As  I understand it, Dr Thomas has a variety of options from just slightly tensioning the vocal chords to a fully invasive procedure. I dont know if he also offers glottoplasty like Dr Kim. From what I have heard of the über critical German people her ist that if they trust anyone to do a successful voice surgery, its Dr Thomas. Dr Kim is unknown here though. I personally think the reason for that is that Dr Thomas also attempts to change resonance to a degree. So if someone was totally unable to train herself to change resonance and pitch and basically has a 100% male voice, a surgery like Dr Kims or the other pitch raising surgeries will relaly only raise pitch but not resonance and then the voice may sound odd. People then call the surgery a failure and this is probably why VFS has such a bad name here. Pitch raising surgeries can only be a success IMO if the voice was a low but female sounding voice before surgery and then becomes a higher female sounding voice. Dr Thomas seems to have a more holistic approach and tries to reshape the whole larynx in a way that allows the patients to speak without the need for resonance or pitch control. If that works, the difference certainly is great and I guess the whole quality and sound of the voice changes. Sadly the invasiveness of the procedure seems to increase the risk of complications to a rather high level. I would say Dr Thomas is somone to consider if it really does not work at all with the voice, Dr Kim is someone to consider if the voice already is allright but can use improvement . Its a bit like botox and a nosejob versus a full FFS

Quote from: LizMarie on January 09, 2014, 09:50:01 PM
Bobbi, I cannot speak for the women who have already been to Yeson and I've not yet done so myself. However, the statistical outcomes from Yeson are extremely high with very high satisfaction rates from the patients. And as we have all learned here from all these brave ladies posting samples, the quality has been amazing.

On the other hand, Dr. Thomas, who I also was looking at, uses an invasive procedure versus the Yeson endoscopic procedure, has a lower satisfaction rate than Yeson, and has some outcomes that are worse than when the patient began. That's not a lot but it is a worry. Yeson seems to never make things any worse than they were and almost always makes things better.

When looking at the two procedures, since, for me, mastering suppression of male resonance was pretty easy but pitch is much harder, Yeson makes more sense to me for all the above reasons.

Thanks Bobbi, I appreciate that. I think Liz outlined it here pretty perfectly in why *I* chose Yeson versus any other voice surgeon. I would think it's similar for most others too. The amount of successful results coming out of Yeson, the natural sound of their voices, and the relative invasiveness of the procedure made it a no-brainier for me. Being almost 2 months post-op now, it's changed my life. I no longer think about my voice at all anymore, and I haven't even started vocal excercises yet, which should increase my range and power much more.

I never considered VFS at all before seeing Jenny's result on YouTube. After that, as well as getting as much info about Yeson and the procedure, I was sold. For me, Dr. Thomas' procedure was too invasive and the satisfaction rate and quality of the voices didn't come close to Yeson.

I hope that help :-)

Being that I'm around the 2 month post-op mark now I thought I'd do another video. My voice is definitely waaaaay stronger than before. I have no trouble speaking at all, even for longer durations. I haven't yet started vocal exercises, nor have I really tried testing my range at louder volumes. I'll be progressing into those in the coming days and weeks. I also haven't really tried singing yet, just really low, short clips. I'm not going to push that until probably another month or two, once I've been doing the vocal exercises for a while.

I really love the results from this procedure. I have no worries anymore about my voice. I used to have so much apprehension pretty much every day whenever I had to talk, meet new people, etc. and that's all gone now. It feels great to be so comfortable with myself now and not have any worries anymore. This would have seriously been the first thing I got done when I first started transition if it was around and I knew about it back then. It just takes so much weight off of me knowing that I don't have to try so hard to sound female anymore, I no longer get a sore throat from trying to raise my pitch all day, I no longer have to think before I talk, etc.

But anyways, here's the video. Let me know what you think

That's fantastic, Sarah!

Hey - really rally great. And it does not sound as if you have a super low volume still or anything. The male voice thing is funny - this time you forced resonance, I think you did not do that last time so you actually do manage to make it sound a bit androgynous. I know that feeling - after many years of talking with the changed resonance it becomes really hard to do that sort of resonance again - it is not something that would happen by accident anyways but good to know that even if it would, it does at least in your case not sound male. If I would do that now - horrible - But I never do. So pretty cool about the Yeson interview, you will also be on the yeson channel then with a pre/post op comparison?

LizMarie, Anja, Sarah - thanks so much for the insights. 

Sarah - WOW!  Just love your voice & your laugh!  Simply amazing - so feminine.  Thank you for giving us continuous feedback & results!

Jenny - your videos are amazing - so feminine & so inspiring!


Yes - the non-invasive Yeson procedure is way more appealing to me.  I had planned Yeson at first (based on Sarah & Jenny), but my speech therapist recommended that I check with Dr. Thomas due to the voice box resonance work. 

But even Dr. Thomas' site states the result of the voice box raising is subtle:
"Benefits and thoughts
I have performed several cases with this as the only procedure. To be successful there needs to be a gap between the thyroid cartilage and the hyoid bone. In some genetic males the voice box is quite low in the neck and can be raised quite a bit. In others the voice box abuts the hyoid bone and I really must remove some of the thyroid cartilage to create a gap for raising the voice box. Mostly I have performed this procedure simultaneously, in conjunction with a feminization laryngoplasty.

I believe the change with this procedure is more subtle than other procedures. There is less risk with this procedure than the other procedures I perform. It does provide a change in the vocal quality not performed by other procedures."

His own site is full of really appalling voice samples, none of which sounded better - several much worse.  And he states a rather high, IMHO, revision rate at an additional $3,500 cost.



My current voice is passing at a high rate in person (a big deal - maybe not so much on the phone, that's where I use "Roberta" to help), but I get tired of maintaining my pitch & resonance simultaneously. And it's almost impossible to maintain my voice if I want to sing - I really miss singing.  I feel that a pitch improvement would allow me to focus on resonance control & improve my voice overall.  And I am a BIG proponent of the Yeson being non-invasive!  Especially since I've already had a tracheal shave with almost invisible scar.  Dr. Thomas's also states that he performs the voice box raising surgery separately.

So my preference is still for the Yeson surgery.  I've used Pratt (thanks to Jenny & Sarah!) to record voice samples & a 75hz improvement would work really well for me.  I plan to continue with my voice therapist to improve my resonance.

I have a phone consultation with Dr. Thomas this coming Wednesday - I'll report on that.

Thank you to everyone for your insights & thoughts!  And to Sarah & Jenny for your real-world data collection that has been an invaluable resource!

Love & hugs,
Bobbi

Sounds you are doing quite a good research there yourself, Bobbi, I also listened to some of the samples at Dr Thomas site and he seems to be not that good in promoting himself as I found them not convincing really. However I have spoken to some people here who in turn are in direct contact with Thomas patients and they all reported very good results, so the recordings in the web may not be representative. A freind of mine suggested I contact Dr Thomas as well and I guess I will do that and send him my recordings, videos of the vocal chords and frequency analysis to see what he has to say about my voice issue - if he confirms the diagnosis of Dr Kim and if he would be more optimistic about VFS working on me. But i will wait for the updated endoscopic video recording to get more data. The resonance issue is really a nig plus with Thomas - interesting that he can do it as a standalone procedure in some cases (though not in all it seems), may be worth to keep in mind if people have serious resonance issues that would make a result from Dr Kim less appealing unless resonance is fixed as well...

Dear Sarah,

congratulations on the development of your voice. It sounds great indeed. And thanks for the thumbs-up for my (and Saskia's) surgery in April! <3 <3 <3

And your attempt at doing a low voice really supports my conjecture that resonance modification becomes less and less important if the pitch problem is taken care of, as male resonance becomes unmaintainable at higher pitches anyway. Thus it is unnecessary to modify resonance as long as the vibrating weight and/or length of the vocal folds is decreased. Apart from the consistency of their great results, this is the main reason for me to favor Yeson's procedure over any other.

Since it's incredibly hard and abstract to describe my voice in words, I've prepared a little diagram that's supposed to show how my voice feels to me (with 2 decades of resonance modification under my belt, but – as of yet – without VFS). This also explains how the region of male resonance becomes increasingly hard to access as the surgery modifies the vocal cords in such a way that they cannot vibrate at high volume at lower pitches anymore.

You can see that without resonance feminization, the male resonance area and falsetto pretty much exist independently of each other, with significant discrepancies in sound quality. Going from one to the other causes a noticeable break.

With resonance feminized, what used to be the falsetto becomes the new speaking voice, but is extended downward and through resonance modification is given greater power and clarity and less breathiness, and so comes closer to the old male register, which is unused altogether. Volume and clarity are hard to maintain at pitches around where the break used to be (my voice sound quality noticeably suffers in that pitch region). The top minor 6th of the range, however, is crystal clear with lots of volume and control.

The pitch boundaries I highlighted reflect my personal voice. They could be different for other people.

I hope this makes sense to you, as it is quite an abstract visualization. And I'm so curious to find out how this diagram will change after surgery!

Greetings,

Amy

Amy. Thanks so much for the diagrams. They totally make sense to me. This is exactly how I feel it too! Especially now that I have explored the voice a bit more recently with voice rehab. Before Iw as not so much aware of it and I had those two low registers in the right picture, but still a break towards the top, that I now can "bypass" as you described it there. I am not sure about the quality of the upper range - but I think you are right, it is clearer, though I lack a bit of control over it. The volume of my "male range" was never really high however, so I would not put that parameter in ther for myself, but clearly it increases in the upper range now - I noticed this by consiously looking at it at a party before Christmas - there was a lot of noise, I was not heard well by others when talking at a table and by increasing pitch I could be heard again. It also strained my voice of course, but it was the only way to really get volume or audibility up without using that male register.
My pitch ranges are different though - but the general scheme is very much the same.
I will be looking forward to an update post-op - the "male register" should probably move and be cut off at the bottom. It probably changes in resonance quality. So I am not sure what this would mean in the diagram though - I guess it would gain more overtones in relation? Curious what will happen to the break and the lower range of the female register.
What I still am very curious about is how the visible shift in that diagram between male and female low register will play out. You can see how with a female resonance, pitch goes up a bit (ok, just the lowest pitch range in the diagram - you did not put in the F0 there). If the pitch increase by Dr Kim is 75 Hz, which F0 and pitch range will it affect? Will both low boundaries go up by 75 Hz? Both F0s? Will it just cut off the lower end of the male resonance field and just a bit on the female resonance bit so that they will be equal at the botton? Will the male and female resonance fields start to overlap or melt together so that it does not matter anymore?

Its great to have someone here who can express vocal qualities so well, Amy - Thanks :*

Hi all

I'm new to this forum, and the more I read about Dr Kim's procedure the more I feel confident to move on and have my VFS done at Yeson. I'm 24 years old and have been perfecting my feminine image for years but my appearence can only take me so far and I feel kinda frustrated for not being able to pass because of my voice. Unfortunately I don't earn much to have my VFS done soon, and neither do I have time, but I'm seriously considering taking a loan or sell a property and solve this issue (as a public employee it isn't difficult to get it), and even so getting VFS in South Korea will mean an additional time to wait for my SRS. I've spent my money with FFS but had I know about Dr Kim I would choose VFS over FFS back in dec. 2012. I've never travelled abroad so making a trip to the other side of the world, knowing my english is still poor, to undergo a surgery feels to me like a kind of an adventure. I'm scheduled to have my annual leave in march but it will be only 15 days, which is too little to let my voice rest. I work at a post office in the reception, so you may see I have to talk all the time. Really things are a bit difficult but I'm not willing to wait months to get it done.

Hi, Sabrina.
It may be a bit fast to go this March already. You will have to check if there is a chance to book this that fast. You can just email them. 15 days is not enough though, so I guess you should see ich you can get something like a months leave if that is possible in your position at all? Where are you from, somewhere in Europe as you have not english as a native language but you still have to pay for all the procedures, that excludes a number of countries (well unless you chose to not use the local insurance covered options for SRS).

Also, my impression is that it totally makes sense to bring a friend with you, who ideally is at least quite ok in english, so you do not have to communicate solely via the touchpad screen. I think all the ladies who have don this procedure up to now and have reported about it went with a friend. I think it makes sense not to go alone!

@Anja

I'm from Brazil, and I have absolutely no one who I can count as a friend (besides my dad), forget about an english speaking friend willing to help me in this journey. I live in a small town and don't have personal contact with transwomen who are transitioning like me. Well the maximum leave is 30-34 continuous days but it will fall in the year end, but I can extend this time only if I arrange a fake medical leave but that is too risky. and I don't wanna lose my job either. The public health system here covers srs but I'll not be taking this risk either, I'm on my way to Thailand but it will take a bit longer.

Hi, Sabrina.
I would suggest then that you take the time to get that 34 days leave. you probably can easily get an official sick leave from a nose and throat doctor in Brasil if you had that surgery done as he could confirm that your throat needs healing. Usually he does not have to write a diagnosis for your employer, just that you need that leave. Otherwise you are risking your voice improvement if you can only keep the 15 days that are needed to heal. Maybe you can arrange to have a different job within the company for a few weeks? Do they know you are transitioning at the job, and are they supportive?
Dont you know anyone who can speak english and is your friend? It does not have to be a transitioning woman with TS but any friend or your dad if they are supportive of your plans. Otherwise it will be really hard if something goes wrong and you cannot talk at all, you may be tempted to talk anyways and then again risk the success. I am sure Jenny an dAbby will tell you that this is really critical. So by all means take the patience and try to get that longer leave and someone to accompany you.
What i am doing now is to tell everyone at work that i have voice issues, that something is wrong and needs to be fixed, that I am doing voice rehab right now. if I then tell them that rehab was not working enough and I need a surgery to correct my distorted vocal chords, i am sure I can easily get enough days off and probably even an official sick leave. Maybe that is an option?

I totally understand wanting to go to Thailand for SRS. I used the insurance option back then and was lucky with it in some ways and suffered from it in others. At present, i would not recommend anyone in my country to do any major surgery that involves TS within the country even if that means that one will have to pay money if going out of the country and it would basically be free within the country.

Thank you Anja for the insights, well maybe I'll have to wait further. Yes they do know I'm transitioning but they don't support it, even my family don't favour that I undergo any surgery even though they ore ok with me living as a woman. Friends, I have none as I said. Well but I'll do this anyway. Changing my job for a while in my workplace is indeed a great idea, I'll contact jessie again to know when I can book this surgery, my leave is in march but I can negotiate it to set it in another date, if I put it closer to a holiday, say.. the holy week, it can be effectively 20 days out of work, plus a medical leave and then returning to work in another job, up until the 2 months required to heal my voice. If for anything it turns to be unfeasible, I definitely set my VSF in the year-end. The trouble with this option is that tickets fares will more than double until there, even if I buy it now, thanks to the upcoming world cup.

What matters afterall is that I have finally decided what I want, and now it's just a matter of time. I was considering seriously to have my voice surgery done in Thailand with Dr Kunachack, he is highly regarded among transwomen here but I heard one patient of him that turned me away definitely. Now we have Dr Kim who I believe is pioneering a true revolution within the VFS field, and I'll go for it.

Good to hear my advice was helpful, I am sure one of the women here that went to Dr Kim can tell you more than me who has just followed all the topics about it but not yet even decided to do anything - So you are working while appearing in your real gender, but they do not support it? Do they allow you to dress as you want and to use a name plate with your new name on it? I guess if they are critical about it, they will possibly make it harder, but I guess still it would really be recommended that you try to get the maximum days possible for recovery. If they can temporarily reassign you to something in the backoffice without the need to talk more than a few words, I guess you can do with the 20 days leave, but make sure to ask Jenny, Abby or Sarah about this. I have not heard of this surgeon in Thailand - what does he do? Also suturing the vocal chords or does he do some of the other methods? Anyways, good that you made your decision - it always feels good to make a decision. And dont worry too much about the ticket prices - if they are more expensive but it is the only way for you to get a proper downtime from the job to allow you to heal, its totally worth it. I kind of really get the impression that in all cases I heard  up to now where the outcome was favourable, it was because enough time was given to heal and proper no-speaking rules were followed. So I think it is crucial, really. The ones that I heard that did not follow this, were smoking or talking too early, they seem to have more issues with the healing in the long run.
Hence also my suggestion to really try to get someone to come with you so you dont get in a situation where you are tempted or required to speak during your stay there. Maybe you can find someone in this forum who goes at the same time and brings a friend and you could team up. It seems there is quite a rush towards Yesons nowadays and people just flock there. I am already a bit worried about him going up significantly in price in the next year or two once this takes hold...

Hi Anja, I wish you the best wishes for determining your best VFS option.  I also have a friend I met in Chonburi that had a remarkably nice voice - she went to Dr. Thomas 9 months before I met her.  So I think rR. Thomas may focus on results & may not expend too much energy on having better/more representative voice samples.  And all the samples were from 2012 & back - I believe he has performed many more surgeries in 2013.
I have my phone consultation with Dr. Thomas at 8am this Wed.  - which is co cost (he charges $550 for a office consultation because he does a lot of testing & analysis.)  I still really like the non-invasiveness of Dr. Kim, especially since I've already had a tracy shave.  i'll report on how it goes.

Hi Amy - great diagram & your discussion is quite illuminating!  Especially the observation regarding the primary importance of pitch. 
Anja - your observation on increasing your pitch to be heard better with improved clarity is right on!  I find myself doing this - I consciously launch at a higher pitch & resonance to communicate more clearly in noisy environment, by giving myself a little more squeeze.  I do like my voice better when I do this, but it is tiring for long periods, so I am judicious in using this.  I try to combine it with closer conversations.  Because of this capability to control both pitch & resonance simultaneously for good results, I am preferring Dr. Kim's down-the-throat surgery.  And I understand the importance of taking someone with me to Korea.

Hi Sabrina, I wish you all the best to be yourself!

Love & hugs - Bobbi

Yes my chief indeed told me once that he doesn't see me as a woman, but to be honest, I couldn't care less. And I do use my chosen name at work because all transgendered public servers here are entitled to it, it's granted by federal law. As for my dress yes it's a standard woman's outfit all women are required to wear on the job. As for Kunachack, he performs VFS in Bangkok (you can read about his technique here http://www.voice-surgery.com/voice.php?subaction=showfull&id=1067359885&archive=&start_from=&ucat=2&), a friend of mine on facebook told me he charges U$10.000, which is about the same as Dr Thomas in Portland I guess and more expensive than Dr Kim. I was thinking exactly the same thing as you, his prices may eventually go sky high as his fame builds up, the same as happened with Dr. Suporn.

Hi Sabrina, go with strength & courage:

       Be Courageous  Be STRONG
           Keep Your Heart OPEN
      There is Pain  There is BEAUTY
Everything You Need is Within You   Always
                    FIGHT ON

Love & hugs - Bobbi

Quote from: Sabrina.R on January 12, 2014, 01:54:59 PM
Yes my chief indeed told me once that he doesn't see me as a woman, but to be honest, I couldn't care less. And I do use my chosen name at work because all transgendered public servers here are entitled to it, it's granted by federal law. As for my dress yes it's a standard woman's outfit all women are required to wear on the job. As for Kunachack, he performs VFS in Bangkok (you can read about his technique here http://www.voice-surgery.com/voice.php?subaction=showfull&id=1067359885&archive=&start_from=&ucat=2&), a friend of mine on facebook told me he charges U$10.000, which is about the same as Dr Thomas in Portland I guess and more expensive than Dr Kim. I was thinking exactly the same thing as you, his prices may eventually go sky high as his fame builds up, the same as happened with Dr. Suporn.

That sounds pretty invasive, it sounds like he severs the vocal cords? I could be wrong though, it's hard to read that medical-speak!

I'm always interested to hear voice samples of these other doctor's work.

Hi Anja,

thanks for your well thought-out reply.

Quote from: anjaq on January 11, 2014, 06:54:02 AM
there was a lot of noise, I was not heard well by others when talking at a table and by increasing pitch I could be heard again.

This is another female voice mannerism: in order to cut through, women use pitch, not volume.

Quote from: anjaq on January 11, 2014, 06:54:02 AM
I will be looking forward to an update post-op - the "male register" should probably move and be cut off at the bottom.

I assume it won't move, but will decrease in size at the bottom: since the new bottom will be at a pitch where female resonance still exists, and given that low notes will tend to be soft, and that female resonance generally is softer than male resonance, the voice will automagically select female resonance at the very bottom, as demonstrated by Sarah's "male imitation" speaking clips. If there's a remainder of male resonance at all, it will be toward the top end of the old male resonance area.

Quote from: anjaq on January 11, 2014, 06:54:02 AM
What I still am very curious about is how the visible shift in that diagram between male and female low register will play out. You can see how with a female resonance, pitch goes up a bit (ok, just the lowest pitch range in the diagram - you did not put in the F0 there). If the pitch increase by Dr Kim is 75 Hz, which F0 and pitch range will it affect? Will both low boundaries go up by 75 Hz? Both F0s? Will it just cut off the lower end of the male resonance field and just a bit on the female resonance bit so that they will be equal at the botton? Will the male and female resonance fields start to overlap or melt together so that it does not matter anymore?

The female resonance lower limit I've displayed is an arbitrary one that I chose. Physically, I can produce female resonance as low as B2, or 123 Hz, which is less than 75 Hz above my lowest note. Here's what I expect: the lower limit will move up by ~75 Hz altogether. Since the lower limit doesn't have full volume, the voice box will opt for female resonance at the very bottom. A bit higher, you should be able to produce both male and female resonance. The upper limit of male resonance should move up a tad (in my case, from 415 Hz to maybe the 500-525 Hz ballpark, which will sound powerful, but not male anymore, since chest voice in that range is impossible with the male voice box). And the uppermost part will be by and large unchanged, maybe with a few notes added on top, and with more clarity and navigability.

Regarding F0s, everybody's natural F0 seems to be their lowest frequency attainable, multiplied by 1.4-1.7. Our female F0 is an arbitrary choice, so it doesn't figure. The natural (male) F0 will shift with the surgery to form the new, female, F0. Choice of resonance is independent of pitch, so we don't have to worry whether this'll be in male or female resonance. If it does end up in male resonance by default, we just need to relax our jaws to get into female res. It's that easy.

Regards,

Amy