Feminization laryngoplasty (also known as FL or FemLar/Femlar) is a reconstructive surgery surgical procedure that results in the increase of the pitch of a patient, making the voice sound higher and more feminine.

The surgery can be categorized into two main steps: Incision and vocal fold modification followed by thyrohyoid elevation.

A recent study notes that the measured changes average 6 semitones for the patients' comfortable speaking pitch (20-80hz).

The procedure is less popular and well-known than other forms of voice feminization surgery at the moment and is currently performed by a limited set of surgeons.

During puberty, testosterone, a male sex hormone produced by the testes, causes the diameter of the larynx to increase and the vocal folds to thicken and lengthen.

The fundamental and resonant frequency of their voice decreases and they no longer match to the desired vocal range that suits their preferred gender identity.

Several cosmetic surgeons have claimed that most of their patients are satisfied with alterations on secondary sexual characteristics and are not tempted to seek additional genital surgery.

[10] The first experimental study to surgically raise the speaking pitch was performed by Japanese otorhinolaryngologist Kazutomo Kitajima and his colleagues in 1979.

[13] Based on this principle, the first surgical procedure for voice feminization, cricothyroid approximation (CTA) was developed to achieve pitch increase by reducing the separation between the two cartilages.

[4] As opposed to previous efforts, feminization laryngoplasty results in a more significant and long-lasting pitch increase along with a more feminine voice quality.

This allows a strip of the anterior thyroid cartilage to be removed using electrocautery to effectively reduce the contour of the Adam's apple and the diameter of the laryngeal opening.

Subsequently, up to 50% of the anterior vocal folds is removed and the length of pharynx is shortened to raise the speaking pitch.

[20] At last, eight holes are drilled on the thyroid cartilage and hyoid bone for the placement of sutures and screws, securing and suspending the structure of the larynx higher in the neck, but still allowing it to move up and down to facilitate functions such as swallowing.

[3] Instead, an alternative procedure, Vocal Fold Shortening and Retrodisplacement of the Anterior Commissure (VFSRAC), a type of modified Wendler Glottoplasty, is generally recommended as it preserves the ability to sing.

[21] Vocal Fold Muscle Reduction, a standalone laser tuning procedure, can also be considered for professional voice users as well.

[16] If the vocal cords heal with asymmetrical tension, laser treatment is generally required to correct the defect.

In some rare cases, severe swelling could lead to difficulty in breathing, which may require tracheostomy to bypass the area of obstruction.