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What comes first? An Adam’s apple reduction or voice feminization surgery?

August 18, 2016

Facial feminization patients often ask how long is best to wait to have voice feminization surgery after a trachea shave, and vice versa. Here our experts give advice on the time to wait and the recommend sequence of these surgeries.


What should come first? The voice feminization surgery or the trachea shave?

FACIALTEAM and Yeson Voice Center, as part of the TransHealth Initiative, have joined to establish a protocol and mutual philosophy regarding this frequently asked question in the subject of FFS.

In the patient’s best interest, a tracheal shave should be performed first.

Here are the two main points that explain why it is best to have the voice surgery in a second stage:

  • First, an important clarification about your anatomy. The trachea, which plays a key role in vital life processes like breathing and phonation, typically has a greater diameter and is longer in males. The trachea itself should never be approached with the idea of feminizing it, since this would pose the unacceptable and unnecessary risk of damaging the vocal cords or even causing respiratory problems. Only the most prominent tip of the thyroid cartilage on the trachea should be modified safely. This allows for a significant reduction in the Adam’s apple without compromising the structural integrity of the trachea. FACIALTEAM performs an anatomically safe and precautionary shaving of the prominence via an incision placed at a distant point from the Adam’s apple (in the fold under your chin), which prevents obvious scarring or scar adhesions between the thyroid cartilage and the overlying tissue layers. The shaving is performed with close attention to detail with diamond burs, since they are very effective for sculpting the cartilage and without unnecessary damage to the adjacent soft tissue, including the delicate vocal chords insertion area (inferior part). Click here to see our 3D animated video and read more about Tracheal Shave Surgery:
READ  Tracheal Shave in Facial Feminization Surgery
  • Unique to the ‘Vocal Folds Shortening and Retrodisplacement of the Anterior Commissure’ surgery (known as voice feminization surgery or VFSRAC) is that this technique perfectly modifies the male vocal folds to mimic the female vocal folds by removing 1/3 of the vocal folds membrane and internal tissue and then suturing them with permanent material using micro-instruments. Through this surgery, which is free of skin incisions, a natural increase in one’s base voice frequency is possible, providing transgender women with a permanently feminized voice. The specialists of Yeson Clinic and FACIALTEAM believe that the voice surgery will be more stable if there is no work done on the cartilage after voice feminization. Also, FFS requires oral intubation (the breathing tube used during surgery), which becomes complicated if the vocal chords have been recently operated.



In conclusion, if you have had a tracheal shave, you should wait a minimum of 3 months before undergoing voice feminization surgery.

Question: I have had my voice feminization already and now I want to have an Adam´s Apple reduction, is that OK? How long should I wait to have the trachea shave surgery?

Answer: Don’t worry, you still can have your Adam’s apple reduction, but you must wait a minimum of 6 months.


In summary, messages to remember:

  • A trachea shave should be performed before voice feminization surgery. On the contrary, if you plan to have voice surgery first, you will be required to wait at least 6 months before having an Adam´s Apple reduction.
  • During a trachea shave, we avoid a direct access to the thyroid cartilage (preventing unsightly visible scarring and adhesions). Careful diamond burring is employed to eliminate the anterior prominence of the Adam´s Apple, always taking care not to damage the attachment area of both vocal cords.
  • Voice feminization surgery is free of external skin incisions (intraoral approach), so after the two procedures you will not have any visible scars.
  • Voice surgery should be the last step in the neck feminization sequence in order to protect the delicate work carried out, which could be compromised if you have surgery in the same anatomical area too soon.