Hello everyone! I am from Austria, Europe and so South Korea is a little far for me. I talked to Dr. James Thomas and he mentioned that there are actually two surgeons who perform the "Wendler glottoplasty" (that seems to be the scientific term for the surgery method performed at the Yeson Voice Center) - Dr Kim in Seoul and Prof Marc Remacle in Belgium.

I contacted Prof Remacle and he confirmed that he regularly performs the same surgery method as Dr Kim. Surgery in Belgium also seems to be a little cheaper and I wouldn't have to travel that far. Dr Remacle sent me a few voice examples and they sounded equally impressive as those from the Yeson center.

Unfortunately there is not much information on Prof Remacle and his surgery method on the internet. This is what I found so far:

http://www.ncbi.nlm.nih.gov/pubmed/20171832
http://www.yourenthealth.com/marc_remacle
http://users.skynet.be/sb151826/FILES/SURGERY/VFS.html (in French)

Has anybody else here heard about him?

I've never heard of him, but this sounds interesting as I'm currently attempting to save for a trip to Yesons and Belgium is considerably closer to the UK than Seoul!!

Do you have any idea what his prices are like hun?

I got a price quote around EUR 4500, including two nights in a hospital. The hospital needs a deposit of EUR 8000 though in case there are any complications. The unused difference will be reimbursed after surgery.

Hi evenstar,

this is interesting information. Without access to the voice samples, however, it's hard to tell. There are a few surgeons in Berlin (Gross/Nawka), Stuttgart (Miethe) and Würzburg (Hagen) who also perform glottoplasties, however, the quality varies drastically. I've heard a quite impressive Hagen result, two Nawka results of very varying quality and that's about it. And that's not very much to base such a life-altering decision on.

Regards,

Amy

Yeah, it is totally annoying that there are no people from Europe speaking up and presenting voices or having threads in any forum like the ones about Yeson here. I heard two results from Germany with glottoplasty so far and one had considerable hoarseness in it, the ohter one I wrote about in another thread about not screaming. Apparently one marked difference is that at least one surgeon in Europe tries to make this procedure work without permanent sutures, so the thread should dissolve with time as the chords fuse together by the body. So far i have not heard any convincing result from anyone in Europe, but I guess if there would be more examples, it would be interesting. I was originally hoping for snyone really good operating in Germany as this would be possible for me then to get with insurance cover, but so far not.
The price is similar to yesons then, about 5000 EU. But the flight to Korea is more expensive, but then again, it is also more interesting - basically you can do a vacation at the same time. Albeit one without talking
I'd be interested though to hear reports and voice samples from Belgium!

P.S.:
the paper says :

Quotean increase in the grade of dysphonia (Gpre=0.2, Gpost=1, P=0.013)

as I understand it, this is on a scale of 0 for no dysphonia to 3 severe dysphonia. I did not find now how bad a 1.0 is, but I assume it definitely would be noticeable. Sadly, Dr Kim does not seem to have published much to compare this to.

Dear Anja,

Quote from: anjaq on February 28, 2014, 06:54:51 PM
Apparently one marked difference is that at least one surgeon in Europe tries to make this procedure work without permanent sutures, so the thread should dissolve with time as the chords fuse together by the body.

To my knowledge, Dr. Kim is the only person using a permanent suture. Maybe that's why his system works.

Regards,

Amy

Another interesting quote from the papers:

QuoteA revision Wendler procedure was necessary for three individuals (9.7%); two of them presented a suture's line breakdown because they did not follow the postoperative recommendations for voice rest and the third one had an insufficient web due to an insufficient estimation of the necessary correction.


Wendler glottoplasty seems to be an effective technique to feminize the voice in MFTs with better results when performed in younger individuals.

Again - people not following instructions.... bad idea!
Interesting that this works better in younger people. Maybe the voice is more flexible at that age...

Interesting fact there, Amy - I was thinking that it would be a bad thing to have that permanent threads in the larynx - not the best thing to have such things there all the time and I was thinking it shoul dbe better to have them go away after some time - but maybe it is not a good idea after all. Although I think it should not change too much - the quality of the voice should not be decreased by them going away - but I would imagine that the risk of an injury may be higher if they are not there - eg screaming or such - if they can at that time still lend some support, maybe that is good - I dont know...

I just contacted Dr. Remacle and got the whole study as his response. In the next months I could not travel to Korea but Belgium would be possible. He saysall patients who followed his post op instructions are very satisfied.

As addition I will have a consultation with the docs from Charite here in Berlin.

Lara

Hi Lara,

I've been looking at Yeson too, but would prefer Belgium as it's much closer. If you can keep us updated on your progress that would be appreciated!

Alena x

One word of caution: The definition of "very satisfied" is extremely subjective. I talked to some people who were satisfied with VFS and thought that htere would have been definitely room for improvement or rather I would not be satisfied with that. Mainly the result was that there was no more misgendering happening, or only occasionally on the phone, but hoarseness or breathiness was a result - the satisfaction came from being able to live without being misgendered by the voice, but I still think that this would not be the only aim.
I also know some people who are satisfied with their GRS but who lost sensibility or vaginal depth - but as it allows them to live unquestioned in terms of genitalia and got their gender marker changed, they are satisfied as well. Or so they say.

So be careful about peoples claims of satisfaction with some procedure - get yourself a clear picture if YOU would be satisfied with what they got.

Quote from: anjaq on May 18, 2014, 08:49:17 AM
One word of caution: The definition of "very satisfied" is extremely subjective. I talked to some people who were satisfied with VFS and thought that htere would have been definitely room for improvement or rather I would not be satisfied with that. Mainly the result was that there was no more misgendering happening, or only occasionally on the phone, but hoarseness or breathiness was a result - the satisfaction came from being able to live without being misgendered by the voice, but I still think that this would not be the only aim.
I also know some people who are satisfied with their GRS but who lost sensibility or vaginal depth - but as it allows them to live unquestioned in terms of genitalia and got their gender marker changed, they are satisfied as well. Or so they say.

So be careful about peoples claims of satisfaction with some procedure - get yourself a clear picture if YOU would be satisfied with what they got.

+1 to what Anja said. There are all these surgeons doing apparently the same procedure but the details are probably all different. And with VFS the details seem to count. For instance Dr Remacle uses a CO2 laser to cut the vocal folds and Dr Kim uses microscalpels.

I never trust a medical doctor until he proves his trustworthness. His published three studies are very promising. Also the first voice example sounds great. I will research more information.

Lara

what does he use that laser for? instead of the sutures? or to deepithalize the folds so they can grow together after surgery?
are those papers online? do they describe the procedure or also results?

Hi guys,

Interesting thread as I've never heard of anyone in Europe with vaguely as good a rep as Dr. Kim.

Couple of you above mentioned some of Marc Remacle's voice samples? Anyone know where these can be found?

Thanks,

Gigi

Quote from: anjaq on May 19, 2014, 06:46:55 AM
what does he use that laser for? instead of the sutures? or to deepithalize the folds so they can grow together after surgery?
are those papers online? do they describe the procedure or also results?

Apparently he uses the laser to de-epithalize the vocal folds. The paper's here http://www.ncbi.nlm.nih.gov/pubmed/20171832

I also think the difference could be because he uses absorbable sutures rather than permanent. Because the scar matures over at least a year (maybe longer as vocal folds are avascular) and absorbable sutures are gone in maybe 70 days the scar could stretch. I should say all that's purely speculation on my part. 

Some more information I got from Prof Remacle:

- The sutures are slowly resorbable (2-3 weeks), not permanent. According to him, that gives enough time for the formation of the web.
- At the upper voice range his patients also have a mean gain of 100 Hz.
- I asked about singing, and he replied that I should typically be able to sing in a more female range after having this type of surgery but I will have a reduction of the voice range for the lower notes of course.
- It is possible to perform a reduction laryngoplasty in the same session, and he doesn't charge anything extra for that.
- I can return home 3 days after surgery (an ENT in my home town can do the check-ups), but I have to strictly rest my voice for 10 days.
- Prof Remacle stresses that voice training is still important because this procedure doesn't change resonance.

I got the videos from Prof Remacle himself - they are not available anywhere on the internet.

A gain at the upper end is unusual, that sounds pretty neat. sutures that dissolve  - I am not sure I trust that as all the ones in Germany use them and the results are very mixed while Dr Kim does not and the results are good... so I am not sure it is a good idea to have them dissolved that fast
So the results you heard in the vids, are they all good and without hoarseness or breathiness? How much does he charge for this - is it comparable to Dr Kim?

If the scar stretches after the sutures have dissolved, this might result in a more breathy voice, doesnt it?
I sadly cannot access the article in full

This whole thing about using permanent vs self-dissolving sutures makes me feel a little uneasy at the moment... I hope I've made the right decision - my surgery is only 4 weeks away from now! BTW, Prof Remacle uses a fibrin sealant to reinforce the suture as well.

I have no concerns about using a laser instead of a scalpel on the other hand - I know that it is possible to make very precise incisions with a CO2 laser and Prof Remacle is a renowned specialist in this field.

What also makes me more confident is that Dr. Thomas - a surgeon I highly respect - explicitly recommended Prof Remacle together with Dr Kim for this technique. And the patients in the video examples are also showing good results (and no - they do not sound breathy or hoarse).

I'll keep you informed.

Cool to hear that there are good voice examples. It would be of value for this forum if you would do something like some of the others here did - some recordings from before and after ("unmodified" voice, "feminized" voice, reading Rainbow passage and/or just talking) - so that people can maybe know that there are alternatives? What is the pricing of him - is it in the same range as Dr Kim? Does Dr Thomas not do this procedure himself as well? Which patients does Dr Thomas send to have this procedure instead of his own - I was thinking he has his own procedure which is rather unique and that he would recommend this one istead of the glottoplasty?
Sorry for the many questions

I hope things will go well for you in 4 weeks. That is fast by the way - no long waiting period, it seems?

Good luck with it