Tensioning Glottoplasty: A Novel Surgical Technique for Voice Feminization

To describe a novel surgical technique for voice feminization that combines anterior glottic shortening with anteriorly directed tensioning, and to report its early acoustic outcomes.

A retrospective analysis of 20 transgender women (mean age 28.7 ± 5.1 years; range 22-41 years) who underwent tensioning glottoplasty for voice feminization was performed. The procedure uses a combined endolaryngeal and external approach: following excision of the anterior vocal fold mucosa, transcartilaginous sutures are placed under endoscopic guidance and tied externally over the thyroid cartilage. Fundamental frequency was measured preoperatively and at 1 month postoperatively. Statistical analysis was performed using a paired-samples t-test following Shapiro-Wilk normality testing.

Mean f_o increased from 126.2 ± 22.6 Hz preoperatively to 241.2 ± 34.1 Hz postoperatively, a mean increase of 115.0 Hz (95% CI: 102.19-127.87 Hz; p < 0.001; Cohen's dz = 4.19). All 20 patients demonstrated postoperative pitch elevation.

Tensioning glottoplasty produced substantial and clinically meaningful pitch elevation. By combining vibratory length reduction with augmentation of longitudinal tension, this technique may offer a distinct biomechanical advantage within the spectrum of gender-affirming voice surgery.