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

October 30, 2019

Facial feminization patients often ask how long is best to wait to have voice feminization surgery after a trachea shave (also known as  Adam’s apple reduction surgery), and vice versa. Here, our experts give advice on the time to wait and the recommended 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.

There are two main reasons why it is best to have voice surgery in a second stage, after recovering from Adam’s apple removal surgery:

  • 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 cautious 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 Adam’s apple shaving is performed with close attention to detail using diamond burs, which are very effective for sculpting the cartilage without doing unnecessary damage to the adjacent soft tissue, including the delicate vocal cords insertion area (lower part). Click the link below to see our 3D animated video and read more about Tracheal Shave Surgery, and make sure to take a look at our “Before and After” patient gallery to see Adam’s apple shave before and after photos.
  • 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 or Adam’s apple reduction, you should wait a minimum of 3 months before undergoing voice feminization surgery.

Common questions about Adam’s apple removal

Question: I have had my voice feminization already and now I want to have an Adam’s aApple reduction., Iis 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.

Question: Can you remove your Adam’s apple completely?

Answer: To protect the trachea, only the most prominent tip of the thyroid cartilage should be modified during an Adam’s apple shaving procedure. This allows for a significant reduction in the Adam’s apple without compromising the structural integrity of the trachea. Remember, both men and women have Adam’s apples, so removing it completely is neither necessary nor desirable.

Question: Does an Adam’s apple shave leave a scar?

Answer: FACIALTEAM performs an anatomically safe shaving of the Adam’s apple prominence via an incision placed in the fold under your chin, which prevents obvious scarring or scar adhesions between the thyroid cartilage and the overlying tissue layers. Adam’s apple removal via incision just above or below the prominence is common but carries a higher risk of scarring.

Question: Is Adam’s apple reduction without surgery possible?

Answer: There is no way to reduce the size of the thyroid cartilage without surgery. However, voice feminization exercises can be used to train the Adam’s apple into a higher and less noticeable position. This often requires months of regular, even daily, practice, and should be done under the supervision of a qualified voice therapist.

Question: Will a tracheal shave make my voice change?

Answer: Voice changes after Adam’s apple surgery are rare, and they are usually caused by vocal cord damage during the procedure or an excessively aggressive reduction in cartilage. If you are concerned about your voice changing, you should clearly communicate this to your doctor before going forward with the surgery.


In summary:

  • A trachea shave should be performed before voice feminization surgery. On the contrary, Iif you plan to have voice surgery first, you mustwill 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). DCareful diamond burring is carefully employed to eliminate reduce the anterior prominence of the Adam’´s Apple, always taking care not to protectdamage the attachment area of both the 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, such as an Adam’s apple removal, in the same anatomical area too soon.

Adam’s apple reduction: before and after procedure photos