The Adam’s apple is an obvious male characteristic.
Tracheal shave surgery (or Adam’s apple reduction) is a popular procedure for patients who wish to reduce the appearance of a prominent Adam’s apple. The term tracheal shave is actually incorrect. We do not shave the trachea, which is a very important structure for breathing. We contour the notch on the thyroid cartilage, and it is more appropriately called a chondrolaryngoplasty. Tracheal shaving is one of the most popular procedures in gender reassignment surgery. Prof. Markus Hess performs this procedure on both transfeminine and cisgender female patients. Tracheal shave surgery can have a life-changing impact, especially for mtf transgender patients.
Tracheal shaving is a surgical procedure on a prominent Adam’s apple and is not intended to change the pitch of the voice. How high or low the voice is depends on how much the larynx grows during puberty. Due to hormonal changes during and after puberty, the male larynx tends to grow larger than the female larynx, resulting in a lower pitched voice. The change in size makes the vocal cords longer and thicker, resulting in a deeper voice. However, the protruding part of the thyroid cartilage is not involved in vocalization.
How to perform a tracheal shave surgery (Adam’s Apple Reduction)
A tracheal shave removes the notch on the thyroid cartilage to reduce the prominence of the larynx, commonly known as the Adam’s apple. It is one of the most requested procedures in gender reassignment surgery. The tracheal shaving procedure reduces the cartilage in this area of the neck so that the Adam’s apple is less prominent. It takes approximately one hour and is performed on an outpatient basis under general anaesthesia.
The patient is under general anaesthesia during the procedure. A small incision is made under the chin, usually near the junction of the head and neck – not directly over the Adam’s apple. Prof. Hess, an experienced specialist, will then use an endoscopic camera and a needle to find the exact location where the vocal cords attach to the thyroid cartilage. The vocal cords are located just below the Adam’s apple.
Various instruments can then be used to remove as much of the cartilage from the thyroid gland as possible without risking damage to the vocal cords. The incision is then carefully and strategically sutured to avoid visible scarring. After the procedure, the patient’s Adam’s apple will be less visible and the cleavage will appear softer and more feminine.
The name Adam’s Apple is derived from the biblical story of the „Fall“. Since Adam ate the forbidden fruit, all men have to wear a mark for it.
In addition to the origin of the name from biblical narratives, there is also the explanation that the name comes from Hebrew. The old Hebrew word for “thyroid cartilage” is the same as for “apple”. The name “Adam” stands for “man” in ancient Hebrew.
Adam’s Apple, in Latin Prominentia laryngea or Pomum Adami, refers to the clearly protruding and palpable section of the thyroid cartilage (cartilago thyroidea) of the men’s larynx at the upper end of the thyroid larynx.
There are several options for where to make the skin incision for surgery. The least complications and problems are expected when the skin incisions are next to the Adam’s apple. Almost everyone has at least one tiny skin fold in the front of the neck. Therefore, it is advisable to make the incision in this area. Alternatively, the skin incision can be made higher in the neck, but then the skin incision usually has to be longer, and this can also be associated with an increased risk of problems. In any case, the most important decision is how to make the sutures. Here we use an intracutaneous cosmetic suture with a very thin absorbable thread. Postoperatively, it is very important to take care of the wound and we will explain this in detail before the surgery.
Healing process after surgery
As with any surgery, there will be some swelling of the larynx, which can be treated with decongestants and cold compresses. Bruising and swelling are common and vary from person to person. Swelling usually goes down within 2 to 14 days. The doctor may remove excess fluid by inserting a thin drainage tube.
Post-operatively, a pressure bandage may be applied for a short time to reduce the risk of bleeding. After the Adam’s apple has been reduced, it is advisable to limit speaking. Moderate pain can be well managed with mild to moderate analgesics. Stitches are removed after 7-14 days, depending on the suture technique. Postoperative scar care is important to ensure that the scar is as inconspicuous as possible. You should avoid epilating the area around the incision until your surgeon advises otherwise.
Most procedures leave a noticeable red scar, which should fade over the next 1 to 3 months. One year after the procedure, you should only see a thin white line.
Further names / Synonyms
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thyroid cartilage reduction (TCR)
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chondrolaryngoplasty
Complications
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Poor cosmetic results / too much or too little demolding and/or uneven contours.
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Some complain of a permanent change in voice quality. This can include weakness, lowering of the pitch, hoarseness, and raising of the pitch. The more cartilage that is removed, the greater the risk.
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You may have temporary bumps along the incision.
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Pain and difficulty swallowing, usually caused by intubation during general anesthesia rather than the surgery itself. Tingling and numbness in the tissues.
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The above descriptions are excerpts and do not replace a detailed consultation with your physician.