Dr. Haben's goals for voice feminization surgery are to produce results that:
effortless voice production .. without 'thinking about it', placing the voice or worring about 'slip-ups' prevents clients from being misgendered PLEASE read through EVERYTHING carefully.
Feminization voice surgery can be performed on both pre and post Gender Confirmation Surgery transgendered clients, cis/ biologic females and gender-neutral individuals.
Surgery to raise the pitch of the voice is relatively straight forward in most patients in experienced hands. Having the final voice perceived as being female instead of just a higher pitched male voice goes well beyond pitch-raising surgery. The first step is understanding the differences between 'pitch' versus 'voice' versus 'speech.' The vocal cords are simply 'sound generators'. Pitch is the rate at which the vocal cords vibrate which determines the frequency of a sound produced. Pitch is essentially ALL that the voicebox (larynx) does. The pitch at which we speak is called the speaking fundamental frequency (SFF) and the array of pitches that our larynx can produce is range. An untrained male voice usually has a little over an octave of range, which are 12 notes on a piano. Voice is what results as we mold that sound. Voice is shaped by the size and shape of our throats, mouth, nose and sinuses, giving it resonance just like the size and shape of a piano gives that sound character. The 'voice' or sound of an upright piano would sound different than that of a concert grand piano even if the same note is being played. It is important to understand that the resonators of your voice, the shape of the throat, mouth, and sinuses, can not be changed in feminization laryngoplasty. Even gender confirmation surgery and/or facial feminization cosmetic surgery can not change these resonators. Assessing these areas pre-operatively are vital to predicting how the voice might sound, and be perceived, afterwards.
Next, voice is shaped into words and sentences. This is speech. A genetic female uses a different part of the brain to produce speech than a genetic male and has a certain sing-song quality called prosody. Prosody can not be changed with hormones or surgery. It must be learned, the way an actor would acquire the skills to take on another's personality of sorts. It requires a speech therapist who is very, very experienced in transgender voice changes. For most, years of practice are required to perfect female prosody and have it sound natural and effortless. Perfecting female prosody is 50% of the final result. This is why a cis-female with a very low speaking voice is still perceived as female even when their speaking fundamental frequency is in the androgynous or high-male (such as many female television reporters).
The average cis-female speaking fundamental frequency (*) is right around 210 hertz or G#3 on a piano (the normal range is within the pink arrows). The average cis-male SFF (*) is around 110 hertz or A2 on a piano, or about 11 notes lower (essentially one octave, including the black keys!).
Pitch can typically be raised 2/3 of an octave or 8 notes (= approximately 60-75 hertz テつア25 hertz) on average and in many cases requiring one or more feminization techniques. Not all clients get meaningful pitch elevation while others can achieve an octave or more. Please see below regarding our metrics of success and guarantees. There are many things that impact the degree of pitch elevation such as age; whether you ever smoked; have had vocal fold polyps or scarring from voice abuse; limited range to begin with; larger body habitus or chronic medical condition such as reflux or diabetes. In general, the lower your voice starts, the lower you will likely end up. A thorough in-person, pre-operative evaluation will help predict the degree the voice could be raised under ideal conditions. If you look at a real piano the higher notes have the shorter, thinner, tighter strings. Vocal folds vibrate in much the same way. Dr. Haben has created and refined several surgical techniques, alone or in combination, to achieve the purpose of shorter, tighter and thinner vocal cords with the goal of a speaking frequency as close to the cis-female range as possible given your anatomy and healing. These include techniques that are endoscopic ('through-the-mouth'), open ('with an incision') and a combination of both. These are different terms for shortening the vocal cords unsing an endoscopic, minimally-invasive, laser-assisted procedure which can be done as a stand-alone surgery or with a Crico-Thyroid Approximation ('CTA'), and/ or thyroid chondroplasty, a 'triple' or 'double' as described below. The terms are descriptive and essentially synonymous in intent: shorten the functional length of the vocal cords thereby raising the pitch. The laser assists in controlling the degree of webbing as well as the amount of anterior commisure retrodisplacement and the final vibratory length of the vocal cords.
CLINIC images before and 6 months after the minimally-invasive feminization alone. Notice the controlled webbing where the yellow arrow is pointing, shortening the functional length of the vocal cords.
PROS of minimally-invasive endoscopic feminization voice surgery alone? Best for those with a speaking fundamental frequency already in the high-male or androgynous range No incision in the neck, less invasive, quicker recovery Pitch could be elevated by as much as 50 hertz or approximately 6 notes on average and in many cases Less time in the O.R., therefore less expensive More dynamic range, important for those who sing CONS of minimally-invasive endoscopic feminization voice surgery alone? NOT recommended for clients 40 years or older without special permission (see FAQs below) Not ideal for those with low or average male speaking fundamental frequency Less pitch elevation compared to open and endoscopic technique combined Procedure shortens vocal cords but can not stretch, tighten or thin them like a rubber band More of the natural lower range is preserved, undesirable to some clients
The following examples represent average results in typical healthy non-smoking clients having undergone the minimally-invasive endoscopic feminization voice surgery alone. These examples aim to provide potential clients with realistic, achievable and reasonable expectations in good candidates. Although these examples are average and typical, not everyone achieves the same results and there are no guarantees to the degree of pitch elevation.
: The patient's speaking fundamental frequency is centered around 165 hz or approximately G3, considered the androgynous range. Post-operatively the voice is centered around 215 hz or approximately A3, high cis-female range, representing a typical and average result of 50 hertz of pitch elevation (see voice analysis below) and a soft natural sound. : Pre-operatively, the speaking voice is centered around C3 in the male range or approximately 120 hz. 3 months after minimally-invasive endoscopic feminization voice surgery the pitch is centered around G3 in the female range or approximately 195 hz which is almost >2/3 of an octave higher, or approximately 7 notes (see voice analysis below), which is slightly greater than average pitch elevation.
Additional Pre and Post 'SINGLE' audio examples:
The vocal cords can be stretched and thinned by making a small incision in a skin crease in your neck and tightening the cartilages that now allow you to go from a regular to a falsetto voice. A 'CTA' mimics contraction of the 'singer's muscles', the cricothyroids. When contracted the cricothyroids raise the pitch the way you could now if you engage your falsetto voice. Through the same incision and at the same setting the Adam's Apple can be shaved, a procedure termed thyroid chondroplasty (aka tracheal shave). If you have had prior facial feminization with a 'tracheal shave', the tracheal shave would need to be re-done (see FAQ) as part of the “triple.” The neck incision is about 2-3 inches long and is hidden as best as possible in a skin crease. Note in the pictures above how the vocal cords become thinner and more taut.
PROS of the CTA added to the endoscopic glottoplasty? Recommended in clients over 40 years, former smokers and テつxA0those with low/ averagefundamental frequency Raises pitch more effectively and consistently higher than the endoscopic procedure alone Stretches and thins the vocal cords in addition to shortening their functional length Better eliminates the lower baritone range CONS of the CTA added to the endoscopic glottoplasty? Speech is somewhat more effortful for the first few months Incision takes 6-12 months to mature, overall longer recovery Takes longer in the O.R., therefore more expensive Not recommended in those where the singing voice is very important as it diminishes the lower dynamic range
The following examples represent average results in typical healthy non-smoking clients having undergone the open (with CTA) and endoscopic feminization with thyroid chondroplasty (aka “triple”). These examples aim to provide potential clients with realistic, achievable and reasonable expectations in good candidates. Although these examples are average and typical, not everyone achieves the same results and there are no guarantees to the degree of pitch elevation.
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Acoustic analysis in a patient with an average cis-male baseline speaking voice. Preoperatively the speaking voice is centered around 115 hertz or about A#2 on a piano. Postoperatively the voice is now centered around 220 hertz, A3 on a piano, representing nearly a full octave of pitch elevation and into the upper cis-female range (see voice analysis below).
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Acoustic analysis in a client with a middle average cis-male baseline speaking voice. Pre-operatively the speaking voice is centered around 135 hertz or about D3 on a piano. Postoperatively the client achieved a greater than average 100 hertz pitch elevation to 235 hertz (see voice analysis below).
Additional Pre and Post 'TRIPLE' audio examples:
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All feminization voice surgeries with or without thyroid chondroplasty are considered elective cosmetic procedures, and, as such, are not covered by any private or government insurance. Unfortunately, we do not participate in Care Credit or have payment plans available.
Each of the procedures come packaged to include the cost of the surgery; pre-operative consultations and all post-operative visits; ALL hospital charges for outpatient surgery including associated anesthesia fees, as well as MediCab transportation to and from the hotel and hospital on the day of surgery; 2-nights Marriott Hotel stay for you and your chaperone as well as all associated taxes. Overnight hospital observation is mandatory for those travelling without a chaperone; airport and clinic transfers; meals; entertainment; special testing or additional rooms are not included. Postoperative medications are not included, however your private insurance may cover these costs.
PLEASE read the sections on REFUNDS, GUARANTEES and REVISIONS carefully.
The package for the SINGLE minimally-invasive feminization voice surgery is $5,500. The hospital requires payment of a $2,500 credit card deposit to secure a confirmed surgery date. The deposit includes a non-refundable $500 assessment (see below regarding refunds). Deposits made by personal checks drawn on a US bank could require a 20 business day holding period before the surgery date can be assigned.
The package for the TRIPLE open and endoscopic voice surgery with thyroid chondroplasty is $7,250. The hospital requires payment of a $3,500 credit card deposit to secure a confirmed surgery date. The deposit includes a non-refundable $500 assessment (see below regarding refunds). Deposits made by personal checks drawn on a US bank could require a 20 business day holding period before the surgery date can be assigned.
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The package for the DOUBLE minimally-invasive feminization voice surgery with thyroid chondroplasty is $7,000. The hospital requires payment of a $3,500 credit card deposit to secure a confirmed surgery date. The deposit includes a non-refundable $500 assessment (see below regarding refunds).Deposits made by personal checks drawn on a US bank could require a 20 business day holding period before the surgery date can be assigned.
The package for the THYROID CHONDROPLASTY withOUT voice feminization surgery is $4,500. The hospital requires payment of a $1,500 credit card deposit to secure a confirmed surgery date. The deposit includes a non-refundable $500 assessment (see below regarding refunds). Deposits made by personal checks drawn on a US bank could require a 20 business day holding period before the surgery date can be assigned.
NOTE: Additional cost for overnight hospital observation for clients without a chaperone is approximately +$650.
What is the policy regarding refunds? Can surgery be rescheduled? Are my results or degree of pitch elevation guaranteed?Am I paying for a surgery or a specific result? https://www.facebook.com/Feminization-Voice-Surgery-1509177442710841Can the surgery be revised if I wish for more pitch elevation? Is there a cost? Why is the “triple” recommended for clients 40 years old and older? Amharic fiction book. What if I do not think I need the “triple”? How many surgeries does the Center perform? Is the surgeon Board Certified? Fellowship trained? Can I book my travel first and then call for a surgery date? Is there pre-operative testing required? I have heard that some surgeons require a CT scan before to prevent damage to the vocal cords. Which / whose technique does Dr. Haben use? Once I come off of voice rest, what will my voice sound like? Will it be feminine? Can I contact any of your prior patients? Can you send me more before/after examples?
For many trans women, Facial Feminization Surgery, or FFS, is medically required surgery that’s just as important as gender reassignment surgery (GRS) for treating gender dysphoria.
Facial Feminization Surgery Cost Canada
Further, studies have shown that the mental health-related quality of life for trans women who have had FFS is significantly higher than for those who have not.
FFS Rhinoplasty
There are subtle yet important differences between the male and female nose. FFS Rhinoplasty is used to feminize a masculine-looking nose and achieve a female facial profile. Rhinoplasty is one of the most popular of the FFS procedures.
Rhinoplasty involves gently raising the tissues of the nose and reshaping them according to more feminine lines. The nose is made to look smaller, with more feminine proportions. The results can make a dramatic difference to a trans woman’s appearance: not only is the nose markedly more feminine in appearance, but FFS Rhinoplasty subtly adds femininity to the face overall, accenting the eyes and cheekbones.
Rhinoplasty is usually done under general anesthesia. Recovery generally takes a few weeks. Results may not final until 6-8 months following surgery.
Cost of FFS RhinoplastyFacial Feminization Surgery Cost Philippines
Feminization Rhinoplasty $3500
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Dr. Alexander’s pricing includes surgeon’s fees, M.D. Anesthesiologist’s fee, and OR fees. Pricing is accurate as of December, 2014. For a custom cost estimate, please contact us.
For a consultation and complete cost estimate, or to ask any questions about FFS Rhinoplasty, please call (954) 589-0722 or send a message using the form at right. Dr. Alexander has more than 30 years of experience and is entirely confidential and non-judgmental towards all of his clients.
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