The reason people still sound like smokers even after they have quit smoking is that long term exposure of the vocal folds to cigarette smoke causes build up of a jelly-like substance under the cover of the vocal fold. This causes heaviness or increase in mass of the vocal folds which lowers the frequency of vibration (just like a thicker guitar string). Sometimes there is a precancerous thickening of the skin of the cover that also causes roughness or heaviness to the voice, and sometimes there may even be an early cancer. All of these conditions can be treated with a new green light laser (KTP laser) to restore normal anatomic vibration and raise pitch. It is a nice thing to do for women who are tired of being mistaken for men on the telephone!