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Objectives: The lateralised vocal fold of unilateral vocal fold paralysis (ULVFP) is unphysiological for expiration wherein vocal folds normally adduct to increase expiratory resistance and prevent small airway collapse. ULVFP may therefore impair ventilatory function and ventilatory volume. This study seeks to test whether vocal fold medialisation improves forced vital capacity (FVC). Design: Prospective inception cohort intervention study. Setting: Academic Tertiary Care Institution. Participants: Twenty‐five patients of ULVFP with a phonatory gap ranging from 2 to 6 mm. Main outcome measures: Vocal fold medialisation was undertaken with autologous fat injection. Forced vital capacity (FVC) assessments by spirometry were undertaken pre‐treatment and 1‐month post‐treatment. Results: Improvement in FVC was noted in all patients with the quantum of improvement ranging from 0.1 to 0.6 litres. Mean FVC improved from 3.10 L pre‐injection to 3.45 L post‐injection. (p <.001). A moderate correlation was noted between the degree of medialisation and improvement in FVC (r =.33, Pearson's correlation coefficient). Conclusions: Objective improvement in FVC is consistently noted in post vocal fold medialisation for ULVFP and is probably mediated by increased glottic expiratory resistance and consequent improvement in intrinsic PEEP. [ABSTRACT FROM AUTHOR]