It has been more than fifteen years since that first transsexual patient asked me if there was not some operation I could do to modify her voice. Her body surgery had been successful, and I was about to perform both hair restoration surgery and nasal surgery to complete the physical transformation. Yet, she was still quite distraught about her voice.
She explained to me that it was quite embarrassing to speak to someone over the telephone and have them say, “Well, thank you for your help, Sir.” Her voice was quite deep, and she was not able to place the pitch into the female range; this obviously presented serious problems in completing a successful transition for gender reassignment.
I explained to her that there was no surgery that I knew of for voice modification, but I would attempt a procedure which might work. I told her that there was no guarantee of success, but she said she was willing to take this chance, even though the procedure might fail, because of the problem that her voice presented. Well, not only was the experimental procedure successful, but it succeeded beyond my wildest dreams. The patient’s voice was well within the female range and nobody referred to her as “Sir” after that! (All transsexual patients owe this person ‘J’ a great deal of gratitude, as she allowed me to develop this revolutionary procedure by her willingness to “take a chance.”)
That was more than fifteen years ago, and since then several hundred patients have undergone similar surgery with a success rate of more than 95%. (The remainder do not achieve a significant change in voice pitch.) This voice modification surgery is unique, it was developed by me, and no other surgeon I am aware of uses this technique.
The voice modification surgery is performed as an outpatient procedure in our surgery suite under local anesthesia. There will be a small, fine, one-inch line in the neck crease after the procedure. If desired, the Adam’s apple can be shaved during the same operation. There is very little discomfort afterwards, and the patient is able to fly home in 48 hours. Contact sports and extreme athletic endeavors are to be curtailed for several weeks after the procedure. The voice remains somewhat hoarse for a few weeks afterwards.
The goal of the surgery is to create a voice which sounds female on the telephone. The surgery is performed to the best of my ability. There can be no guarantee of the results, but there have been no serious complications or problems with this procedure to the present time.
Quite often other types of surgery are performed in conjunction with the voice modification procedure, such as our unique method of hair replacement for transsexual patients using the flap technique. Facial feminization procedures including; forehead and brow lifts with lowering of the hairline can also be done as well as contouring of the forehead-orbital bone. Nasal surgery to create a more feminine nose, without an artificial or overly scooped or pinched look, is often requested.
Our method of hair replacement depends upon the degree of hair loss already experienced by the patient. In some patients the hairline can be moved forward since there is no further hair loss once the patient is on estrogen. A simple advancement with or without tissue expansion is all that is necessary. Using a procedure which has been developed and perfected by Dr. Fleming and myself, hair will grow through the incision that is made at the frontal hairline so no scar will be detectable afterwards. Utilizing this same approach, excess bone over the ridges of the forehead can be smoothed to create a more feminine appearance as well.
For patients with more advanced hair loss, the Fleming/Mayer Flap procedure can be used to create a natural hairline, without “corn rows”, hair texture change, and poor density associated with the hair transplant procedure. With the Flap procedure an entire section of hair is transferred at one time from the sides of the scalp to the front, resulting in a very natural and thick hairline. Dr. Fleming and I are recognized as authorities on hair flaps throughout the world, and we are the originators of this advanced development. We have performed more than two thousand hair flap procedures on patients from all over the world, including numerous entertainers, celebrities, athletes and professionals.
Toby G. Mayer, M.D., F.A.C.S. and Richard W. Fleming, M.D., F.A.C.S. are Medical Directors of the Beverly Hills Institute of Aesthetic and Reconstructive Surgery. They each have dual Board certifications, and are Fellows of both the American Academy of Facial Plastic and Reconstructive Surgery and the American College of Surgeons. Dr. Fleming and Dr. Mayer are clinical professors and former co-chairmen of the Facial Plastic and Reconstructive Surgery Division of the University of Southern California. The doctors have been partners in private practice for over twenty years; their Beverly Hills office is designed for patient comfort and privacy with state-of-the-art surgical suites designed to accommodate the specific, delicate procedures they perform.
Highly regarded as world-renowned authorities on cosmetic and reconstructive surgery, Dr. Fleming and Dr. Mayer are frequently requested as speakers at medical conferences all over the world. As recognized leaders in hair replacement surgery they have co-directed the National Symposium on Hair Replacement Surgery for seven years. Dr. Fleming and Dr. Mayer have published numerous papers on their innovations to the revolutionary flap technique for permanent hair replacement, and both doctors have contributed to many leading textbooks on cosmetic and reconstructive surgery. Their medical reference textbook, Aesthetic and Reconstructive Surgery of the Scalp, made its debut in January 1992. A subsequent book entitled The Everyman’s Guide to Hair Replacement Surgery was published in 1995, and is available by request.