The vocal folds can atrophy, or lose muscle bulk and tone, due to a vocal fold paralysis or simply as a process of aging. In both cases, muscle atrophy can lead to poor vocal fold closure and a weak, hoarse voice.

Temporary Augmentation

Some patients may benefit from temporary augmentation of the vocal folds, when the weakness is felt to be transient, or if the patient wants to undergo a trial augmentation before undergoing a permanent procedure.

In these cases, your doctor may inject the vocal fold  with Cymetra or Gelfoam. Both of these materials are reabsorbed into the body over time.

Cymetra is reabsorbed by the body usually in two to six months. Gelfoam is usually reabsorbed by the body in two to three months.

Injections of Cymetra and Gelfoam can be completed under general anesthesia in the OR. The injection is made through a laryngoscope placed in the mouth.

Permanent Augmentation

Your doctor can inject a very small amount of your own fat into the atrophied vocal fold to help "bulk up" the vocal folds, rather like adding air to a deflated tire.

The doctor completes the fat augmentation procedure in the operating room while the patient is under general anesthesia. The doctor takes a small amount of fat from the belly area, and prepares it in the operating room, and injects it into specific areas of the vocal cords.

This results in plumping up the vocal folds to improve vocal fold closure, which is important for swallowing as well for producing a stronger voice.

Postoperative Instructions

Permanent Augmentation

Immediately after the procedure, there will be a small drain in the incision where the fat was harvested, in the belly area.

This drain is not sutured in, and can be easily removed by pulling on one end of it. It can be removed without discomfort, and should be removed on the morning after your surgery.

Once the drain is removed, we recommend that you place a bandage over the area, and dress the wound with some antibiotic ointment that can be obtained over the counter.
Generally there will be some bruising in this area that will resolve over the course of several weeks.

Please notify your doctor if you note any signs of infection.

Permanent and Temporary Augmentation

You can eat and drink normally after the surgery, although if your throat feels mildly sore, you can choose softer foods.

During the first week after surgery, we recommend that you use a confidential voice, which is the volume and quality of voice that you would use in talking to a close friend in a crowded area about a personal topic.

On your return visit to DVCC, you will begin to work with the speech pathologist, who will coach you on healthy voice production. Voice therapy will help you achieve your best voice following surgery.

We generally see excellent improvement in the voice within two weeks after the surgery is performed. For those using fat augmentation, since a small amount of the fat may be re-absorbed into the body, some patients may need to undergo the procedure once again in six months to make the changes permanent.

For those using temporary augmentation procedures, you will be followed by your surgeon to determine if you would benefit from further surgical procedures.

This article is intended as a resource for patients receiving their voice care at Duke Voice Care Center. It is not intended to substitute for medical advice from your health care team. If your doctor’s instructions differ from the information in this article, please talk with your doctor before making any changes.