Voice Modification Procedures

Voice modification procedures involve interventions to rejuvenate weakened, often older, voices by injecting fat, collagen or other substances into the vocal cords or by repairing the cords with synthetic mesh. The muscles that control the voice are often affected by aging in the same way as other muscles in the body. Atrophy deteriorates the muscles over time, resulting in lost volume and bulk. In the vocal cords, the tissues that vibrate with speech also become thinner and stiffer over time, resulting in changes to the quality and strength of the voice, a condition known as presbylaryngitis. As with other conditions connected to aging, vocal cord atrophy may occur prematurely because of genetics, disease or injury. By adding bulk and reducing stiffness of the vocal cords, voice modification procedures can help patients restore lost volume and produce stronger, clearer sounds.

Voice modification procedures can be performed because the patient is experiencing difficulties in communication or projection, or simply because the patient is dissatisfied with altered voice quality. These procedures are sometimes necessary for individuals whose voices are central to their employment, like actors, singers or announcers. Voice modification procedures are always part of a comprehensive program, including proper medical diagnosis and voice therapy. Typically, an effort is made to alleviate symptoms with voice therapy before a voice modification procedure is considered.

Reasons for Voice Modification Procedures

Candidates for the voice modification procedures may be experiencing any or all of the following symptoms:

  • Breathiness
  • Hoarseness
  • Diminished volume
  • Vocal fatigue
  • Vocal instability or tremors
  • Change in habitual pitch when speaking

While aging is a primary cause of these symptoms, deterioration of the vocal folds (cords) may also be caused by a number of medical problems, such as acid reflux, diabetes, low thyroid function, tumors, and other conditions of the larynx. Genetic makeup, or vocal paralysis (paresis) due to disease or injury may also be the reasons for vocal difficulties. Since voice deterioration can be the first symptom of a more serious medical problem, it is important for any patient with vocal difficulties to receive a full physical examination prior to treatment.

Voice Modification Procedures

Typically, when a patient has voice problems, a voice care team, consisting of an otolaryngologist, a speech pathologist, and perhaps a singing or acting voice specialist, work together to create an individualized voice treatment plan prior to any voice modification procedure. The patient undergoes a program of vocal therapy exercises that, in many cases, may be sufficient to improve vocal strength and quality. In cases where vocal therapy provides inadequate improvement, the next step is usually one of two voice modification procedures: an injection laryngoplasty or a thyroplasty. The type of operation performed depends on the patient's physical condition and the goals of treatment. Both are performed on an outpatient basis.

Injection Laryngoplasty

An injection laryngoplasty is performed by injecting a material through the mouth or neck into the tissues adjacent to the vocal fold in order to bulk up the vocal tissues and bring the vocal folds closer together. The material injected is usually collagen, fat, or hydroxylapatite, a type of calcium mineral. This treatment may be performed under local or general anesthesia.


Alternatively, vocal modification is accomplished by performing a thyroplasty. In this procedure, the doctor makes a small incision in the neck, and the laryngeal tissues are compressed slightly using synthetic implants. A thyroplasty is normally performed under general anesthesia.

Risks of Voice Modification Procedures

The most common complication of a vocal modification procedure is that voice improvement is not sufficient or that evident improvement diminishes over time. In such cases, a second procedure may be needed. There is also a very slight a risk that the vocal cords may become over-closed, which can worsen voice quality. The most serious complication of a voice modification procedure is that it may result in hemorrhage, difficulty swallowing, airway obstruction or vocal cord paralysis, although these complications are extremely rare.

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