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Voice Pitch Shaping and Genderization: New Needs of Cosmetic Phonoplastic Surgery

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Abstract

Voices can convey content, emotion, and essential information about an individual’s gender and social information. Closely related to gender identification and sexual attraction, voices also positively affect many psychological factors of individuals. Surgeries have evolved from treating congenital diseases to fulfilling an individual’s aesthetic needs for voice. Voice shaping is emerging as the next cosmetic surgery hotspot after skincare and appearance and body shaping. This paper summarizes the development of voice pitch shaping and genderization procedures out of the cosmetic need.

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References

  1. Apicella CL, Feinberg DR (2009) Voice pitch alters mate-choice-relevant perception in hunter-gatherers. Proc Biol Sci 276(1659):1077–1082

    PubMed  Google Scholar 

  2. Cartei V, Garnham A, Oakhill J, Banerjee R, Roberts L, Reby D (2019) Children can control the expression of masculinity and femininity through the voice. R Soc Open Sci 6(7):190656

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kamachi M, Hill H, Lander K, Vatikiotis-Bateson E (2003) “Putting the face to the voice”: matching identity across modality. Curr Biol 13(19):1709–1714

    Article  CAS  PubMed  Google Scholar 

  4. Blank H, Anwander A, von Kriegstein K (2011) Direct structural connections between voice- and face-recognition areas. J Neurosci 31(36):12906–12915

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Anderson JA (2014) Pitch elevation in trangendered patients: anterior glottic web formation assisted by temporary injection augmentation. J Voice 28(6):816–821

    Article  PubMed  Google Scholar 

  6. Davies M (2014) Would you have surgery to change your VOICE? Rise in Chinese people undergoing radical procedures to sound deeper or more high-pitched. Daily Mail.com. http://dailym.ai/1p1j8xi

  7. ABC News (2004) The latest in plastic surgery: the 'Voice-Lift'. ABC News.com. https://abcnews.go.com/GMA/DrJohnson/story?id=127887

  8. Rha KH (n.d.) Plastic surgery to change not only appearance but voice. Medical Tourism Magazine. https://www.magazine.medicaltourism.com/article/plastic-surgery-to-change-not-only-appearance-but-voice.

  9. Zhang Z (2016) Mechanics of human voice production and control. J Acoust Soc Am 140(4):2614

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gray SD, Titze IR, Alipour F, Hammond TH (2000) Biomechanical and histologic observations of vocal fold fibrous proteins. Ann Otol Rhinol Laryngol 109(1):77–85

    Article  CAS  PubMed  Google Scholar 

  11. Kim HT (2020) Vocal feminization for transgender women: current strategies and patient perspectives. Int J Gen Med 13:43–52

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hiramatsu H, Tokashiki R, Nakamura H et al (2012) Analysis of high-pitched phonation using three-dimensional computed tomography. J Voice 26(5):548–554

    Article  PubMed  Google Scholar 

  13. Hong YT, Hong KH, Jun JP, Hwang PH (2015) The effects of dynamic laryngeal movements on pitch control. Am J Otolaryngol 36(5):660–665

    Article  PubMed  Google Scholar 

  14. Roers F, Murbe D, Sundberg J (2009) Predicted singers’ vocal fold lengths and voice classification-a study of x-ray morphological measures. J Voice 23(4):408–413

    Article  PubMed  Google Scholar 

  15. Okui A, Konomi U, Kanazawa T et al (2020) Therapeutic efficacy of basic fibroblast growth factor in patients with vocal fold atrophy. Laryngoscope 130(12):2847–2852

    Article  CAS  PubMed  Google Scholar 

  16. Hodges-Simeon CR, Grail GPO, Albert G et al (2021) Testosterone therapy masculinizes speech and gender presentation in transgender men. Sci Rep 11(1):3494

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Hillenbrand JM, Clark MJ (2009) The role of f(0) and formant frequencies in distinguishing the voices of men and women. Atten Percept Psychophys 71(5):1150–1166

    Article  PubMed  Google Scholar 

  18. Re DE, O’Connor JJ, Bennett PJ, Feinberg DR (2012) Preferences for very low and very high voice pitch in humans. PLoS ONE 7(3):e32719

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Puts DA, Jones BC, DeBruine LM (2012) Sexual selection on human faces and voices. J Sex Res 49(2–3):227–243

    Article  PubMed  Google Scholar 

  20. Gray ML, Courey MS (2019) Transgender voice and communication. Otolaryngol Clin North Am 52(4):713–722

    Article  PubMed  Google Scholar 

  21. Brown KM, Dahl KL, Cler GJ, Stepp CE (2021) Listener age and gender diversity: effects on voice-based perception of gender. J Voice 35(5):739–745

    Article  PubMed  Google Scholar 

  22. Watt SO, Tskhay KO, Rule NO (2018) Masculine voices predict well-being in female-to-male transgender individuals. Arch Sex Behav 47(4):963–972

    Article  PubMed  Google Scholar 

  23. Leongomez JD, Pisanski K, Reby D et al (1840) Voice modulation: from origin and mechanism to social impact. Philos Trans R Soc Lond B Biol Sci 2021(376):20200386

    Google Scholar 

  24. Nolan IT, Morrison SD, Arowojolu O et al (2019) The role of voice therapy and phonosurgery in transgender vocal feminization. J Craniofac Surg 30(5):1368–1375

    Article  PubMed  Google Scholar 

  25. Kitajima K, Tanabe M, Isshiki N (1979) Cricothyroid distance and vocal pitch. Experimental surgical study to elevate the vocal pitch. Ann Otol Rhinol Laryngol 88(1):52–55

    Article  CAS  PubMed  Google Scholar 

  26. Bernal GL, Morales LJ, Hernandez VJ, Beltran O (2016) Modified type IV thyroplasty (cricothyroid approximation) in a patient with androphonia. Acta Otorrinolaringol Esp 67(3):179–181

    Article  PubMed  Google Scholar 

  27. Gibbins N, Bray D, Harries ML (2011) Long-term quantitative results of an Isshiki type 4 thyroplasty-a case study. J Voice 25(3):283–287

    Article  PubMed  Google Scholar 

  28. Koufman JA, Isaacson G (1991) Laryngoplastic phonosurgery. Otolaryngol Clin North Am 24(5):1151–1177

    Article  CAS  PubMed  Google Scholar 

  29. Yang CY, Palmer AD, Murray KD, Meltzer TR, Cohen JI (2002) Cricothyroid approximation to elevate vocal pitch in male-to-female transsexuals: results of surgery. Ann Otol Rhinol Laryngol 111(6):477–485

    Article  PubMed  Google Scholar 

  30. Neumann K, Welzel C (2004) The importance of the voice in male-to-female transsexualism. J Voice 18(1):153–167

    Article  PubMed  Google Scholar 

  31. Tucker HM (1985) Anterior commissure laryngoplasty for adjustment of vocal fold tension. Ann Otol Rhinol Laryngol 94(6 Pt 1):547–549

    Article  CAS  PubMed  Google Scholar 

  32. Wagner I, Fugain C, Monneron-Girard L, Cordier B, Chabolle F (2003) Pitch-raising surgery in fourteen male-to-female transsexuals. Laryngoscope 113(7):1157–1165

    Article  PubMed  Google Scholar 

  33. Song TE, Jiang N (2017) Transgender phonosurgery: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 156(5):803–808

    Article  PubMed  Google Scholar 

  34. Mastronikolis NS, Remacle M, Biagini M, Kiagiadaki D, Lawson G (2013) Wendler glottoplasty: an effective pitch raising surgery in male-to-female transsexuals. J Voice 27(4):516–522

    Article  PubMed  Google Scholar 

  35. Remacle M, Matar N, Morsomme D, Veduyckt I, Lawson G (2011) Glottoplasty for male-to-female transsexualism: voice results. J Voice 25(1):120–123

    Article  PubMed  Google Scholar 

  36. Kim HT (2017) A new conceptual approach for voice feminization: 12 Years of experience. Laryngoscope 127(5):1102–1108

    Article  PubMed  Google Scholar 

  37. Orloff LA, Mann AP, Damrose JF, Goldman SN (2006) Laser-assisted voice adjustment (LAVA) in transsexuals. Laryngoscope 116(4):655–660

    Article  PubMed  Google Scholar 

  38. Kocak I, Akpinar ME, Cakir ZA, Dogan M, Bengisu S, Celikoyar MM (2010) Laser reduction glottoplasty for managing androphonia after failed cricothyroid approximation surgery. J Voice 24(6):758–764

    Article  PubMed  Google Scholar 

  39. Isshiki N, Taira T, Tanabe M (1983) Surgical alteration of the vocal pitch. J Otolaryngol 12(5):335–340

    CAS  PubMed  Google Scholar 

  40. Geneid A, Rihkanen H, Kinnari TJ (2015) Long-term outcome of endoscopic shortening and stiffening of the vocal folds to raise the pitch. Eur Arch Otorhinolaryngol 272(12):3751–3756

    Article  PubMed  Google Scholar 

  41. Cartei V, Bond R, Reby D (2014) What makes a voice masculine: physiological and acoustical correlates of women’s ratings of men’s vocal masculinity. Horm Behav 66(4):569–576

    Article  PubMed  Google Scholar 

  42. Tsuji DH, Sennes LU, Imamura R, Trezza PM, Hanayama EM (2002) Cirurgia para diminuir a freqüência fundamental da voz - tireoplastia tipo III de Isshiki. Rev Brasileira de Otorrinolaringologia 68(1):133–138

    Article  Google Scholar 

  43. Cler GJ, McKenna VS, Dahl KL, Stepp CE (2020) Longitudinal case study of transgender voice changes under testosterone hormone therapy. J Voice 34(5):748–762

    Article  PubMed  Google Scholar 

  44. Buckley DP, Dahl KL, Cler GJ, Stepp CE (2020) Transmasculine voice modification: a case study. J Voice 34(6):903–910

    Article  PubMed  Google Scholar 

  45. Dahl KL, Francois FA, Buckley DP, Stepp CE (2022) Voice and speech changes in transmasculine individuals following circumlaryngeal massage and laryngeal reposturing. Am J Speech Lang Pathol 31(3):1368–1382

    Article  PubMed  PubMed Central  Google Scholar 

  46. Aaron Ziegler TH, Wiedrick J, Helou LB (2018) Effectiveness of testosterone therapy for masculinizing voice in transgender patients: a meta-analytic review. Int J Transgenderism 19(1):25–45

    Article  Google Scholar 

  47. Allen JE, Belafsky PC (2009) Botulinum toxin in the treatment of vocal fold nodules. Curr Opin Otolaryngol Head Neck Surg 17(6):427–430

    Article  PubMed  Google Scholar 

  48. Biello A, Volner K, Song SA (2022) Laryngeal botulinum toxin injection. StatPearls, Treasure Island (FL)

    Google Scholar 

  49. Whurr R, Lorch M, Fontana H, Brookes G, Lees A, Marsden CD (1993) The use of botulinum toxin in the treatment of adductor spasmodic dysphonia. J Neurol Neurosurg Psychiatry 56(5):526–530

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Estes C, Sadoughi B, Coleman R, Sarva H, Mauer E, Sulica L (2018) A prospective crossover trial of botulinum toxin chemodenervation versus injection augmentation for essential voice tremor. Laryngoscope 128(2):437–446

    Article  CAS  PubMed  Google Scholar 

  51. deSilva B, Crenshaw D, Matrka L, Forrest LA (2019) Vocal fold botulinum toxin injection for refractory paradoxical vocal fold motion disorder. Laryngoscope 129(4):808–811

    Article  CAS  PubMed  Google Scholar 

  52. Cannito MP, Kahane JC, Chorna L (2008) Vocal aging and adductor spasmodic dysphonia: response to botulinum toxin injection. Clin Interv Aging 3(1):131–151

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Isshiki N, Tanabe M, Ishizaka K, Broad D (1977) Clinical significance of asymmetrical vocal cord tension. Ann Otol Rhinol Laryngol 86(1 Pt 1):58–66

    Article  CAS  PubMed  Google Scholar 

  54. Bultynck C, Cosyns M, T’Sjoen G, Van Borsel J, Bonte K (2021) Thyroplasty Type III to lower the vocal pitch in trans men. Otolaryngol Head Neck Surg 164(1):157–159

    Article  PubMed  Google Scholar 

  55. Hoffman MR, Devine EE, Remacle M, Ford CN, Wadium E, Jiang JJ (2014) Combined type IIIB with bilateral type I thyroplasty for pitch lowering with maintenance of vocal fold tension. Eur Arch Otorhinolaryngol 271(6):1621–1629

    Article  PubMed  Google Scholar 

  56. Pasternak K, Francis DO (2019) An update on treatment of voice-gender incongruence by otolaryngologists and speech-language pathologists. Curr Opin Otolaryngol Head Neck Surg 27(6):475–481

    Article  PubMed  Google Scholar 

  57. Casado JC, O’Connor C, Angulo MS, Adrian JA (2016) Wendler glottoplasty and voice-therapy in male-to-female transsexuals: results in pre and post-surgery assessment. Acta Otorrinolaringol Esp 67(2):83–92

    Article  PubMed  Google Scholar 

  58. LeJeune FE, Guice CE, Samuels PM (1983) Early experiences with vocal ligament tightening. Ann Otol Rhinol Laryngol 92(5):475–477

    Article  CAS  PubMed  Google Scholar 

  59. Tucker HM (1985) Anterior commissure laryngoplasty for adjustment of vocal fold tension. Ann Otol Rhinol Laryngol 94(6):547–549

    Article  CAS  PubMed  Google Scholar 

  60. Yang CY, Palmer AD, Murray KD, Meltzer TR, Cohen JI (2002) Cricothyroid approximation to elevate vocal pitch in male-to-female transsexuals_ results of surgery. Ann Otol Rhinol Laryngol 111(6):477–485

    Article  PubMed  Google Scholar 

  61. Mora E, Cobeta I, Becerra A, Lucio MJ (2018) Comparison of cricothyroid approximation and glottoplasty for surgical voice feminization in male-to-female transsexuals. Laryngoscope 128(9):2101–2109

    Article  PubMed  Google Scholar 

  62. Donald PJ (1982) Voice change surgery in the transsexual. Head Neck Surg 4(5):433–437

    Article  CAS  PubMed  Google Scholar 

  63. Anderson J (2007) Endoscopic laryngeal web formation for pitch elevation. J Otolaryngol 36(1):6–12

    Article  PubMed  Google Scholar 

  64. Meister J, Hagen R, Shehata-Dieler W, Kuhn H, Kraus F, Kleinsasser N (2017) Pitch elevation in male-to-female transgender persons-the wurzburg approach. J Voice 31(2):e7–e15

    Article  Google Scholar 

  65. Yilmaz T, Kuscu O, Sozen T, Suslu AE (2017) Anterior glottic web formation for voice feminization: experience of 27 patients. J Voice 31(6):757–762

    Article  PubMed  Google Scholar 

  66. Rohlfing ML, Kuperstock JE, Friedman D, Spiegel JH (2020) An ex vivo porcine model of the anterior glottoplasty for voice feminization surgery. Laryngoscope 130(4):E206–E212

    Article  PubMed  Google Scholar 

  67. Brown SK, Chang J, Hu S et al (2021) Addition of wendler glottoplasty to voice therapy improves trans female voice outcomes. Laryngoscope 131(7):1588–1593

    Article  PubMed  Google Scholar 

  68. Chang J, Brown SK, Hu S et al (2021) Effect of wendler glottoplasty on acoustic measures of voice. Laryngoscope 131(3):583–586

    Article  PubMed  Google Scholar 

  69. Titze IR, Palaparthi A, Mau T (2021) Vocal tradeoffs in anterior glottoplasty for voice feminization. Laryngoscope 131(5):1081–1087

    Article  PubMed  Google Scholar 

  70. Gross M (1999) Pitch-raising surgery in male-to-female transsexuals. J Voice 13(2):246–250

    Article  CAS  PubMed  Google Scholar 

  71. Kunachak S, Prakunhungsit S, Sujjalak K (2000) Thyroid cartilage and vocal fold reduction_ a new phonosurgical method for male-to-female transsexuals. Ann Otol Rhinol Laryngol 109(11):1082–1086

    Article  CAS  PubMed  Google Scholar 

  72. Thomas JP, Macmillan C (2013) Feminization laryngoplasty: assessment of surgical pitch elevation. Eur Arch Otorhinolaryngol 270(10):2695–2700

    Article  PubMed  Google Scholar 

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Author notes

  1. Zhijin Li and Dingyue Zhang contributed equally and shared the first-authorship.

Authors and Affiliations

  1. Department of Plastic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China

    Zhijin Li

  2. Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China

    Dingyue Zhang

  3. Department of Otorhinolaryngology, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

    Hongsai Chen

  4. Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, No. 639 of Zhizaoju Road, District Huangpu, Shanghai, 200011, China

    Ying Liu & Hayson Chenyu Wang

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  1. Zhijin Li
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  2. Dingyue Zhang
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  3. Hongsai Chen
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  4. Ying Liu
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  5. Hayson Chenyu Wang
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Correspondence to Ying Liu or Hayson Chenyu Wang.

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Li, Z., Zhang, D., Chen, H. et al. Voice Pitch Shaping and Genderization: New Needs of Cosmetic Phonoplastic Surgery. Aesth Plast Surg (2024). https://doi.org/10.1007/s00266-024-03919-0

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