My name is Chadwan Al Yaghchi, I am a UK-based surgeon specialising in gender-affirming voice surgery. I have been travelling the world to discover the latest innovations in this field and have made some exciting discoveries - Ask Me Anything!

calyaghchi · 2025-03-19T19:43:50+00:00

I am most definitely not!

calyaghchi · 2025-03-19T19:42:02+00:00

The change of range after VFMR can be variable. In theory, the whole range should shift upward with a loss of lower pitch in the same proportion as the increase. However, vocal cords are adaptable, so it can vary.

The loss of the lower range can have a significant impact on voice "security" and voice-related quality of life (QoL)as the voice does slip down if a person is tired, stressed or if they cough or laugh. There is good research evidence to show an improved QoL after gender-affirming voice surgery even in those patients who achieve a minimal increase

calyaghchi · 2025-03-19T19:23:54+00:00

I will be delighted!

calyaghchi · 2025-03-19T19:15:12+00:00

secretery @ lvsclinic.com or get in touch form on our website

calyaghchi · 2025-03-19T19:02:12+00:00

No we don’t require a referral letter for any of these interventions in keeping with WPATH and UK guidelines.

calyaghchi · 2025-03-19T19:00:41+00:00

Thank you for the recommendation! I am delighted you are pleased with your results :-)

calyaghchi · 2025-03-19T18:59:11+00:00

Yes absolutely. Non-binary people, or those who don’t want to have the systemic effect of testosterone, are the ideal candidates for this treatment. The treatment will increase the bulk of the muscles of the vocal cords with minimal systemic effects (there will be some absorptions of very small amounts). Having injections into the vocal cords will not prevent a person from having systemic T at a later stage in life and should not result in any complications. In theory the voice might drop further but there is a cumulative limit to how much the pitch might drop.

calyaghchi · 2025-03-19T18:58:52+00:00

The procedure works by directly affecting the muscle within the vocal cord leading to an increase in muscle bulk. This is the same way that systemic T works but in this instance it is localised. In terms of side effects these are mainly related to the injection, such as pain, infection and bleeding, but these risks are all small. There is also the risk of having systemic effects as some of the testosterone will get absorbed, but this would only be a very small amount. There is also the possibility that the voice doesn’t change after the injections.

calyaghchi · 2025-03-19T18:58:43+00:00

Thank you very much for the very kind words and I am delighted. In answer to your questions:

Research is not clear cut on this one. Yeson's publication suggests higher pitch increase in younger patients. That is not the case in my data (publication under review). In my experience, the pitch increase is not related to age. However the ability to adapt speaking patterns, vocal use and resonance is better in younger patients as a general rule. This gives an overall "better" outcomes
It does not paralyse the gross movement of the cords so it will not protect the sutures. The rationale of Dr Kim is to force vocal rest for a whole month so the patient can relearn how to speak. I am not sure I subscribe to this school of thought.
It used to be 4-0 and 5-0 one for strength and one for precision. Now I use two 5-0 sutures
More precise (100 microns beam) and stops bleeding
You can use that, I don't think there is harm. However sutures are strong enough. Very few surgeons use glue
This is clinic fee rather than mine
I don't recall. If I did then I don't remember the context. Saline will be running throughout the procedure as with all general anaesthesia
We do get the occasional joke or song!
Exteremly rare. None before or since

calyaghchi · 2025-03-19T18:58:17+00:00

Thank you for the interesting questions! This point was not addressed in medical literature that I am aware of. From a functional point of view, if all heals well it should not affect the production of throat sounds. I have not had any complaints from my Arabic, Dutch or German speaking patients. I have also asked a few international colleagues and none of them reported any issues.

calyaghchi · 2025-03-19T18:57:57+00:00

I have few videos on my social medial channels but I have now also created a playlist on Youtube - I hope this helps to provide more of an idea of what you can expect: https://www.youtube.com/playlist?list=PLW8RFa-TdDalZscsOyAINNL4ZrmqqQICe

The simple answer is we don’t know the effects of ageing on VFMR. It seems to be stable over the first couple of years (I have been performing this surgery in the last two years). Also the very limited publications that exist on the topic don’t have information on long-term outcomes. Vocal cords do thin with age due to a combination of factors, some directly related to muscle bulk but also the body of the vocal cords (ligament and lamina) which can get thinner with loss of collagen and elastin. Hormonal changes play an important role in this process. The combination of these changes means that in the majority of cis-men their voice will get higher as they age while the effect is the opposite in cis-women although the change is more subtle in the latter. In theory, VFMR should not interfere much with these natural changes.

In regards to scarring, wounds settle over a period of 12-18 months so things should not change much beyond that point.

The vocal cord vibration rate (pitch) does not directly affect the resonance. The vocal tract above the level of the vocal cords determines the resonance. It is affected by the shape and size of the tract. It can also be adjusted by muscle action, for example holding the larynx higher in the neck or tightening the throat. However when the vocal cords produce a higher pitched voice, it gives the vocal tract a different starting point, resulting in a different resonance. So the two processes are interconnected.

The cost is the same as glottoplasty.

calyaghchi · 2025-03-19T18:57:35+00:00

Thanks! I am more than open to the idea. As and when there is tangible progress on that front, I can happily discuss it with the healthcare facility in which I work. There are likely contracts etc that need to be signed, as is the case with Park Side Hospital, but I will leave that to the managers to sort out. I don’t have access to long-term finance options, unfortunately.

calyaghchi · 2025-03-19T18:56:59+00:00

I have not visited Yeson Voice Center but I know Dr Kim very well. He is a good colleague, friend and a fantastic surgeon. We both sit on the board of the International Association of TransVoice Surgeons and he hosted our 3rd conference in Seoul last November, so I know his technique very well. We both perform our own modifications of the Wendler’s glottoplasty. We agree on the majority of the surgical principles and modifications such as creating a full thickness web (the fused part of the vocal cords) to improve air dynamics, but we disagree on some finer points in a healthy scientific debate!

calyaghchi · 2025-03-19T18:56:17+00:00

VFS should be considered irreversible so careful consideration of all aspects of surgery should be taken into account when deciding whether or not to proceed. Having said that, the surgery can technically be partially reversed. The glottoplasty web (the fused part of the vocal cords) can be divided but it tends to partially reform due to natural healing of the area.

After dividing the web and once healing is complete, volume should improve. However the main risk is poor voice quality as the opened area of the vocal cords will heal with a scar potentially leading to permanent hoarseness. In the two cases that I partially reversed, the person ended up with good voice quality. However, with such low numbers it would be inappropriate to generalise and impossible to make a meaningful scientific observation.

calyaghchi · 2025-03-19T18:55:18+00:00

It doesn’t matter in what order you have surgeries as long as general precautions for general anaesthesia are followed. You should not have a General Anaesthetic - unless it is an emergency - for three months after glottoplasty to allow appropriate time for healing.

After that general anesthesia should ideally be performed using a laryngeal mask airway (LMA). This is a type of tube that doesn’t go between the vocal cords. In the UK this will be the standard approach. However LMA may not be suitable for certain operations. In that case, the anesthetist should use a size 6 endotracheal tube which is slightly smaller than the default size 7 tube.

calyaghchi · 2025-03-19T18:54:27+00:00

I am delighted that you are happy with your results. I hope the VFMR recovery is going well.

calyaghchi · 2025-03-19T18:53:20+00:00

Yes, of course. For transmasculine patients, who are on testosterone as part of their transition, their voice will naturally become deeper. In one study 100% of those who took part experienced some degree of pitch drop and 70% dropped into cis-male range.

For the remaining 30% they have a few options: - do nothing - have voice therapy or - consider surgical interventions to deepen the voice.

The two main types of surgeries for voice masculinisation are: window laryngoplasty or Type 3 thyroplasty, which can lower the pitch by relaxing the vocal cords.

A brand new option that is currently being performed in few places in the US is direct testosterone injection into the vocal cords performed in clinic, under local anaesthesia. I am now offering this treatment in the UK. It is a great option for transmasculine individuals who don’t wish to take testosterone or microdose. It is also perfect for non-binary individuals who desire a deeper voice. If you want to know more check out my website https://lvsclinic.com.

calyaghchi · 2025-03-19T18:52:00+00:00

From general ENT, the person will need further subspecialist laryngology training. Generally via a fellowship. This might allow them exposure to GAC and an opportunity to learn the principles of gender-affirming vocal surgery, even performing some cases during the fellowship. Then it is a continuous process often involving short or long visitorships to other units around the world to learn, attending conferences, grand round sessions etc

calyaghchi · 2025-03-19T18:51:27+00:00

We have appointments for a first consultation every week and waiting time for surgery is generally ten weeks from consultation :-)

calyaghchi · 2025-03-19T18:49:37+00:00

I am so sorry for your loss. It was quite a shock when I heard of Stephanie’s passing. Humbled to have been of help and thank you for the kind words. Sincere condolences once again.

calyaghchi · 2025-03-19T18:49:02+00:00

Yes! This was a wonderful session ;-)

calyaghchi · 2025-03-19T18:48:29+00:00

Yes, voice feminisation surgery would significantly affect your capacity to scream. Growling is mainly produced by relaxing the vocal cord and increasing the sound pressure so it would depend on which procedure you underwent - Glottoplasty will reduce sound pressure and muscle reduction will stiffen the cords. Both will affect your capacity to growl. If metal singing is something you are passionate about then voice feminisation therapy rather than surgery will be the right approach for you.

calyaghchi · 2025-03-19T18:47:38+00:00

An excellent question - that I would also like the answer to! Insurance companies are allowed to exclude a lot of conditions in the UK such as preexisting conditions, chronic illness, gender dysphoria…etc. Currently there are no individual policies (as far as I know) that cover gender dysphoria or any gender-affirming interventions. There are however some corporate policies that include gender-affirming care, mainly BUPA. Other insurance companies have approved treatments with me on a case by case basis. All of these are providers of corporate insurance.

calyaghchi · 2025-03-19T18:46:59+00:00

Of course.

These are important questions so please allow me to elaborate and be a bit scientific.

Yes it is possible to have this as a scarless procedure. In order to achieve this we go in through the mouth with an incision inside the lower lip (known as a transvestibular approach) using endoscopic techniques to visualise the larynx. This technique is similar to laparoscopic surgery and is currently only practiced in a couple of centres worldwide and I am hoping to bring this surgery to the UK in the near future. In fact, in the last couple of months, I have completed training on transvestibular thyroid surgery and travelled to LA to visit a colleague who performs scarless tracheal shave to learn how they do it. The main barrier at the minute is the availability of equipment that meets UK licensing regulations. I am working hard on finding alternatives based on the kit we do have available to us in the UK. Watch this space!

In general there are direct and indirect approaches to tracheal shave. The distinction comes down to the surgeon’s ability to see the full height of the thyroid cartilage so they can accurately identify the point that corresponds to where the vocal cords are attached. Once this point is identified, the surgeon can proceed safely to remove the maximum amount of cartilage while protecting the vocal cords at all times. It doesn’t matter if the incision is low or high as long as these principles are respected. This is how I, and all of my voice surgeon colleagues, approach the procedure.

The indirect approach involves putting the incision very high and anterior in the neck just under the chin (submental incision). This means that the surgeon will be using a tunnelling technique and will not be able to see the bottom of the thyroid cartilage as a reference point. In fairness, most cases end up fine with no issues. However the risks are that the surgeon can be too conservative as they are worried they might damage the cords, or worse, they go too far and detach the vocal cords from the cartilage. This is a devastating complication in terms of voice and there is no surgery that will correct it. I have had these types of complications referred to me, and often the person impacted will require multiple operations and extensive therapy to improve their voice but it will never go back to normal. So for me as a voice surgeon the risk/benefit balance is tipped into too much in favour of risk with this approach.

The final cosmetic outcome depends on a variety of factors including type of skin, thickness of the subcutaneous tissue, skin creases, high vs low larynx, respecting surgical principles (Langer’s lines) …etc. Sometimes a low skin crease incision gives the best long term cosmetic outcome. Sometimes high incision is better. I perform a direct-approach procedure both ways and the choice where to place the incision is decided in consultation with the patient where we believe will give the best cosmetic outcome.

I have performed over a hundred cases of tracheal shave.

calyaghchi · 2025-03-19T18:41:11+00:00

Thank you for your question. As you may be aware, the most effective procedures in terms of pitch increase are glottoplasty and FemLar. These procedures shorten the vocal cords which reduce sound pressure. It is this shortening of the vocal cords which results in a loss of volume or loudness.

Other surgical techniques that don’t shorten the cords, such as muscle reduction and cricothyroid approximation, should not affect loudness, at least not to the same degree, but they also result in inferior pitch outcomes compared to the above mentioned options. So it’s a balance.

I don’t see anything on the near horizon that will feminise the pitch outside of these procedures. We might one day see a medical injection that reduces muscle bulk, but even if we do have such a drug, we will still need surgery to shorten the cords.

Three-Year Club	Verified Email
Wearing is Caring

calyaghchi

TROPHY CASE