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>Make a top tier elegant/sexy mature model for Pekora.
>Make a reveal stream for the full grown woman version. Use real voice. Maybe work on character traits just for this version with the help of professional actors (do your fucking job, cover).
>Be honest about it. Tell viewers she needs to take care for medical reasons. Do it briefly, and clearly. Could even be offstream.
>Slowly make such streams more common in her schedule.
From here she will be able to alternate between the two when she needs to give her voice a break.
If the alternative is a perpetually bleeding throat, this is perfectly reasonable.