Will FFS Change My Voice?

Publication date: 6/2026

For nearly every patient, no. Facial feminization surgery reshapes bone and soft tissue in the face, the forehead, and the jaw. None of those procedures touch the vocal cords or the structures inside the larynx that produce voice. The one FFS procedure that gets anywhere near the voice box is the tracheal shave, and even that procedure carries a relatively low risk of voice change when it is performed correctly.¹

Dr. Paul Mittermiller hears this question often during consultations. Voice is one of the most personal parts of how a patient is perceived, and the idea of unintentionally altering it during a feminizing procedure is a reasonable concern to raise. The good news is that the anatomy of FFS and the anatomy of voice production are largely separate, and the research supports what Dr. Mittermiller sees in practice. Voice changes after FFS are uncommon, and when they do occur, they are temporary and limited to the first week or two after a tracheal shave.²

If you are still researching what FFS involves before diving into this question, the overview article “What is Facial Feminization Surgery” is a good starting point.

Why Most FFS Procedures Are Nowhere Near Your Voice Box

Voice is produced by the vocal cords (also called vocal folds), which sit inside the larynx, a few centimeters below the chin. The pitch and quality of the voice depend on the length, thickness, and tension of those cords, along with the resonating spaces in the throat, mouth, and nasal passages.

Now compare that to the anatomy involved in facial feminization. Forehead contouring works on the frontal bone of the skull. Brow bone reduction reshapes the bony ridge above the eyes. Orbital rim contouring softens the bone around the eye sockets. Rhinoplasty reshapes the nasal bones and cartilage. Cheek augmentation adds volume or implants to the midface. Jaw feminization reduces the angle and width of the lower jaw, and genioplasty reshapes the chin. Hairline feminization moves the hairline forward.

None of those procedures involve any structure that sits inside the larynx. The bones and cartilage being worked on are all above the neck. The surgical planes used during FFS do not enter the airway, and they do not approach the muscles or cartilage that control pitch. A patient who undergoes a full set of FFS procedures without a tracheal shave will sound exactly the same after surgery as they did before, because nothing in the operating field touches the voice-producing apparatus.

This is why Dr. Mittermiller routinely tells patients during consultation that voice training and voice surgery are entirely separate conversations from facial feminization. Whether a patient wants to pursue voice feminization is a decision made with a speech-language pathologist and, if surgery is desired, with a laryngologist who specializes in the larynx.

Tracheal Shave: The One FFS Procedure Near the Larynx

The tracheal shave, formally called chondrolaryngoplasty, reduces the prominence of the thyroid cartilage, which is the structure most people call the “Adam’s apple.” It is performed through a small horizontal incision in the front of the neck, ideally hidden in a natural skin crease. The surgeon then exposes the thyroid cartilage and shaves down the projecting portion.

Why does this procedure even come up in a discussion about voice? Because the thyroid cartilage is part of the larynx, and the vocal cords attach to the inside of the thyroid cartilage at a specific point called the anterior commissure. If too much cartilage is removed, or if the cartilage is removed too low, the anterior commissure can be destabilized, which can in turn affect the way the vocal cords vibrate.

The key word in that sentence is “if.” The anterior commissure often sits well below the area that needs to be reduced for an aesthetic result. Surgeons have multiple methods for determining how much cartilage can safely be removed. It can often be helpful for patients to ask their surgeon about their specific technique and complication rate.

If a patient is curious about how the tracheal shave fits into the broader set of feminizing facial procedures, Dr. Mittermiller’s “Tracheal Shave” page explains the procedure and recovery in more detail.

What the Research Says About Voice Risk After Tracheal Shave

The published literature on chondrolaryngoplasty is reassuring. A prospective study of fifteen transgender women who underwent chondrolaryngoplasty, published in the International Journal of Transgender Health, measured fundamental frequency (the acoustic measure of pitch) and perceptual voice quality before and after surgery. The difference between the preoperative and postoperative mean fundamental frequency was not statistically significant. There was also no statistically significant change on the GRBAS scale, which is a clinical tool for rating voice quality. The authors concluded that the surgery caused no noticeable vocal change in pitch or perception.³

In that same study, two patients (13%) reported hoarseness during the first postoperative week, and that hoarseness resolved without any specific treatment. There were no major complications such as disinsertion of the vocal folds or epiglottis.

Taken together, the prospective and retrospective evidence supports a consistent conclusion. Tracheal shave is a safe procedure for voice.

Frequently Asked Questions

Can FFS make my voice deeper?

The procedures that make up FFS, with the exception of tracheal shave, do not touch the larynx at all and have very little chance of making the voice deeper. Forehead contouring, jaw feminization, rhinoplasty, and the rest of the standard FFS procedures will not change pitch, range, or vocal quality. When a permanent deepened voice does occur after a tracheal shave, it almost always reflects resection of cartilage at or below the anterior commissure, which is preventable with conservative surgical planning.

Is hoarseness normal after a tracheal shave? How long after a tracheal shave does the voice fully return to normal?

Mild hoarseness for a few days is fairly common and almost always temporary. In one prospective study of fifteen patients, 13% reported hoarseness in the first postoperative week, and it resolved without treatment in all cases. The hoarseness usually comes from swelling, breathing-tube irritation, or short-lived inflammation rather than any injury to the vocal cords themselves.

Will a tracheal shave raise the pitch of my voice?

No. The tracheal shave is purely an appearance-based procedure that reduces the projection of the Adam’s apple. It does not raise pitch. The published data on fundamental frequency before and after chondrolaryngoplasty shows no statistically significant change. Patients who want a higher-pitched voice need voice feminization surgery, voice therapy, or both, performed by a laryngologist and a speech-language pathologist.

If you have specific questions about whether a tracheal shave fits into your own FFS plan, the consultation page is the right place to start. Dr. Mittermiller and his team are happy to walk through anatomy, surgical planning, and realistic expectations for both the appearance change and the voice safety profile during a one-on-one consultation.

Citations

1. Aires MM, de Vasconcelos D, Bruno Teixeira de Moraes (2021) Chondrolaryngoplasty in transgender women: Prospective analysis of voice and aesthetic satisfaction. Int J Transgender Health 22 (4):394–402. doi:10.1080/26895269.2020.1848690 https://pmc.ncbi.nlm.nih.gov/articles/PMC10553374/
2. Aires MM, de Vasconcelos D, Bruno Teixeira de Moraes (2021) Chondrolaryngoplasty in transgender women: Prospective analysis of voice and aesthetic satisfaction. Int J Transgender Health 22 (4):394–402. doi:10.1080/26895269.2020.1848690 https://pmc.ncbi.nlm.nih.gov/articles/PMC10553374/
3. Aires MM, de Vasconcelos D, Bruno Teixeira de Moraes (2021) Chondrolaryngoplasty in transgender women: Prospective analysis of voice and aesthetic satisfaction. Int J Transgender Health 22 (4):394–402. doi:10.1080/26895269.2020.1848690 https://pmc.ncbi.nlm.nih.gov/articles/PMC10553374/