Aim: To describe a novel therapeutic approach and clinical outcome in a female laryngectomy patient with absent pharyngoesophageal (PE) segment vibration, using neopharyngeal fat injections to facilitate voice restoration. Methodology: A 76-year-old female with previous history of neck irradiation, underwent salvage laryngopharyngectomy with radial forearm free flap reconstruction for a post cricoid SCC. A radiologically guided air insufflation test was performed to assess suitability for secondary tracheoesophageal puncture, revealing a neopharyngeal stricture and absent tracheoesophageal voicing. She was successfully dilated, however, on repeat air insufflation testing, she continued to demonstrate an absent of vibration at the PE segment with no audible voicing. This is likely due to absence of contact between the walls of the neopharynx. We proceeded with bilateral autologous fat injections to the neopharynx to augment tissue bulk and facilitate formation of a functional vibratory segment. Results: Post-procedure air insufflation testing demonstrated restoration of PE segment vibration with functional fluency and volume. Unilateral digital neck pressure is still required to optimise the tissue approximation and voice production. At the time of submission, the patient is undergoing further augmentation to improve voice quality. A secondary tracheoesophageal puncture and voice prosthesis insertion is scheduled. Conclusion: Neopharyngeal fat injection is a viable alternative to increase the volume of free flap reconstruction. It helped restore PE segment vibration and enabled functional voicing, in a patient previously unable to achieve adequate phonation, due to soft tissue deficiency or significant tissue stiffness. This technique may represent a promising adjunct for voice rehabilitation in complex post-laryngopharyngectomy patients with absent PE segment vibration. Further outcomes will be available and presented at the conference.