Chondrolaryngoplasty in transgender women: Prospective analysis of voice and aesthetic satisfaction.

Introduction: Chondrolaryngoplasty or "tracheal shaving" is cosmetic surgery to reduce the laryngeal prominence in transgender women. Complications may include damage to the vocal folds and epiglottic destabilization or aesthetic dissatisfaction. Objective: To assess and compare acoustic and perceptual voice outcomes and aesthetic satisfaction of transgender women submitted to chondrolaryngoplasty. Methods: Prospective interventional cohort of transgender women submitted to chondrolaryngoplasty between March 2018 and October 2019. Voice analysis included simple-blind application of the GRBAS Hirano scale by speech therapist and measurement of the fundamental frequency, in the preoperative and 1-month postoperative periods. The visual analog scale was used to analyze the aesthetic satisfaction, before and 6-months after chondrolaryngoplasty. Results: Fifteen patients participated, with a mean age of 31.7 ± 8.3 years (range 22-51 years). The mean postoperative follow-up period was 15.3 ± 6.1 months (range 6-25 months). There was a significant improvement in the visual analog scale for aesthetic satisfaction, with a preoperative mean = 0.7 ± 1.0 and a postoperative mean = 9.3 ± 1.1 (95% CI for difference = 7.3 to 9.6; p  < 0.001). All patients presented a positive variation. The preoperative mean fundamental frequency was 171.3 ± 41.2 Hz and the postoperative, 177.1 ± 39.5 Hz, with no statistical significance (95% CI for difference = -30.1 to 41.7; p  = 0.74). There was no statistically significant difference in the pre- and postoperative comparison of each component of the GRBAS scale. One (7%) patient presented a hyperpigmented scar and 2 (13%) reported hoarseness during the first postoperative week. There were no major complications such as disinsertion of the epiglottis or vocal folds. Conclusion: Chondrolaryngoplasty led to significant aesthetic satisfaction in transgender women. The surgery caused no noticeable vocal change in pitch or perception.