LAUSR

BACKGROUND Feminization laryngochondroplasty (FLC) evolved from a midcervical incision to a submental less visible incision. This scar may be unacceptable to the patient since it bears witness to gender reassignment. An endoscopic transoral approach to FLC inspired by transoral endoscopic thyroidectomy was recently suggested to avoid the neck scar, however, it requires special equipment and has a long learning curve. A vestibular incision is used to approach the chin in lower-third facial feminization surgery. We propose that this incision may be extended to the thyroid cartilage in performing direct FLCs. We describe a novel minimally invasive, direct trans-vestibular use of the chin reshaping incision, and describe our experience with it. METHODS The medical records of all patients who underwent direct trans-vestibular FLC (DTV-FLC) from December 2019 to September 2021 were retrieved and reviewed for this retrospective cohort study. Data on the operative, postoperative and follow-up courses, complications, and functional and cosmetic results were retrieved. RESULTS Nine transgender females were included. Seven DTV-FLCs were performed during lower-third facial feminization surgery and two were isolated DTV-FLCs. One was a revision DTV-FLC. Transient minor complications were encountered and resolved by the postoperative visit at 1-2 months. Vocal fold function and voice quality remained intact. Eight available patients were satisfied with the surgical results. A blinded assessment by eight plastic surgeons determined that seven procedures were successful. CONCLUSIONS The novel DTV-FTLC approach either in isolation or as part of lower-third facial feminization surgery facilitated scar-free FLC with satisfactory cosmetic and functional results.