Several surgical techniques may be used to raise the pitch of the voice in transgender women (see Voice Feminization). These procedures aim to increase vocal fold tension, shorten vocal fold length, or reduce vocal fold thickness.
- Cricothyroid Approximation (CTA):
The most common surgical procedure for pitch elevation in transgender women.
It is performed under local anesthesia through a small incision in the neck, allowing the surgeon to listen to the patient’s voice during surgery and adjust the pitch. The cartilages of the larynx are brought closer together and sutured in place, which increases vocal fold tension.
- Wendler Glottoplasty (Vocal Fold Shortening):
Performed through the mouth under general anesthesia with microscopic magnification. Sutures are placed in the vocal folds to shorten their effective length.
- Laser Reduction Glottoplasty (Vocal Fold Thinning):
Also performed through the mouth under general anesthesia. A laser is used to thin the layers of the vocal folds, finely “tuning” the voice.
- Feminization Laryngoplasty:
A more extensive surgery performed through the neck. Not only the vocal folds but also a portion of the thyroid cartilage (the cartilage that forms the Adam’s apple) is removed. This shortens and tightens the vocal folds simultaneously.
While this procedure often produces a more feminine voice, recovery is slower and more challenging compared to other surgical techniques.