Indications
A CO2 laser can be used to remove some of the vocal cord, thinning and lightening it. Typically I remove some of the superior surface of the vocal cord. Then, depending on how thick the vocal cords are, some muscle can be removed as well. This reduces the bulk of the vocal cords and can raise the comfortable speaking pitch as well as raise the lowest pitch attainable.
Partially useful: Although I use this in transgender individuals to raise pitch, when used alone, the degree of pitch elevation is usually insufficient to go from a male voice to a completely female voice.
Very useful: I find it particularly useful after other vocal cord surgery such as Feminization Laryngoplasty or Vocal Cord Webbing when the pitch elevation was not adequate.
Very useful: Enlarged vocal cords, such as individuals with smoker's polyps can be made much smaller and the pitch elevated.
Procedure
This is performed under general anesthesia with a laryngoscope through the mouth. I excise an elliptical portion of the superior vocal cord. Then, based on with the patient and I have decided, I remove some of the vocal cord (thyroarytenoid) muscle.
Cautions
Depending on how much muscle is removed, the vocal cords will be stiff. While they are stiff, they tend not to vibrate, leaving you with no voice. If I remove a small amount of muscle, there may be no temporary voice loss at all. The vocal cords may swell moderately and create a laryngitis quality. Or if I remove a large amount of muscle, some patients have lost their voice for up to three months. So it is important to have a discussion before surgery about how much you desire to have your pitch raised balancing that with how much time you can afford to go without your voice.
After surgery
Discomfort tends to be minimal to moderate. It is actually more likely that you will have pain from the scope through the mouth than from the actual surgery. Although you are allowed to talk after surgery, it can be difficult because of swelling. I typically suggest though that patients not talk for one week after the surgery. The area that has been lasered gradually tightens over several weeks up to three months and this typically brings the pitch up. It is possible to perform additional treatments if indicated although this is uncommon since this is already a reasonably aggressive procedure.