Voice Surgery: A Follow-Up Report 

Author:                Sarah S.

This article is reproduced on Feminet by permission of JSS. Please
note that  the surgical fees have since risen to $6000. or more   

The following was published in PASSAGES, the newsletter of "The
Gathering",  the support organization for transsexual individuals
in the New York area,  May, 1987. It is reproduced on JSS with
permission granted by the editor.  Permission is also granted to
any other individual or organization to  distribute this text,
provided that this message is left intact.  

For more information on "The Gathering," please write to P.O.
Box 21052,  Columbus Circle Station, New York, NY 10023.  

Voice Surgery: A Follow-Up Report  By  Sarah S.   

(Editor's Note; The following is a report on a new surgical procedure 
which is being performed on the vocal cords by two California
physicians in  order to help M-F TSs achieve a pleasant and natural
feminine voice. Sarah S.  recently underwent the surgery and offers
the following report, which has been  slightly edited.)  

Both physicians specialize in surgery of the head and neck. Their
most  celebrated work is in the fields of hair flap transplants/
hairline advancement  and design and VOCAL CORD MODULATION. Dr.
Mayer specializes in the latter, a  technique developed by physicians
in Japan.  

To my knowledge, no one else is performing this specific technique,
although Dr. Paul of Sacremento has done a few voice modulations
using the  unpopular and complication-ridden technique of shortening
the vocal cords by  severing them. (Barbara's note: this is apparently
a reference Dr. Paul  Donald, FRAS, at the Univ. Cal. at Davis
Medical Center. I have personally  corresponded with Dr. Donald,
and his technique does NOT sever vocal cords,  nor have serious
complications resulted. Dr. Donald's method differs from Dr.  Meyer's
in that the vocal cords are made to fuse at one end by means of 
removal of a layer of tissue and temporary binding with absorbable
sutures.  The work is done under a general anesthetic. A high percentage
of patients  have been very pleased with the outcome, with the
best improvement going to  those who began with the deepest pitch
range. Dr. Donald's technique is  detailed in an article in the
journal "Head and Neck Surgery." Based on what I  know at this
time, Dr. Donald's technique is at least equivalent to Dr.  Meyer's,
and apparently at a considerably lower cost.)  

In Dr. Mayer's approach, the vocal cords are not cut nor the
voice box  tampered with. He fashions the cartilage that exists
behind the cords into an  elongated "shoestring" tissue. Then,
as one ties a shoelace or wraps the  frayed ends of a piece of
rope, he binds the cartilage to the upper and lower  extremities
of the vocal cords. This raises the voice pitch, since the  vibrating
portion of the cords has been shortened.  

The entire procedure is performed under LOCAL anesthesia. The
patient  determines the desired pitch as she counts backwards from
100 while the doctor  tightens or loosens the binding until the
preferred pitch has been attained.  

I opted to have my thyroid cartilage (Adam's Apple) reduced at
the same  time. This dual procedure (voice modulation and thyroid
cartilage shaving)  lasted 1-1/2 hours and cost $2,200. As of this
writing, the fee has risen to  $2500. I cannot quote the two procedures
individually or how the fee is  divided between them.  

I have gradually become more positive about the success of the
voice  pitch that has been surgically obtained. Due to the swelling
and healing of  tissues, a hoarseness will persist anywhere from
two weeks to six months  postoperatively. This depends on the individual
and how much and how often  the voice is used. By all means, one
should be virtually silent for the first  two weeks after the operation
to accelerate the disappearance of hoarseness.  (Editor's note:
C'mon! NO woman can remain virtually silent for two hours,  let
alone two weeks!)  

As well as being able to choose your desired pitch, another advantage
of  this surgery is that it prevents slipping back into a masculine
vocal range.  The deep registers have been eliminated. Likewise,
the unnatural falsetto  voice used before the operation will also
be eliminated.  

To be sure, the surgery provides one with a natural-sounding
female  voice. I would recommend this procedure and would advise
prospective patients  to listen to some of the tapes Dr. Mayer
has, to guage the before and after  results of others.  

The surgeons are Drs. Richard W. Fleming and Toby G. Mayer. Their 
address is Suite 216, 9730 Wilshire Boulevard, Beverly Hills,
CA 90212. Their  telephone number is 213-278-8823.   

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