Introduction: Loss of vocal fold pliability can result in significant hoarseness. This usually comes from persisting phonotrauma. Evolving as a treatment option other than prolonged speech therapy or subepithelial resection, intra-lesional steroid injection has given some patients a sound alternative. An emerging replacement of steroids is platelet-rich plasma (PRP) with theoretical benefits Methodology: A retrospective chart review analyzed treatment outcomes of consecutive patients with similar conditions treated by a single surgeon with either dexamethasone or PRP intra-lesional injection(s). Comparisons were made between the treatment and outcome for each substance. Results: Seventy consecutive patients were identified with half each, undergoing dexamethasone or PRP intra-lesional injection(s). Laryngeal high resolution stroboscopy, voice handicap index, singing voice handicap index and voice-related quality of life measures were collated and the two groups compared. The data set is not finalized but preliminary comparison shows a marginal benefit in the PRP group. Conclusion: This study suggests that the newer PRP approach for intra-lesional injection of vocal fold scar may provide clinical benefit over the more traditional dexamethasone injection. There are theoretical advantages of PRP which will be discussed but some minor technical disadvantages. This will assist clinicians on selecting to optimal substance they feel will suits their specific indication for intra-lesional vocal fold injection in phonotrauma.