There are three main surgical techniques: Thyroplasty, Wendler Glottoplasty and Laxer Reduction Glottoplasty.

Thyroplasty – The Isshiki Technique

This procedure involves modifying the cartilage where the vocal cords are located. By adjusting and tightening the cartilage, the voice becomes higher in pitch and more feminine in frequency. The advantage is that it doesn’t involve directly touching the vocal cords.

The Adam’s apple can also be removed (chondroplasty) during this procedure. However, a small incision in the neck is required, and the success rate is about 40%, which may necessitate additional techniques.

The surgery can be performed under general or local anaesthesia. Afterwards, the pitch is restricted, which can affect singing abilities. The voice is immediately usable but may deepen slightly over time as tension decreases.

Wendler Glottoplasty

This technique directly targets the vocal cords. The front portion of the vocal cords is stitched together, and the front cartilage is tightened, leaving the back part of the vocal cords to vibrate freely. Shortening and tightening the vocal cords results in a higher pitch. The advantage is that no external incision is needed, and it can significantly raise vocal frequency.

However, it may result in a tight, childlike tone or cause voice disorders (dysphonia) and has a variable success rate. The voice cannot be tested during surgery since the procedure is performed under general anaesthesia. Post-operative complications like granulomas or tremors may arise. Singing abilities can be impaired, and the time it takes for the voice to recover and be fully functional can vary.

Koçak Laser Reduction Glottoplasty

In this surgical technique, the thickened layers of the vocal cords caused by testosterone are removed using a laser, and the vibrating part of the vocal cords is reshaped to a more feminine form. This results in a natural feminisation of the voice, with minimal risk of dysphonia as the vibrating area is preserved. Although this technique is more technically challenging than others, it boasts a high success rate. The advantage is that there is no external incision, and it eliminates the masculine tone of the voice.

It can be applied to all age groups, even individuals who have developed thickened vocal cord layers after puberty. The voice quality is excellent, and singing abilities remain largely unaffected. A temporary granuloma may rarely develop during healing, and the voice recovery period can vary between 3 weeks and three months. This procedure is performed under general anaesthesia only.

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