Tracheal Shave / Adam’s Apple Reduction

The Adam’s apple is an obviously masculine trait.

Tracheal shave surgery (or Adams Apple reduction) is a popular procedure for patients looking to reduce the size of the appearance of a prominent Adam’s apple. The term tracheal shave is actually incorrect. We do not shave the trachea, that is a very important structure for breathing. We contour the notch on the thyroid cartilage and is more appropriately called a chondrolaryngoplasty. Tracheal shave is one of the most sought-after procedures in gender affirmation. Prof. Markus HessI perform this procedure on both transfeminine patients and cisgender female patients. Tracheal shave surgery can have a life-changing impact especially for mtf -transgender patients.

Tracheal Shave is a surgical procedure on a pronounced Adam’s apple is not intended to change the pitch of the voice. The high pitched or low pitched voices depend on how much the larynx grow during puberty.  Because of hormonal changes during and after puberty, the male larynx tends to grow larger than the female’s, which also creates a deeper voice. By changing the size, the vocal cords are lengthened, become thicker and, as a result, the voice becomes lower. However, the protruding part of the thyroid cartilage is not involved in vocalization.

How to perform a tracheal shave surgery (Adam’s Apple Reduction)

In a tracheal shave surgery the notch on the thyroid cartilage is removed to reduce the laryngeal prominence, commonly known as the “Adam’s apple.” It is one of the most requested procedures in gender affirmation surgery. Tracheal shave surgery reduces the cartilage in this area of the neck, so that the Adam’s apple is less pronounced. It takes about an hour and is carried out on an outpatient basis under general anesthesia.

During the surgery, the patient will be under general anesthesia. A small incision is made under the chin, usually near the juncture of the head and neck — not directly over the Adam’s apple. Prof. Hess as an experienced specialist will then use an endoscopic camera and a needle to find the precise location where the vocal cords attach to the thyroid cartilage. The vocal cords are located directly under the Adam’s apple.
Then, various instruments can be used to remove as much cartilage of the thyroid notch without risking damage to the vocal cords. The incision is then carefully stitched back up in a strategic fashion to avoid visible scarring. After the procedure, the patient’s Adam’s apple will be less apparent, and the neckline will appear softer and more feminine.

There are several options where to make the skin incision for surgery. The least complications and problems are assumed to be when skin incisions are next to the Adam’s apple. Almost everybody has at least a tiny skin crease in the anterior neck. Thus, it is advisable to do the incision at this location. Alternatively, the skin incision can be done higher in the neck, but then the skin cut usually has to be longer, and this can also go with an increased risk of problems. At any rate, the most important decision is how to make the sutures. Here, we use an intracutaneous cosmetic suture with a very thin resorbable thread. Postoperatively, it is very important to take care of the wound, and we will explain this very detailed before surgery.
Reduktion des Adamsapfels

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.

Healing process after surgery

As after any surgery, there is swelling of the larynx area, which can be treated with decongestant medication and cooling. Bruising and swelling are common and vary from person to person. The swelling usually subsides within 2 to 14 days. The doctor can remove the excess secretion by inserting a thin drainage tube.
Postoperatively, a pressure bandage with light pressure can be applied briefly to reduce the risk of bleeding. After shrinking the Adam’s apple, it is advisable to restrict speaking. The moderate pain can be managed well with mild to moderate pain relievers. The sutures are removed after 7-14 days, depending on the seam technique. Postoperative scar care is important in order to ensure the most inconspicuous scar healing possible. You should avoid hair epilation next to the incision until your surgeon recommends continuing.
Most procedures leave a distinctive red scar initially that should clear up over the next 1 to 3 months. A year after the procedure, you should only see a thin white line.

Further names / Synonyms

  • thyroid cartilage reduction (TCR)

  • chondrolaryngoplasty

Complications

  • Bad cosmetic results / too much or too little demolding and / or uneven contours.

  • Some complain about a permanent change in the quality of the voice. This can include weakness, lowering the pitch, hoarseness, and raising the pitch. The more cartilage that is removed, the greater the risk.

  • You may have temporary skin dimples along the incision.

  • Pain and difficulty swallowing, mostly caused by intubation during general anesthesia rather than the surgery itself.
    Numbness and tightness in the tissues.

The above descriptions are excerpts and do not replace a detailed consultation with the doctor

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