Feminization laryngoplasty

This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. Find sources: "Feminization laryngoplasty" – news · newspapers · books · scholar · JSTOR (July 2022) (Learn how and when to remove this message)

Feminization laryngoplasty
Before and after images of a feminization laryngoplasty patient
Pronunciation	/ˌlærɪŋˈɡɒplæsti/
Other names	FemLar
Specialty	Laryngology
MeSH	D058753
[edit on Wikidata]

Feminization laryngoplasty (also known as FL or FemLar/Femlar) is a reconstructive surgery surgical procedure that results in the increase of the pitch of a patient, making the voice sound higher and more feminine. It is a form of Open Laryngoplasty and effectively reaches its goals via a Partial Laryngectomy of the anterior portion of the larynx, thereby diminishing the size of the larynx to cisgender female proportions. It also changes the vocal weight or resonance quality of the voice by diminishing the size of the larynx. It is a type of voice feminization surgery (VFS) and an alternative to vocal therapy. Feminization laryngoplasty is performed as a treatment for both transgender women and non-binary people as part of their gender transition, and women with androphobia. The surgery can be categorized into two main steps: Incision and vocal fold modification followed by thyrohyoid elevation. Risks and complications include granuloma, dysphonia and tracheostomy. Patients are recommended to follow perioperative management such as voice rest to hasten recovery.

Typically, the surgical procedure could shift the lower limit of the patients' vocal range upward, with little to no effect on the higher end of the vocal range, and reduce the patient's vocal weight and resonance by reducing the size of the larynx. Studies have shown a very high long-term satisfaction rate with the pitch change from this surgery, and the measured pitch change outcome is known to be typically greater than Wendler Glottoplasty, a current, separate procedure that also attempts to increase pitch by shortening the vibrating length of the vocal cords via an alternative, and less destructive, endoscopic approach. A recent study notes that the measured changes average 6 semitones for the patients' comfortable speaking pitch (20-80hz).^[1] However, there have been a few outlying cases where the pitch change was too high/effective for the patient, with a maximum reported increase of 320hz in one particular case, albeit it may be possible to mitigate this by carefully choosing how much vocal cord to remove in the operating room for an individual patient.^[2]

Other than pitch change, the operation could also diminish the masculine neck profile caused by "Adam's apple" after the removal of anterior cartilage, thus achieving a more feminine neck appearance.^[3] This effect is more pronounced than the reduction that can be typically achieved with a tracheal shave as it explicitly goes further than a tracheal shave and removes tissue that should be avoided by the surgeon during a tracheal shave in order to feminize the voice. Thus, if a patient opts for this procedure, they will typically not need a tracheal shave.

The procedure is less popular and well-known than other forms of voice feminization surgery at the moment and is currently performed by a limited set of surgeons. This includes, but is not limited to several surgeons in the US,^[4] Thailand,^[5][6] and Australia.^[7] There are also other doctors using this term to describe their suite of voice and larynx feminization procedures that do not actually perform this particular procedure, but rather other procedures such as glottoplasty, cricothryoid approximation, and tracheal shaves.^[8]