Voice Feminization Surgery (VFS)

Sounds really feminine!

Each person is unique, so is the person’s gender identity. Our goal is to help transgender women to develop voice and communication that reflects their gender. The voice feminization package in the MEDICAL VOICE CENTER consists not only of the voice feminization surgery (Glottoplasty, Vocal Fold Webbing) but of a whole package of treatments.
Anyone who feels that she belong to the female sex would like to be perceived and, for example, be addressed accordingly on the phone. Everytime! If our voice does not match our identity, it often leads to frustration, silence or social isolation. Voice feminization is an important step in the whole transition process.
The MEDICAL VOICE CENTER is a renowned center that specializes in voice feminization surgery. The concept combined most advanced surgical techniques with voice training and speech therapy. We take a lot of time for every single patient, listen carefully and do not give up until we understand all your worries and sensitivities.

Example of a voice before and after voice feminization surgery by Prof. Markus M. Hess.

A very experienced surgeon

Prof. Markus M. Hess, MD, specializes in voice feminization surgery to alter the voice and enhance it’s feminine qualities for clients in Hamburg, Germany. Prof. Hess routinely performs vocal feminization operations, a total of approx. 30-50 glottoplastics or other surgical methods (see infobox) per year. He gives lectures worldwide and is a leader in the research of surgical methods and therapy-accompanying measures.

Surgeries for voice feminization focus on raising the pitch and reducing the ability to produce a low-pitched voice. The goal is a voice that has all qualities of a female voice. To get this it is necessary to train the new voice after the surgerty by a professional voice-therapist.
The MEDICAL VOICE CENTER designed a special voice feminization therapy for women who want to develop their authentic female voice and match their gender identity. This trans*voice-therapy is part of our feminization package.

The first two surgical methods listed on the right  are performed in microlaryngoscopy. The CTA and FemLar require an intervention on the outer neck. (Note: The reduction of the Adam’s apple, the so-called chondroplasty or trachel shave, does not lead to a change of voice. The most common surgical techniques for voice feminization are described here  (in German language)
Prof. Markus M. Hess explaining voice feminization surgery (Glottoplasty) and the post-operative behavior.
Frequently used surgery thechniques
  • Vocal Fold Webbing (according to Wendler, Gross, Kim, Anderson and vielen anderen
  • Laser Reduction Glottoplasty (according to Orloff)
  • Cricothyroidale Approximation (CTA according to Isshiki et.al.)
  • Feminization Laryngoplasty (FemLar according to Thomas)

Preparing your voice feminization surgery

The voice change operation starts with a detailed interdisciplinary initial discussion together with the surgeon Prof. Dr. med. Markus M. Hess as well as the speech therapist (voice and speech trainer). This interview will also analyze the potential need for preoperative vocal therapy. Our treatment package ‚voice-feminization’ comprises interdisciplinary history taking with a physician (ENT doctor) trained in voice disorders / phonosurgery and a logopedist specially trained in clinical voice disorders / vocal coaching. Diagnostics include videostroboscopy, endoscopy, electroglottography, electroacoustic voice analyses, perceptual voice assessment, voicerange profile, Acoustic Voice Quality Index, Transsexual Voice Questionnaire and further tests. Subsequently a detailed briefing and discussion are offered. In case of surgery, a consent form is handed out explaining in detail all options for the following feminization laryngoplasty procedure.
Prof. Markus Hess provides you with information about treatment options and alternatives (conservative and surgical) and explains you all possible surgical procedures.

The voice feminization surgery

The voice feminization surgery (glottoplasty) is based on three kexstones:
1. Shortening of the vocal cords.
2. Change the vibration dynamics of the vocal cords.
3. Reduction of the vibratory mass of the vocal cords.

Outpatient glottoplasty is painless and under general anesthesia. The only a few millimeters short vocal cords are permanently connected with two hair-thin, firm threads.
This surgery creates a web or scar band at the front of the V of the vocal cords. This shortens the vocal cords to help raise voice pitch. Anterior glottal web formation affects frequency range by eliminating the ability to produce lower pitches.

An additional injection of the vocal folds with a temporary implant reduces the tensile forces on the sutures during the postoperative period. Depending on the vocal fold volume, ablation is performed using the LAVA method. In addition, if necessary, the vocal folds are temporarily sedated with BTX.

Setting the sutures in a voice-feminization-surgery (glottoplasty)
Nähte bei der (Glottoplastik)

Voice feminization surgery and aftercare

Surgery is carried out ambulatory by Prof. Hess. The surgery will take place in the Operations Center (AOZ) about 200 meters further away. There we work together with very experienced and highly qualified medical staff. After the surgery in general anesthesia, the postoperative monitoring follows in the recovery room. About 2 hours later, we conduct the follow-up examination in the MEDICAL VOICE CENTER with postoperative video laryngoscopy and detailed after-care consultation and discussion of the following steps. As a general requirement in Germany, all patients receiving general anesthesia need an accompanying person for a 24 hour period.
The next day you come to the re-phoniatric check-up and the further concrete scheduling. We discuss the follow-up examinations in the following months (according to individual agreement).
Your therapeutic care includes pre- and / or postoperative speech training or speech therapy according to your personal needs. We offer you up to 10 sessions, individually planable also in double lessons, in blocks and / or in connection with the medical follow-up. Postoperatively, after the „release“ of the voice by Prof. Hess, the first voice training takes place after 2-3 weeks.   Therapy via Skype is always possible.

Medical follow-up

We individually discuss the follow-up examinations in the following months. Normally, we ask our patients after 2 and 6 weeks and after 6 and 12 months for laryngeal examinations, acoustic analysis and for new voice recording.

You therapeutical care includes pre-and / or postoperative speech training or speech therapy according to personal needs. We offer you up to 10 sessions, individually planable also in double lessons, in blocks and / or in connection with the medical follow-up. Postoperatively, according to our rehabilitation scheme, it will soon be possible to whisper ‚loose‘ again. After the „release“ of the voice by Prof. Hess is started after 3-5 weeks with first vocal exercises.

Targets of Trans*Voice Therapie

  • Prosody is the melody of speech and includes loudness, pitch and stress changes. Men tend to use stress or loudness for emphasis, while women often use greater pitch variability.

  • Vocal resonance. This term often refers to the perception of vibrations when using one’s voice. The location of vocal resonance isn’t fully dependent on your gender. You can have a throaty resonance, where vibrations are focused in the throat or chest, or a forward resonance, where vibrations are experienced around the lips and nose. A speech-language pathologist can help you find a healthy resonance that reflects who you are. This takes practice, exploration and experimentation with your voice.

Therapy will also address:

  • Voice quality

  • Articulation

  • Speech rate and phrasing

  • Nonverbal communication, such as eye contact, use of hand gestures, facial expression, posture and head nodding

The voice feminization package contains:

• Pre-operative vocal exercises • Post-operative vocal rehabilitation • Sociocultural feminization • Surgery, glottoplasty and medical follow-up • Speech therapy (articulation, speech melody and speech) • Resilience training of the new voice • Reinforcement of female pitch and resonance • Coaching and conversations to authentic female. Communication patterns. Your therapeutic care includes pre-and / or post-operative speech training or speech therapy according to personal needs. We offer you up to 10 sessions, individually planable in double lessons, in blocks and / or in connection with the medical follow-up. Postoperatively, according to our rehabilitation scheme, it will soon be possible to whisper ‚loose‘ again.

Our flat rate offer includes a whole spectrum of medical and nonmedical services, where multidisciplinary pre- and postoperative voice care and consultation are obligatory and are always accepted with great appreciation.

3-5 weeks after the „release“ of the voice by Prof. Hess, we start with first vocal exercises.

Modern, cosmopolitan and highly professional

The MEDICAL VOICE CENTER is located in Hamburg and is easy to reach by plane and train. Hamburg is a vibrant city known for its international and safe atmosphere.
In the MEDICAL VOICE CENTER diagnostics and therapy area are physically separated from the state-of-the-art Operation Room. When you first enter the MEDICAL VOICE CENTER, the bright, modern feel-good atmosphere and the interior design with its design elements convey a welcoming and cheerful ambience that does not remind you of a clinic. Here, the preliminary talks, examinations, aftercare and the voice therapies are carried out. The Ambulatory Operation Center (AOZ), about 200 meters away, is equipped with state-of-the-art equipment.

FAQ – Frequently Asked Questions

A frequently asked question is one concerning examples and statistics on pre- and post operative voice, fundamental frequencies and videos. In Germany, these kind of pre- versus postoperative comparisons are not allowed due to our competition protection laws. However, we will be happy to give you an individual recommendation when we analyze your perceptual, electroacoustic and videostroboscopic (endoscopic) recordings which always will be measured before any intervention.
If you have further questions, please let us know (send to contact@mevoc.de). We will publish the answer here.