Many Transwomen struggle to adopt an acceptable female voice and find that although their physical presentation is acceptable to them, the voice often lets them down.

Many of the available voice feminising surgeries appear to be limited and, even when they do work, still require voice therapy and/or coaching.

Deciding whether you need to work on the voice is a very personal decision but for those of you who do, the programme by Kathe Perez may be invaluable.


The following is a precis of an article by Dr Doug Ousterhout a California based surgeon who pioneered this surgery.

“If you are a transwoman looking feminine is, of course, extremely important to you. First impressions are often based just upon your face. That which is first seen in an initial contact is frequently what defines you. It establishes not only who you are, but often what gender you are as well. As a transsexual, perhaps nothing is more important to you than appearing sexually the same as you feel emotionally. Facial feminizing surgery can help bring these two together”.

Cosmetic (aesthetic surgery) of the face can be directed toward many aspects of facial appearance. The majority of facial aesthetic surgery in this country is to reduce the effects of aging – reducing wrinkles, lifting sagging skin, or removing fat deposits. Facelifts, brow (forehead) lifts, blepharoplasties (cosmetic surgery of the eyelids), and removing excess fat in the neck are among the most frequently completed aesthetic facial soft tissue procedures that I do. A great deal of my aesthetic surgery, though, is directed toward changing facial contours by modifying the basic bony supporting configuration of the face.

Surgery such as a rhinoplasty (nasal surgery), chin, cheek and forehead modifications (either reduction or augmentation), changing the shape of the mandibular angle, and – in certain patients – moving the upper and/or lower jaws are frequently completed by me as well.

There are basic differences between a male and a female skull – differences long appreciated not only by anthropologists studying skulls, but by artists as well. Females have a more pointed chin and less nasal prominence than males. The forehead is quite different, especially the areas of the brows and the mid forehead. The shape of the skull affects the drape and contour of the skin. Changing the shape of the skull will assist in changing one from distinctly male to female.

Modifying the angle of the lower jaw and the prominence of the cheeks can also help improve femininity.The techniques used and the areas modified are individualized. Quite obviously some transsexuals are already much more feminine than others. What is completed is based upon a combination of skeletal and artistic evaluations, radiographs (x-rays), anthropological measurements, asymmetry gauges, facial masks and photographs. Patient self assessment is also very important to surgical planning. Based on all of the above, a treatment program is established.”