The term "voice lift" was coined by Dr Robert Sataloff in 2004 to describe the techniques used to repair a damaged or ageing voice. Sataloff, professor and chairman of the ear, nose and throat department at Drexel University College of Medicine in Philadelphia and one of the leading specialists in voice surgery, gives an exaggerated sigh when I ask if he regrets inventing the phrase. "I haven't thought of a better term," he says, "but I have certainly spent more time than I would like explaining that it's not just like dropping in and having an operation like a facelift. It's complex and requires a multi-disciplinary approach."
Last week a series of newspaper articles highlighted the growing interest in "voice lift" treatments in the UK, and reported how a course that ran in Manchester was oversubscribed by laryngologists wanting to learn more about how to repair damaged – and ageing – voices, including the use of fat or fillers usually employed in cosmetic procedures.
"In the past, it was difficult to administer without major operations but now there is better technology and substances that are compatible with the body," says Yakubu Karagama, an ENT consultant who leads the voice clinic at Manchester Royal Infirmary, and who ran the course. He thinks the number of procedures will increase in the UK: "We have an ageing population who are working longer, and I think people will have it done because they are struggling in the workplace. I would rather people think of it as a functional, not a cosmetic, thing."
John Rubin, consultant surgeon at the Royal National Throat, Nose and Ear hospital in north London, is another of Britain's few specialists using the techniques that make up a "voice lift", though he too stresses that "we're not really talking about cosmetic surgery".
Rubin explains that surgery is just one part of a group of treatments with an aim to bring the vocal cords, or folds, together more efficiently (it is the vibration of the vocal folds that produces the voice): "We often use this treatment on people who have vocal cord paralysis or weakness. There are lots of reasons for that. They may have had thyroid surgery and one of the nerves to the vocal folds had to be cut and so they can't quite come together; or someone had a cold that affected the nerves." And in older people? "During the ageing process, the vocal folds become thinner and they don't come together, causing the voice to sound weak, shaky or breathy. An older voice is very easy to recognise. The first thing we do is send the patient to our speech therapist and we also get them involved in gentle exercise. Often that is enough to make the voice sound younger and more fit. If that doesn't work satisfactorily, then we may suggest a little augmentation."
This usually involves taking fat from the stomach and injecting it into the vocal folds, although other substances such as collagen can be used. "It effectively makes them thicker, and allows them to have better contact," says Rubin. The voice is still recognisably theirs, "but it becomes less effortful, they won't be straining as hard, the pitch of the voice often comes down slightly and it becomes easier and more comfortable". He says he treats very few people who are concerned with ageing: "We treat many more people who come to us with vocal cord paralysis or damage," though he suspects demand will increase.
In the US, where the treatment is more common, Sataloff says there has been a "huge increase" in the number of older people – the baby boomer generation – seeking voice rejuvenation. He also insists it is not a trivial, or cosmetic, procedure: "As people age, they have real quality of life problems – their voices are getting softer and breathier, while all their friends are going deaf. It becomes harder for people to have conversations or interact and eventually it gets to be such a struggle they stop trying."
He also points out that – sad for us as a society – we are quick to judge people by their voices, and older people can fall victim to this: "As people's voices become unsteady, they become less convincing to us," he says. "So older people, who are often the most experienced and wise, have voices that begin to sound infirm and people unconsciously infer that those people are infirm, and their spoken opinions don't have the weight they should. Correcting these problems is worthwhile for people in many professions, but also for those who are interested in being able to continue to interact socially."
Those worried by vocal ageing start coming to him in their 50s, he says, though most common are people in their 60s and 70s. The majority are worried about how their voice is affecting their career: "It's not even primarily singers. Business people, clergy, attorneys, politicians, secretaries – you don't want somebody who sounds feeble and unpleasant answering your phone and being your first interaction with the public. There are also people who are retired but don't want to sound like an old woman or man, wants to be able to sing in the retirement community choir, wants to be able to have conversations with people without yelling."
Surgery, says Sataloff, is the last option – although filler injections are a temporary measure, he also offers tiny implants made from silicon or Gore-Tex. "That's why 'voice lift' confuses people. It's actually a complex package of activities that include establishing an accurate medical diagnosis, and exercises with a team of voice specialists to improve or eliminate some of the changes." This, he says, can take "decades off the sound of the voice. More than 80% of the time, people are satisfied without having to resort to surgery."