Aim: Dysphonia resulting from glottic insufficiency or vocal fold immobility can be a distressing and debilitating condition. The ability to medialize a vocal fold and reposition an immobile arytenoid to allow patients to regain quality, stamina, and reliability of their voice can be achieved through type I medialization thyroplasty with concurrent arytenoid adduction when indicated. Background: Medialization thyroplasty and arytenoid adduction techniques have been honed and reliably performed for decades. The durability of these procedures has been well demonstrated. Additionally, they are routinely performed under local anesthesia with moderate anesthetic sedation enabling frail patients, suffering from glottic insufficiency who are otherwise poor surgical candidates, the opportunity to pursue laryngeal framework surgery and regain vocal strength while risking low overall morbidity. Review results: Understanding how to apply the nuances of these surgeries can yield reliable and successful outcomes. Appreciating these subtle details in the context of the historical development of these procedures is beneficial for any otolaryngologist performing these procedures. Conclusion: Type I thyroplasty and arytenoid adduction procedures have been meticulously refined over time. As a result they are technically elegant and simple procedures that rely on intraoperative precision to optimize postoperative voice outcomes. Disclosures: Please note, this manuscript has not been submitted or presented elsewhere prior to submission here. All authors have no conflicts of interest, sources of external funding related to this publication, or financial disclosures related to this publication to declare.