Tracheal Shave (Adam’s Apple Reduction)

Tracheal Shave (Adam’s Apple Reduction)
Incision preview. Image credit: Chris Gralapp
Incision preview. Image credit: Chris Gralapp

What is the difference between the Adam’s apple in men and women?

The Adam’s apple is one of the most noticeable gender-related differences between men and women. In men and some women, the small bump known as the Adam’s apple is formed when the thyroid cartilage on the throat is large and projects forward.

The thyroid cartilage is not usually noticeable in women and this makes the Adam’s apple one of the most prominent features creating a masculine appearance. The prominence of the Adam’s apple can hinder a trans woman’s ability to ‘pass’ as her true gender identity and can become stigmatizing for someone in the process of transitioning.

Some trans women may choose to have a tracheal shave procedure (chondrolaryngoplasty) to reduce the size of a prominent Adam’s apple because it is stigmatizing, whereas others may just not like the appearance of the bump in the middle of their throat.

If you’re seeking facial feminization surgery (FFS) to appear more feminine, the tracheal shave (also known as Adam’s apple reduction or thyroid cartilage reduction) will almost always be included in a cluster of facial feminization procedures.

The Art of the Tracheal Shave: A Vital Component of Facial Feminization Surgery

It is critical that tracheal shave surgery is performed by a qualified and experienced plastic surgeon to avoid damaging the structural support of the vocal cords and to ensure a natural-looking result.

Dr. Deschamps-Braly is an innovator in surgery for the Adam’s apple including:

  • Feminization of the Adam’s apple with tracheal shave for trans women and cis-women (who may also have a prominent Adam’s apple)
  • Masculinization of the Adam’s apple for trans men (wherein Adam’s apple is augmented via a natural implant) – a procedure globally adopted as the standard methodology.

Dr Deschamps-Braly is trained and has extensive experience in three surgical disciplines critical to facial feminization:

This enables Dr. Deschamps-Braly to combine surgical experience, innovation, and artistry to successfully integrate the tracheal shave procedure into a cluster of facial feminization surgeries that will provide a result best suiting his clients’ needs.

How is the Tracheal Shave Performed?

As a common surgical procedure in facial feminization, the tracheal shave involves the shaving down of the Adam’s apple to reduce its size to make the neck and throat appear smoother and more feminine.

Two approaches can be taken to the tracheal shave procedure:

  • Indirect approach (our preferred option)
  • Direct approach (not our recommendation).

The indirect approach involves a horizontal incision just under the chin (submental incision) followed by separation of the vertical throat muscles to expose the cartilage. This is our preferred option because the scar is not on the front of the neck and so is concealed and less visible. The scar does not adhere to the underlying cartilage and does not move during speech or swallowing.

The direct approach involves a small incision directly over the thyroid cartilage. Thyroid cartilage reduction is then performed carefully with a knife. This approach can:

  • Leave a noticeable scar on top of the voice box on the front of the neck
  • Create scar tissue over the voice box that adheres to the underlying cartilage and then moves during speech and swallowing, becoming even more noticeable.

When you have a tracheal shave as part of a cluster of facial feminization surgeries, you will need general anesthesia in an operating room and longer surgery time. During the recovery period, your throat will feel sore and you will have some bruising, swelling and difficulty swallowing.

Our Approach To Tracheal Shave Surgery

Dr. Deschamps-Braly is continually innovating with regards to Adam’s apple reduction (and augmentation via natural implant) techniques within the context of facial gender confirmation surgery. Typically, the procedure involves an incision in the throat just under the chin. The vertical muscles of the throat are then separated to expose the Adam’s apple and the tracheal cartilage is shaved to reduce its size.

We are critical of techniques that place the incisions on the front surface of the throat where potential scarring will be more visible. You don’t want to draw attention to something that you may be trying to draw attention away from! In addition, we have seen a number of patients who have had this incision placed inappropriately on the front of the neck, only then to have the scar stick to the cartilage underneath; and move up and down when the patient speaks or swallows. Obviously, this is not an ideal outcome.

NOTE: It is important that Adam’s apple reduction is performed correctly by a qualified and experienced plastic and craniofacial surgeon. If performed incorrectly, the tracheal cartilage may grow back partially. Dr. Deschamps-Braly uses advanced techniques to significantly minimize that possibility.

Tracheal Shave Techniques - A Word of Caution

The tracheal shave is one of the four most common facial feminization surgeries where new clients ask us to correct their previous surgeon’s work. The most common complaint that we hear from new patients seeking revision of facial feminization surgery is that their facial features have not been successfully ‘captured’ or represented as their preferred gender by their previous surgeon.

The choice of surgeon and surgical approach to reduce the size of the Adam’s apple can have a marked effect on the final result. Although this procedure might sound straightforward, care and an intimate understanding of the anatomy of the vocal cords is needed.

The success of a tracheal shave depends very much on the skill and expertise of the surgeon performing the procedure. If performed incorrectly, too little cartilage can be removed, risking partial cartilage regrowth. Alternately, if too much cartilage is removed or the cartilage is removed incorrectly, voice changes such as long-term hoarseness can occur. Damage to the voice is often difficult to correct.

Dr. Deschamps-Braly uses advanced and innovative techniques that:

  • Reduce the risk of the thyroid cartilage growing back
  • Avoid creating a noticeable scar on top of the voice box in the middle of the neck
  • Avoid a scar that moves during speech and swallowing
  • Protect the vocal cords and greatly reduce the risk of voice changes.

Dr. Deschamps-Braly does not recommend surgical approaches that create any incisions on the front surface of the throat where any potential scarring will be more visible. Trans women want a neck and throat that is scar-free and smooth and that enhances a natural feminine appearance.

Tracheal Shave – Next steps?

Different surgeons use different surgical approaches to facial feminization and Adam’s apple reduction. Before you commit to any specific procedure, we recommend that you carefully consider your healthcare options. An Adam’s apple reduction is most efficiently performed as part of a cluster of facial feminization procedures.

Discussing your final goals during a consultation with Dr. Deschamps-Braly can help you to plan for the best result for your feminine transformation. Although located in San Francisco in California, Dr. Deschamps-Braly supports clients from all over the world to achieve their gender-affirming goals.

Want to know more?

  • Facial Feminization Surgery – A Complete Guide To FFS
  • How NOT To Choose Your Facial Feminization Surgeon

References – for those who like to dig deeper: