No idea which is the "best." And I've never heard of anyone having a successful experience with the procedure. Pretty much every medical professional I've encountered advocates against surgery except in extreme cases. And I personally would expect you to at the very least see a speech therapist before considering it. However, as someone who has not had to do serious voice work, I don't think it's reasonable for me to judge women who prefer to accept the risks of surgery.
Here is relatively up-to-date info on the currently available procedures (there are five):
1. Anterior commissure advancement involves removing a section
of thyroid cartilage and then using splints to wedge the section of
cartilage forward by several millimeters. This pulls the vocal folds
tighter (increases the tension). The surgeons who have used this on
MTFs recommend that it only be used if cricothyroid approximation
is not successful, as they feel it is a difficult surgery to perform.
2. Creation of an anterior vocal web is done by scraping the front
section of the vocal folds. The scar tissue that forms creates a web of
tissue between the folds fusing them together. This shortens the
folds. There is an estimated 33% risk of permanent hoarseness with
this technique. There are also concerns that if, in future, the patient
had a breathing emergency and needed a breathing tube, the
narrowed opening of the windpipe might make it difficult to get the
tube in.
3. Cricothyroid approximation (CTA) mimics the contraction of the
cricothyroid muscle that is used naturally in speech to tense the vocal
folds. The thyroid cartilage is pushed down against the cricoid
cartilage below it, and clamped in place at the front by stitches or
metal plates. Pulling the cartilage down stretches the vocal folds.
In theory, CTA is reversible – but in some cases scar tissue has
permanently fused the cartilages together. Where this fusion has not
happened, the stitches/plates can loosen over time, causing the
cartilage to move back to its original position and the pitch to drop.
Because the vocal folds aren't directly surgically changed by this
technique, it may be possible to do further surgery if the CTA is not
sufficient.
This is the most commonly done type of pitch-elevating surgery.
4. Induction of scarring has been used to raise pitch in non-trans
women who have low voices.
A deep cut is made along the fold with the intention of causing a scar
that irreversibly stiffens the folds which increases the rate of
vibration. Voice quality may be damaged.
5. Reduction of the vocal fold mass may be accomplished by one of
three methods:
a) Steroids injected into the folds cause the folds to atrophy.
b) Carbon dioxide laser can be used to evaporate part of the vocal
fold. Laser Assisted Voice Adjustment (LAVA) is the most
commonly used laser technique in MTFs. The procedure is
irreversible.
c) Thyroid cartilage and vocal fold reduction (also called
"feminization laryngoplasty") involves multiple changes to the
vocal tract. As shown in the picture on the next page, a strip at the
front of the thyroid cartilage is removed. Parts of the vocal folds
are then removed (making them shorter and decreasing their
mass). A loop of stitching through the ends of the cartilage and the
vocal folds pulls the folds tighter and stretches them. The larynx
may also be raised in the neck to shorten the resonance chamber.
The surgeons who perform this technique warn that voice quality
will likely be negatively affected.
from
http://vch.eduhealth.ca/PDFs/GA/GA.100.C362.pdfIf you'd like to have a look at some studies on surgical results:
http://transhealth.vch.ca/resources/library/tcpdocs/guidelines-speech.pdfThere are a number listed in the reference section.
Best wishes,
Sarah