometime it is easier to accept the higher voice, so maybe it will come as a gimmie, so because of that, maybe it'll come on its own, but not always. Some years back people made fun of others who had VFS. Shame on the nay-sayers.

Yet with a body mostly in alignment, I allowed myself to let go. Still, some of the recent voice surgery is fantastic (in some patients, not all) so if I had the money and had to do it over again, that would be the frosting on the cake and if it had been available in 1976, I would have gone for it in a heartbeat. Younger vocal cords do better than older ones, so why wait--but I have heard it is not "magic" and requires a long recovery period.

We are blessed by modern medical technology and should take advantage of it wherever we can. We've all been cheated out of enough, even at a young age. At least that's my view.

[Virginia Hall]

So I remember reading on another thread that VFS should be the final surgery if you're planning on having others (such as SRS/FFS). What is the reason behind this?

Would the best order of surgeries be: FFS first, SRS second (possibly BA third) and VFS last?

Thank you for your knowledge and expertise. <3

Hello Ellement_of_Freedom,

A friend PM'd me about my rankings. She said that for many people it takes quite a bit of time to save up for the surgeries. She suggested if I could only have one surgery and then had to wait for many years to save up for the next one, or possibly only ever get just one, would that change my answer?

The answer to that is YES. It would.

If I could only get one, it would be SRS.

[Ellement_of_Freedom]

Thank you for your insight, it's very nice to hear.

[Ellement_of_Freedom]

I hope someone can shed some light with regards to the dangers of doing VFS and then having other surgeries after. I have heard something about it being an issue - perhaps with the breathing tube during other surgeries post-VFS.

Or maybe I'm being silly.

[anjaq]

The practical reason for this is, that with some types of VFS, there is a risk of damaging the voice with further surgeries.

This specifically applies to any sort of vocal fold shortening aka glottoplasty - the thing that Dr Kim/Yeson and Dr Haben and Remarcle do. In it the vocal colds are sutured together. Surgeries after that have to be done with special care in respect to the intubation. The intubation tube has to be smaller than usual, it has to be carefully inserted and removed in order to not damage the suture or vocal folds. Several FFS and GRS surgeons are aware of this issue and know how to deal with it properly, others may not be . In that case the anaesthesist has to be carefully instructed. I know that FacialTeam and Dr Suporn are well familiar with glottoplasty patients and other surgeons probably are as well, in that case it should not be an issue, but to be sure there are less risks, it is better to do VFS last.

[Virginia Hall]

The practical reason for this is, that with some types of VFS, there is a risk of damaging the voice with further surgeries.

This specifically applies to any sort of vocal fold shortening aka glottoplasty - the thing that Dr Kim/Yeson and Dr Haben and Remarcle do.

I have not had VFS so please take this with a gain of salt. At the same time I have returned to a T-board after about 15 years because I was considering VFS, so I have done a lot of reading. Naturally people who have has VFS know a lot more firsthand than I.

Vocal surgery has a bad rap going back to the 1970s when I has SRS. But then again, so did SRS and FFS was in its infancy.

Early vocal surgeries were a litany of bad results. Some trach shaves prior to VFS were done aggressively and also led to trouble. My otolaryngologist was complementary about Biber's work not being too agressive when I went in to get the "pictures" that Yeson wanted prior to me flying all the way to Korea. So trach shave is an issue.

There is also a large psychological competent insofar as outcome, at least in my view, whether or not voice is achieved by surgery or not. I have encountered a few people post-op VFS who start to drive their high pitch downward following VFS. It seems there is a dissonance between their actual voice and how they "speak" to themselves inside their heads. They work at it to get back to the internal narrator voice back down. Their ears cannot stand the fact that now their speak in a higher register.

Yeson says there is a re-learning phase to teach the vocal folds to respond. The younger the better--while the vocal cords are still supple--and Yeson is leery of doing surgeries on those over 50 insofar as outcomes are mixed, but he wil do them even for people older than that, though he does make it clear the change is not as great for patients 50+.

There are a couple of non-surgical sites that are helpful







And then the Yeson before and after,



Jenny obvious is Yeson's poster girl, but notice, her voices goes into pitch excursions, probably because now it can, but you can bet she did not awaken from surgery knowing this any more than in real life, as opposed to Hollywood films, after SRS the patient wakes up with makeup on and beautifully done hair. Jenny's voice is a result of seven months of work.



The graphic and voice are nice to document the shift, but again notice the infections and more singing of words than the monotone from before.

SO! WHY have VFS LAST? The practice is unavoidable. Starting with practice may obviate the need to the $7,300 base surgery plus airfare and expenses. If after that I am not making progress, I'll meet you in Seoul!

[anjaq]

Yes that is a good reason, too. I did the VFS 15 years after GRS and indeed it takes quite some practice in addition to the surgery. But one also has to say that with the surgery it is much much easier to actually use the upper vocal range and thus do voice melody and inflections in a range that was hard to do before. I had a singing lesson today and the woman told me that she can hear from my speaking voice already that I have a very wide pitch spectrum I can use. Before the VFS, everything in the upper range was much more "work".

But these considerations about trying other things first and about other things being a priority psychologically or in respect to "passing" are not what was asked in the original post. I intend to do more surgery after I am now done with VFS - I will need a revision of the breast implants after 16 years of having them. I may opt for FFS now. As you said, in the past FFS and VFS were considered exotic, drastic and risky - now they are getting more safe and this is why I now consider it, when I never would have wanted it when I transitioned back then.

[Ellement_of_Freedom]

The practical reason for this is, that with some types of VFS, there is a risk of damaging the voice with further surgeries.

This specifically applies to any sort of vocal fold shortening aka glottoplasty - the thing that Dr Kim/Yeson and Dr Haben and Remarcle do. In it the vocal colds are sutured together. Surgeries after that have to be done with special care in respect to the intubation. The intubation tube has to be smaller than usual, it has to be carefully inserted and removed in order to not damage the suture or vocal folds. Several FFS and GRS surgeons are aware of this issue and know how to deal with it properly, others may not be . In that case the anaesthesist has to be carefully instructed. I know that FacialTeam and Dr Suporn are well familiar with glottoplasty patients and other surgeons probably are as well, in that case it should not be an issue, but to be sure there are less risks, it is better to do VFS last.

Thank you so much that's exactly what I needed to know. <3