Christella Antoni explains that after seeing hundreds of cases, people who start with a very low, croaky voice often have poorer outcomes from voice surgery. She advocates raising the voice to a certain level with therapy first, since surgery can only increase pitch to a limited extent and cannot improve clarity or intonation. Building in these qualities before surgery can maximise results, and because therapy typically requires relatively little time and cost compared to investing thousands in surgery, pre-surgery voice work is presented as a worthwhile step to achieve better outcomes.