VFSRAC (VFS) with Dr. Kim at Yeson Voice Center

[Kendra]

Arrived in Seoul last night, headed to the Gangnam-Gu neighborhood.  I am not quite 6 weeks post-op from GCS, ain't gonna do any Gangnam Style dance moves quite yet.



Pre-surgery meeting at Yeson Voice Center is three hours from now, surgery tomorrow.  Post-surgery follow up March 7, return to US March 8.

Rented an AirBnB, 18th floor studio next to Gangnam subway station - excellent location just $600 USD total for 1-1/2 weeks.  Building is new, apartment includes two internet routers - one is pocket size I can travel with in Korea to avoid roaming fees.  It's the building on the left in this photo:



Bought a four day Korean Rail Pass for unlimited high speed rail travel anywhere in South Korea.  Although I won't be very talkative the month of March, a couple days after surgery I'll jump on the train and see other areas.

Before leaving for this trip I printed out some paper cards - planning one month of voice rest. 

[Jessica]

Sounds like your ready!
Good luck Kendra!

Jessica

[Rachel]

Hi Kendra,

Good luck tomorrow. I am so happy for you. From your preparation it looks like you really prepared well.

I have come to a conclusion that not using a laser may provide less tissue damage and a greatly reduced potential of scar tissue forming at the location where the vocal folds meet. So the issue of vocal power is much less an issue. This is my opinion from seeing several vocal folds from before and after from surgeons that do laser and Dr. Kim's results. Also From talking to patients from surgeons that did a laser assist vfs.

I am so happy for you. Please provide detailed. Last I looked mid last year the cost for the vfs all in was about $7,000. I would love to know the current tally.

I wish you a speedy recovery and fantastic results.

One of the reasons I did the procedure I had was that the vocal folds are not touched. I gained about 30 hz from the operation and going below 160 hz is locked out. I planned to do a glottoplasty if I was not satisfied with the pitch. I am going to plan for a glottoplasty in the summer.

From what I have read from many accounts you are in very competent hands and will be happy with the results. I am so happy for you.

[Kendra]

Had the pre-surgery meeting today.  They ran a lot of tests - two hours of 'em.  And then I met with Dr. Kim. 

1. Four page questionnaire to help assess current voice and goals.
2. A strange test I don't understand with a bunch of electrodes stuck to me. 
3. Blood test. 
4. Read the rainbow passage which was video recorded and spectrum analyzed.
5. Put on a mask and say a tone (aahhhhhhh) for as long as possible.  Turns out this checked several things.
6. They placed a camera down my throat, say aahhhh at different pitches.  The camera is tiny, wasn't bad.  And it isn't just any camera - this takes very high speed video.  Vocal chords move much faster than 30 frame per second video - so their camera has to run faster.
7. XRay of throat area.  That involved a walk across street to a different clinic, then back to Yeson.
8. Anesthetic sprayed into my nostrils and ... a small camera shoved waaay up my nose.  All in the name of science so I'm ok with that.  Dr. Kim ran this particular test - all the others were by assistants. 

Equipment used for test #5:



Equipment used for test #6:



After two hours of tests I met with Dr. Kim for a half hour.  The tests don't just show whether someone is a good candidate for this surgery - the tests show where things are out of norm (regardless of gender) and may be a factor in the surgery plan.  He showed me a couple areas where my voice has additional problems that might be unrelated to gender, although made worse by pushing my voice into a range my vocal chords don't like.

Test #5 showed I use twice as much air to speak as the average person.  Test #6 showed this isn't because I am loud, it's because my vocal chords don't quite close when they vibrate and are slightly asymmetric.  Watching mine in slow motion compared to one from a sample patient the difference is obvious.  Other test numbers showed I am using up to 8 times the energy to create the same sound as other people would. 

I have a pretty bad tremor to my voice - a sign of muscle strain.  I could clearly hear it during some of the tests.  This is from my brain learning to compensate for problems by tensing up the muscles in that area. 

During surgery he will work to correct these physical things but I'll also need to re-train my brain.  This is why the results are not immediate - in addition to months of completely healing and settling in, there are voice exercises to do starting 2 months after surgery.  I'll be getting a botox injection to calm down the tremor, but that is temporary and I'll need to train my brain to relax and adapt to my new voice. 

[Saha]

Wow, that is some cool technology!  And what good information to have, in order to fix it.

[Kendra]

They measured my natural pitch centered at 149 Hz.  I've been pushing it to ~175 when I try, but after a few minutes I feel the strain and my voice drops.  Dr. Kim said I may be able to settle in at a natural 200-220 Hz.  Based on healing and post-op vocal practice, hopefully around end of this year. 

[Julia813]

Kendra,

Thank you for posting such detailed information! This is something I have considered off and on for a while. Just out of curiosity did you spend a significant amount of time trying to train your voice (speech therapist or solo) prior to surgery? I am currently going to a speech therapist, and just wondering if there is only so much I am going to be able to accomplish through therapy alone.

Looking forward to your next update!

[kwala]

Best of luck, Kendra. You're in good hands. This team is very professional. I wasn't a candidate for VFS because of a past botched attempt, but Dr. Kim was able to get my voice into a better place with another procedure. He really knows what he's doing. 

[Kendra]

> Just out of curiosity did you spend a significant amount of time trying to train your voice (speech therapist or solo) prior to surgery? I am currently going to a speech therapist, and just wondering if there is only so much I am going to be able to accomplish through therapy alone.

I had weekly one hour sessions with a local speech pathologist for 5 months.  Things started out well but I quit when I realized that was the worst experience of my transition.  I'm normally a fan of speech therapists but the one I selected wasn't a good fit for me.  They were qualified as a scientist, co-authored clinical books and I believe wanted the best results for their patients, but made several remarks that really set me back when I believed I was making progress.  Voice is my worst dysphoria - I hated my voice when it changed in 1975 - and that professional made me even more self-conscious.  In hindsight I should have bailed at our first meeting when they told me to never get vocal surgery - don't even consider it, VFS always fails and always damages the voice.  That's like an electrologist saying never try laser and claiming it always fails (the accurate answer depends on many individual factors). 

VFS is risky and the community has seen many results that are terrible.  This is an area where we have to be cautious in who we choose and have realistic expectations.  At my age I don't expect a 70 Hz natural increase, I'll be happy with half that.  Unlike other surgeries this one is messing with a delicate musical instrument.  When someone tells me they selected a particular VFS surgeon I don't judge but I ask what their reasoning was.  If they say it's because the surgeon happened to be within driving distance or offered to add it to a cosmetic procedure I recommend do additional research and be extremely picky about something that is irreversible.

There are many success stories with voice training alone.  Depends on each individual's body and brain.

[Kendra]

About to take a nap.  This is the recovery room where I'll spend the day.  Surgery is down the hall. 



Surgery starts a bit after 9am.  One hour procedure, they said I'd wake up after about 4 hours.  Can drink water 2 hours after surgery, soup 4 hours after, discharge at 5pm - return to AirBnB apartment.

[judithlynn]

Hi Kendra;
Best of luck darling. Am thinking of you. Actually I have just got a referral to  a Speech pathologist that specialises in Transgender patients (she also trains Opera singers). Most people already say that I have a natural female voice (I used to sing a lot  and have an excellent range), but since transitioning I really would like to re-join a choir, but I dont want to revert to my male singing voice, so I have signed up for a 8 session course to see if she can help me to be able to sing a female part (I will never have a Soprano range without surgery, but if I can get to Contralto voice I will be satisfied), although I would be very interested in your results (pre and post) after your surgery.
Again best of luck and my very best wishes
JudithLynn

[Kendra]

안녕!  난 3 시간 후 깨어 났다.  난 괜찮아, 행성의 반대편에로 리의 트럭에서 안전 해요

[Laurie]

안녕!  난 3 시간 후 깨어 났다.  난 괜찮아, 행성의 반대편에로 리의 트럭에서 안전 해요

너 너 여자 야 너 재미 있다고 생각하니? 내가 너를 때려 눕힐 것이다. 그냥 기다려

Hugs,
   Laurie

[Jennifer W]

Good thoughts and prayers for good results coming at you! Hugs!!!

[Laurie]

 Hi Miss Kendra,

I will try to remember you are having some sort of cosmetic work done tomorrow. Isn't makeup better than surgery? Somehow I just can't seen to understand some of the things you do girl. Watch out for splinters in those restaurant chop sticks don't want you swallowing something and hurting your throat. And oh yeah don't eat the insects there either they might have sharps claws. Don't eat the eggs either I've heard they are rotten. Kimchi is okay provided it's not moldy. Well good luck on your vacation girl.

Hugs,
   Laurie

P.S. Can I have the Audie if you decide not to come back?

[Kendra]

I love Korean food.  Considered Kimchi as my middle name.
Korea is a step ahead, metal chop sticks are the tradition here.  Easier to clean and ain't got splinter.
I ate a few insects until I learned to keep my mouth shut riding my motorcycle. 
The Audi is gone - I had it converted to an Innie on January 18.

And all of us, thanks so much for the comments and encouragement.  Even Laurie.   

[Kendra]

Back at the AirBnB apartment now.  They sent me with a very nice car and driver who works for the clinic - not a taxi, so the driver knows to avoid encouraging passengers to talk after VFS.  (I don't normally use taxis in Korea - prefer subway and trains).  Same driver will provide a ride to the airport a week from now.

In addition to the pre-op meeting yesterday, Dr. Kim sat down and carefully explained several things this morning.  I admire how careful his explanations are, never rushed.  I can see his eyes quickly scanning numbers.  Based on measurements he expects my initial voice may sound lower or similar (1 month later when I can carefully speak), by month 2 should gradually improve and that's the point where I can start voice exercises.  At month 3 or 4 the botox wears off (I'm getting injections into that muscle next week), and without botox I'll be relying on training to get used to my new voice.  By month 5 or 6 the goal is naturally hit a higher range with continued improvement physically possible for a full year.  Once I hit the desired range the goal isn't to keep going higher - the point is to develop a natural female voice.

In the surgery room while the anesthesiologist was making adjustments, Dr. Kim placed his hand on my shoulder - didn't have to say a word.  He does care.  I can see it in his eyes. 

There is so much to human language.  In my failed attempt with a professional trainer I did learn interesting things about inflection, choice of words, how body language and posture directly affects speech.  When you hear a female radio announcer you can hear them smile - it shapes their words.  And that's another area where I disagreed with my local speech therapist - criticized me for listening carefully to female radio announcers since some might have bad speech patterns - an additional reason I decided to bail on that particular speech therapist.  I will continue to listen and learn from female radio announcers without guilt - it's my body and my future.

After the sleepy stuff wore off from surgery I met briefly with Dr. Kim again - he showed before and after photos of the surgical site and carefully explained what he did.  I can see my vocal chords are now symmetric, they were not before.  I'll ask for copies during a post-surgery meeting 6 days from now (they might send them to me regardless - they have been very accurate and thorough with information). 

Medicines every 8 hours for the next week, mostly to help avoid coughing. 
- Cough suppressant pill
- Another cough suppressant pill
- Cough suppressant syrup
- Antibiotic
- Digestant
- Analgesic

Really doesn't hurt much right now - just a sore throat which is understandable.  I was expecting a sore jaw from having my mouth jacked open for surgery but it isn't sore at all.  No visible marks or bruises anywhere.

And a goodie bag!  Contains post-op instructions (they also sent a 51 page PDF before surgery).  One week of medications - basic stuff to suppress coughing, an analgesic and an antibiotic.  The pink bottle thingie is a USB-powered humidifier (handy if someone was returning to Arizona, or wants to annoy people on the flight home).  An airline-type travel kit.  And - this is really cool - a nice quality Yeson writing book with blank pages, first several pages contain post-op summary instructions and common phrases in Hangul (Korean Language) and English.  They also packed dinner, same as lunch which I found quite yummy. 

[Sonja]

Hi Kendra,
I hope you find your new voice, good luck! 
Do you think you will upload a before and after once your vocal cords have healed and you've trained through the last part?

Kind Regards,
Sonja.

[Kendra]

I'll definitely upload before and after recordings - I'll add them to this thread in the future.  Day before surgery, and every 3 months for one year. 

People here at Susan's have helped me so much.  It's the least I can do. 

After this surgery I require a smaller endotracheal tube for anesthesia, cis-gender female size to avoid damaging the smaller vocal chord opening in my larynx.  My next surgery (FFS) is 2-1/2 months from now. 

Dr. Kim wants me to send voice recordings every 3 months to check progress and potential issues (and of course welcome to contact them any time).  And although they don't require it, I will visit Seoul near end of 2018 for a follow-up.

[Laurie]

I'll definitely upload before and after recordings - I'll add them to this thread in the future.  Day before surgery, and every 3 months for one year. 

People here at Susan's have helped me so much.  It's the least I can do. 

After this surgery I require a smaller endotracheal tube for anesthesia, cis-gender female size to avoid damaging the smaller vocal chord opening in my larynx.  My next surgery (FFS) is 2-1/2 months from now. 

Dr. Kim wants me to send voice recordings every 3 months to check progress and potential issues (and of course welcome to contact them any time).  And although they don't require it, I will visit Seoul near end of 2018 for a follow-up.

Hi girly,

Glad to hear that everything seems to have gone well for you. Wow no talking for quite awhile huh? I sure Beth and Saha will enjoy the peace and quiet.
  Enjoy the rest of your vacation.

Hugs,
   Laurie

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