Will My Voice Change After Vocal Cord Surgery

I Would Like To:

Voice Masculinization

Dr. Haben aims to create a voice for you that:

sounds natural
more than commanding
avoids being misgendered

PLEASE read through EVERYTHING carefully.

PITCH LOWERING masculinization vocalization surgery can be performed on both pre or post GCS transgendered clients; cic-gendered males and gender-neutral individuals seeking lower pitched voices. It is intended for those who have tried and failed or cannot have testosterone therapy for whatever reason.

The DEGREE of pitch reduction is finite and largely determined by the size, shape and mass of someone's larynx.

Range of Male person and Female voices

The average cis-gendered female speaking key frequency is right around middle "C" on a pianoforte (the normal range is inside the pink arrows). The boilerplate cis-gendered male SFF is in a range nigh an octave lower than female, within the blueish arrows in the motion-picture show. An octave is 12 notes on the piano (including the blackness keys!). Generally, pitch can be lowered up to ii/iii of an octave, or 6±ii notes, on boilerplate and in many cases for those with speaking fundamental frequency that begins in the cis-gendered female range. Notation: results tin never exist guaranteed in anyone. The goal is to finish upwards with a SFF in or near the normal cis-gendered male range. There are many things that aid predict the degree of expected pitch reduction, such every bit age (older clients take less anticipated healing), whether yous ever smoked; have (or had) vocal fold polyps or scarring from voice abuse; and where your natural SFF lies. A thorough pre-operative, in-person evaluation volition help predict the degree the vocalization could be lowered nether ideal conditions. Please review the FAQs below.

Surgery

If you look at the strings of a real piano, the lower notes have strings that are thicker, longer and less tension (think of relaxing a rubber ring). Human vocal cords vibrate in much the aforementioned style. The goal of masculinization vox surgery is to make the vocal cords act thicker, longer and less tension to vibrate at a slower frequency which equates to a lower pitch. To achieve this, voice masculinization surgery requires both an endoscopic ("through the mouth") and transcervical ("incision in a cervix crease") component and takes nearly ii-2.5 hours in the operating room under full general anesthesia. Endoscopic-merely surgery is not effective.

Questionnaire

Please fill out the medical and voice questionnaire Email at the top of the folio AFTER having read through all of the important data here. Please specify if you are or e'er were a smoker, accept a chronic medical status such equally diabetes, take blood thinners, or always had surgery on your song cords (for any reason).

Examples

The post-obit examples represent Boilerplate results that a TYPICAL customer undergoing vocalization masculinization could accomplish. These examples aim to provide potential clients with realistic, doable and reasonable expectations in nearly cases. In each example the client is outset reading the "rainbow passage" (pre-operative) and and so re-reading the same passage at least 3 months post-operative. 90% of the final surgical result depends on how one heals and the caste to which postal service-operative instructions are followed. Equally such, final results can never be guaranteed.

Cost

PLEASE Note:

The post-obit information is valid Just for masculinization procedures COMPLETED before 31 Dec 2021. Costs are anticipated to increase in 2022.
All masculinization vocalism surgeries with or without thyroid chondroplasty (Adam's Apple tree reconstruction) are considered elective cosmetic procedures, and, as such, are not covered past whatever individual or government insurance. Unfortunately, we do not participate in Care Credit or take payment plans available.
Each of the procedures come packaged to include the price of the surgery; pre-operative consultations and all post-operative visits; ALL hospital charges for outpatient surgery including associated anesthesia fees. Post-operative medications are not included; however, private insurance frequently covers this pocket-sized expense. Infirmary discounted rates for hotel lodging at the Marriott are bachelor to clients upon request (please contact the part for boosted information). Travel, lodging, aerodrome/ infirmary/ clinic transfers; meals; amusement; special testing, mail service-operative medications and overnight in-patient hospital observation (if necessary) are non included in the packet. Overnight hospital observation is mandatory for those travelling without a chaperone.

PLEASE read the sections on REFUNDS, GUARANTEES and REVISIONS advisedly.

The electric current package for the open and endoscopic masculinization vox surgery withOUT thyroid chondroplasty (Adam'south Apple reconstruction) is currently $viii,345. Prices are expected to increase for surgery dates after 31 December 2021. The hospital requires payment of a $three,000 credit carte du jour deposit to secure a confirmed surgery appointment. The deposit includes a non-refundable $500 cancelation fee (see below regarding refunds). Deposits made past personal checks drawn on a US banking concern could crave a xx business day holding period before the surgery date can be assigned.
NOTE: Boosted cost for overnight hospital observation for clients without a chaperone is currently approximately +$1,052.
The current packet for the open and endoscopic masculinization voice surgery WITH thyroid chondroplasty (Adam'southward Apple reconstruction) is currently $8,845. Prices are expected to increase for surgery dates after 31 Dec 2021. The hospital requires payment of a $3,500 credit card eolith to secure a confirmed surgery date. The deposit includes a non-refundable $500 cancelation (see beneath regarding refunds). Deposits made past personal checks drawn on a The states bank could require a 20 business twenty-four hour period holding period before the surgery date can be assigned.
NOTE: Additional toll for overnight hospital observation for clients without a chaperone is currently approximately +$1,052.

COVID-19

What are the current COVID-19 protocols? Am I required to be vaccinated?
A; Currently, all clients are required by the State of NY Department of Wellness to arrive on the Sunday earlier their procedure to undergo a COVID-19 nasaopharyngeal test. IF this exam is POSITIVE your case volition be rescheduled for at to the lowest degree iii months. Yous can NOT be re-tested "in a few days." These are State of NY guidelines and can NOT be overruled for whatever reason, fifty-fifty if you are vaccinated. Additionally, the State of NY does Not take results from labs or hospitals outside of NY State. We STRONGLY recommend all clients to be fully vaccinated at to the lowest degree four weeks prior to their arrival, notwithstanding, vaccination is not a pre-requisite for surgery. If you are fully vaccinated, we strongly suggest arriving with proof of vaccination. These guidelines are irresolute regularly. Delight contact our part or the NY State Section of Wellness for the almost upwards-to-engagement data.

Refunds

What is the policy regarding refunds? Can surgery exist rescheduled?

A: We understand emergencies occur and are happy to reschedule your surgery at no additional cost. If you decide to cancel your surgery altogether you will be assessed a not-refundable $500 fee to cover the Heart's expenses in setting up your surgery, even if an in-person consultation has not notwithstanding been done. Refunds accept 10 business organisation days to process.

What if my case is cancelled/postponed for a medical reason?

A: It is very important that you disclose whatever medical condition well earlier surgery. Should you develop a severe cough, cold, flu, illness or breathing problem the week before surgery you must call the office at once. Your surgery will probable be rescheduled. Rarely, patients are non cleared for surgery due to an undisclosed medical condition after they have travelled to New York and are awaiting their surgery. Your surgery volition be postponed until the medical status has been evaluated/ corrected and rescheduled for the first available date. At that place may be some additional infirmary costs if unexpected testing is required. No reimbursement is possible for the travel expenses incurred.

What if I miss my pre-operative consultation the 24-hour interval before surgery?

A: The pre-op consultation on the day or two before surgery is mandatory even if you lot take had a prior in-person consultation. If y'all miss this appointment your surgery will be rescheduled even if it was missed due to travel delays / bad weather or circumstances across your control. Nosotros recommend anyone travelling during the winter months, having a connecting flying, or coming internationally arrive a 24-hour interval early.

Guarantees

Are my results or degree of pitch reduction guaranteed? Am I paying for a surgery or a specific upshot?

A: You are paying for a surgical procedure which has inherent risks, including that of non-healing, surgical failure and suboptimal results. The degree of pitch reduction is finite and largely determined by the size, shape, historic period, condition and mass of your larynx. Additionally, nearly of the final surgical outcome is determined by factors out of the surgeon's control, including how well clients heal, as well as how carefully post-operative instructions are followed. As such, at that place tin can be no consequence guarantees, unsaid or expressed except that Dr. Haben will use all his expertise and experience for every client.

What is your metric of success? Is pre or post-operative speech therapy necessary?

A: The best metric for surgical success is Not how much the pitch is lowered, but rather how often one is misgendered over the telephone to an unknown, blinded listener. Remember, spoken language therapy is a vital component of the final effect. Working with a trans-qualified speech therapist pre-operatively and resuming no sooner than three months post-operatively is important. The best place to look for a trans-qualified speech therapist is through recommendations from others in the customs.

Revisions

Tin can the surgery be revised if I wish for more pitch reduction? Is there a price?

A: It is unusual for vocalization masculinization surgery to require revision at our Eye. Unfortunately, the pitch is usually lowered to the greatest amount allowed by one's anatomy and pregnant farther pitch reduction is non physically possible, unless previously done elsewhere. Rarely, this is non the instance and revision surgery could exist considered. As with procedures paid for by private or government insurance, revision surgery will incur a charge, although Dr. Haben will petition for the greatest amount of cost reduction permissible.

FAQ

What if I would similar to come in just for a consultation?

A: Consultations are one hour and include phonation analysis, physical examination, a telescopic of the voicebox and a lengthy give-and-take regarding expectations. The charge of $500 will exist applied towards the cost of the surgery parcel.

Can't I just ship y'all a vocalisation recording?

A: The Heart gets dozens of requests daily for vox analysis. It is impractical also as unfair to those who have taken the time and expense to travel for an in-person consultation to do complimentary vocalization analysis for everyone. Additionally, voice analysis is just a pocket-size part of determining whether a customer is a adept candidate for vox surgery and cannot replace an in-person consultation.

Where is the incision?

A: The incision is made in a pare crease in the centre of the neck. The incision is hidden equally best as possible in a skin crease and closed using plastic surgery technique. Prior incisions cannot usually be used.

Tin y'all create or augment the Adam's Apple?

A: Yep, although the masculinization procedure is intended to be functional not cosmetic, a surgical implant to increment the projection of the Adam's Apple tree may be washed if desired.

Can I get a letter of the alphabet of support for proper name/gender alter legal petitions?

A: Absolutely, once you are at least 3 months mail-operative vocalism masculinization.

General

How many surgeries does the Center perform? Is the surgeon Board Certified? Fellowship trained?

A: The Center is dedicated to laryngeal (voicebox) surgery. Dr. Haben has performed hundreds of pitch amending surgeries and thousands of phonation surgeries. The different techniques involved in masculinization voice surgery have been adult by Dr. Haben and keep to be perfected at the Center over the last ten+ years. Dr. Haben is Board Certified in Otolaryngology and Fellowship trained in laryngology and voice surgery, as well as earning a Master's Degree for his research in vox and laryngology. Dr. Haben routinely lectures and publishes research on voice surgery and related topics.

Why is a chaperone needed after the surgery? What if I do not have one?

A: It is mandatory hospital, State and Federal guidelines that any patient undergoing general anesthesia MUST have a responsible developed with them for 24 hours afterward surgery. An acceptable chaperone must be eighteen years or older and known to the client for at to the lowest degree one year. It is UNACCEPTABLE to "meet" a chaperone while in Rochester, "bunk" with some other customer having surgery the aforementioned day, or "hire" someone to stay with you. If yous are not accompanied by an acceptable chaperone, you will be required to spend the nighttime in the hospital. In that location is currently an boosted cost of $1,052.

Do you take Care Credit? How much is required to ostend a surgery date? What payments are accepted? What happens if I need to change the surgery date at the concluding infinitesimal? How far in accelerate do you volume?

A: The practice does not accept Care Credit. Credit cards are the preferred method of payment. Surgery may just be booked and confirmed one time the listed deposit is made. Personal checks are accepted ONLY from US clients with checks drawn from a Usa bank and surgery dates are not confirmed until the bank check clears, typically 10-twenty business organisation days depending on the origin of the check. Changes are permitted without penalisation, equally long every bit the policy is non repetitively driveling. Near non-top surgery dates volume ii-three months in advance.

Do you have Medicare or private insurance for masculinization? Do I go whatever forms that tin be submitted to my insurance? Or to my auditor for taxes? Is there a procedure (CPT) code for the surgery?

A: Masculinization voice surgery is an elective cosmetic process. Nosotros neither accept Regime nor private insurance for the procedure. We are non permitted to submit whatever forms to regime or private insurance. A receipt of payment is provided; nevertheless, we are non responsible for insurance reimbursement, revenue enhancement rebates or credits. Receipts tin Not be altered, modified or amended nether whatever circumstance to meet whatever requested criteria. The procedure (CPT) code used for "open and endoscopic masculinization laryngoplasty with or without thyroid chondroplasty" is 31599.

All your surgery dates are on Wednesdays. Practise you operate any other twenty-four hours?

A; No. All surgeries occur on a Wednesday and the Heart cannot conform special requests.

How will we communicate?

A: It is vitally important that nosotros have an accurate electronic mail, telephone number and current mailing address. ALL confirmations and instructions occur via e-mail and it volition exist your responsibility to check your e-mail often as your surgery date approaches.

Travel

Tin can I volume my travel outset and so telephone call for a surgery date?

A: No. Surgery dates are non confirmed until the deposit is paid. We cannot "hold" a date without payment and strongly suggest against booking travel until you receive confirmation of your surgery date past email.

I am coming internationally. Does this change annihilation?

A: International clients, except those from Ontario and Quebec, Canada, are required to stay an additional 7 days postal service-operatively before being cleared to return dwelling. Clients from Alaska and Hawaii are considered "international" in this case due to the distance of air travel. Boosted hotel days may be arranged through the hospital at a discounted rate.

When should I arrive?

A: See to a higher place regarding current COVID-19.

Any other advice for foreign travelers?

A: We recommend informing your credit card company of your travels and having a back-up just in case. Recollect, yous will be on voice residue post-operatively and can Non accept a "give-and-take" with your credit bill of fare company or bank if your bill of fare is declined for any reason.

Medical Questions

Is there pre-operative testing required? I take heard that some surgeons crave a CT scan earlier to prevent damage to the vocal cords.

A: In general no, unless you take a chronic medical status, such every bit diabetes, or a history of eye issues, etcetera. Sometimes medical clearance from your Primary Care Md is required. If you take a question or concern please contact our office before you brand whatever arrangements. The infirmary will make a pre-operative telephone call to yous the week before the surgery and make any necessary testing or clearance recommendations. You MUST conform to be available for the anesthesia call or your surgery could be CANCELLED. A CT browse is not required. A surgeon that requires a routine CT browse in every patient to better understand the anatomy of the voicebox well enough to avoid damaging the vocal cords probably should non exist doing this sort of surgery. This is not true for facial feminization, where CT scans are mostly recommended.

Should I run into my primary intendance physician first? What if I accept a chronic medical condition?

A: In nearly cases information technology is not necessary, however, if you lot have a chronic medical status such as asthma or heart problems; have not seen a dr. in many years; are concerned most your ability to undergo general anesthesia or are over age lx a visit to your PCP is brash.

Practise yous perform the surgery on someone nether 18? Older than 60?

A: Clients under 18 must have parental permission, be accompanied by a parent or legal guardian and have a letter of the alphabet of support from a qualified psychologist or psychiatrist. There is no "maximum age" even so, the expectations for achieving a truly masculine sounding voice decreases with age due to reduced plasticity, hardening of the cartilages, stiffening of the vocal cords, and less optimal healing compared to younger individuals. Results, and correspondingly expectations, should be more modest in older individuals. This does not hateful that very good results cannot be achieved, just that they are harder to accomplish due to factors that are out of our command. Reasonable expectations volition vary from client to client and can only be accurately adamant at the fourth dimension of consultation and test with voice analysis.

I am/was a smoker. Does this matter?

A: Overall, old smokers heal worse than nonsmokers. Current or recent smokers fare much worse than former smokers. Of course, the amount and duration of smoking matters a lot. I do not exam for recent or current smoking, relying on patients to tell the truth. Failure to disclose prior/ recent/ current smoking status inevitably results in suboptimal outcomes, frustration and disappointment. Current and/ or post-operative smoking (or extensive second-hand smoke exposure) will accept a significantly negative bear upon on success. One-time smoking does not automatically prevent successful surgery.

I take not even so had gender confirmation surgery (GCS). How did this bear upon my vocalisation? Is it meliorate to accept GCS first?

A: Following masculinization voice surgery clients are not permitted to accept whatsoever elective surgery under general anesthesia ('with a breathing tube") for six months. Some clients will heal fast enough to reduce this restriction to 3 months; however, they are required to present to the clinic in-person at 3 months for an exam and clearance. If the vocal cords have non fully healed, clearance is non granted. This possibility must be taken into consideration when timing this and other associated surgeries. Pre versus mail service GCS does not otherwise impact the success of masculinization voice surgery.

Functioning and Technique

Tin can you re-use a prior scar? Do yous use a "plastic surgery" type closure?

A: In general, a prior incision cannot be re-used because they are under the mentum and too far away. Incisions are as small as reasonably possible without compromising the surgery; are hidden to the greatest extent possible in a skin crease; and are closed using plastic surgery technique.

I am a vocalizer. How does this touch on things?

A: Pitch-lowering masculinization voice surgery does non give anyone a singing voice that did not exist earlier. Nor does it requite additional baritone or bass range. The surgery is intended to lower SFF pitch and not positively impact singing range or capabilities.

How much can you lot lower the pitch?

A: The average is 8±4 notes on a piano, or two/three of an octave or roughly eighty hertz in many clients DEPENDING on where is the natural pre-operative SFF. Non every client will attain the average pitch reduction and results can never be guaranteed.

I hear there is a take chances for a chipped or broken tooth or teeth?

A: The endoscopic portion of the procedure is "trans-oral" (= through-the-oral fissure). Every precaution is taken with the teeth, withal clients with smaller mouths, larger tongues, sleep apnea, limited cervix extension, baseline poor dentition or extensive dental work are at an increased risk. Overall, at that place is roughly a ii-3% risk for intra-operative dental trauma. If you have had extensive dental work, have bad dentition or are concerned most the risk of dental trauma, y'all may contact your local dentist to create a SOFT, UPPER custom molar guard. In ALL patients, a standard toothguard is used during surgery.

How long is the surgery? How long am I in the hospital?

A: 2-ii.five hours in the operating room. Clients arrive 1-1.5 hours before the surgery and get out ii-3 hours afterwards. Program on 6 hours start to terminate.

I have changed my mind and want my old voice back, can the procedure be reversed?

A: No. Just so that I am clear: no.

Post-operative

Once I come off of voice rest, what will my voice sound like? Will it exist masculine?

A; Once yous come up off of post-operative voice residual your voice volition audio much, MUCH worse before it gets better. Expect to be quite hoarse and crude sounding. This is due to 'surgical laryngitis' from the procedure and can final from a few weeks to months depending on how you heal. Do not worry, this is normal and expected. The surgical laryngitis usually resolves past 12 weeks notwithstanding the concluding consequence could take half-dozen months when all healing has finished.

Do some clients get longer voice residuum? Is there a benefit for longer voice rest? I employ my voice a lot for my work. When can I resume my normal vocalization usage without harming my voice?

A: All clients are placed on mandatory phonation residuum for 30 days. Additional vocalism rest is not required. Once you lot complete the voice residue, you may utilize your phonation to an average, reasonable amount. Do not yell for 6 months. Do not whisper for 6 months. Speak unremarkably just look a raspy hoarse vocalisation for the kickoff iii months.

Is there much post-operative pain?

A: No. Most people state that the hurting is tolerable and really controlled well-enough with ibuprofen + Tylenol at the aforementioned time. Having a niggling more than or a little less pain is not a sign of "something incorrect" unless the hurting is increasing solar day after day which could indicate an infection. All patients are placed on post operative antibiotics and steroids.

Can I use anti-scar cream or patches? What about the run up removal?

A: The neck incision is as small equally possible, hidden in a skin crease and airtight with plastic surgery technique. All but one suture is absorbable. The ane (bluish) stitch on the outside is removed on the seventh post-operative twenty-four hours either by myself (whenever possible) or by a medical person in your community. If your local medical professional has any questions regarding removal of the run up, they are encouraged to telephone call the part. Clients may non remove their ain suture. One time the suture is removed, you may start to shower. Pat, do not rub, the incision dry out subsequently showering for the first month. If going out doors, apply a >30 SPF sunscreen, or cover the incision with a scarf. Anti-scar creams/ patches, Vitamin E oils, etcetera, may exist used later on the start month. Scars typically have 12 months to mature and heal. 12 months. Be patient.

Any other advice for the incision/scar?

A: Aye! Later on the sew together is removed, accept a towel and wet it with water as hot as you lot can comfortably stand. Hold information technology over the incision similar a compress for xx minutes, 3-4 times a day until 1 month. This helps information technology heal.

It is somewhat effortful to produce vox for the first few months even though it sounds great. Why?

A: Your larynx has been tuned to a much lower frequency. As such, you will now have to learn to "play" a cello, when y'all were used to playing a violin. The effortful feeling goes away afterwards about 12 months.

How many times am I seen mail service-operatively? Tin can I get voice analysis of the concluding production?

A: All clients are seen the day afterwards surgery and cleared for travel. International clients are seen on the first and 7th mail service-operative days before being cleared for travel. All clients are recommended to render at 3 months for an examination and vox analysis. All post-operative care is included in the package, even if you have questions or concerns YEARS down the road. For those who cannot get in back at 3 months, I recommend recording the "Rainbow Passage" (found on the internet) on a smartphone and e-mailing it for analysis. You will receive a reply comparison pre and post-operative vocal parameters, a copy of both pre and post recordings every bit well as the voice analysis in 4-6 weeks.

When can I have other elective surgery without harming my pharynx? When are things permanent?

A: >6 months. 3 months is minimum however you would need to exist seen and examined in person before clearance could be granted. In cases where it has non healed, and clearance is not granted, you need to be prepared to delay the constituent surgery. In cases of emergency surgery, yous will go along and we will bargain with whatsoever happens afterwards if necessary. Always tell your anesthesiologist that y'all have had voice masculinization surgery and that they should utilise a "smaller" breathing tube and give steroids. If they have questions, they may always phone call the office to speak with Dr. Haben for specific recommendations.

Testimonials

Can I contact any of your prior patients? Can you send me more before/later examples?

A: The Center does not use clients for advertising, nor provide client contact information, even with their permission. Many clients, however, are active on several transgender websites and blogs. Frequently, if you post a request to contact someone who has had a procedure at the Center, yous volition find a former customer willing to speak with you. We take patient confidentiality and HIPPA very seriously.

Source: https://www.professionalvoice.org/masculinization.aspx

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