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Adam's Apple reduction, Voice Feminization

Voice feminization or Adam’s apple surgery. Which first?

May 8, 2021
Reading Time: 4 minutes

Adam’s apple reduction or voice feminization first?

Facial feminization patients often ask how long is best to wait to have voice feminization surgery after a tracheal shave (also known as an Adam’s apple reduction), or vice versa.

And, they’re often unclear about which procedure they should have first.

A tracheal shave is a surgical procedure in which the thyroid cartilage (not to be confused with the thyroid gland) is shaved to minimize the prominence.

On the other hand, voice feminization is usually performed by an ear-nose-throat surgeon and makes changes to the space between the vocal cords.

Here, our experts share advice on how long to wait between them and the recommended order of these two different surgical procedures.

The Adam’s Apple explained

Surgery to the trachea itself should never be attempted, since this would pose the risk of damaging the vocal cords or even causing breathing problems.

Only the most prominent tip of the thyroid cartilage on the trachea, known as the Adam’s apple, can be modified safely.

The appearance of the Adam’s apple can be significantly reduced without compromising the structural integrity of the trachea. Complete removal of the excess cartilage isn’t always safely possible as this may affect the structures which stabilize the vocal cords.

Facialteam carefully shaves the Adam’s apple in an anatomically safe way.

This is done via an incision in the fold under your chin, preventing obvious scarring between the thyroid cartilage and the overlying tissue layers.
Adam’s apple shaving is performed with diamond burs. These are very effective for sculpting the cartilage without doing damage to the adjacent soft tissue, including the delicate vocal chords attachment area (lower part).

Click the link below to see our 3D animated video and read more about tracheal shave surgery. Make sure to take a look at our patient gallery below to see Adam’s apple shave before and after photos.

Voice Feminization Surgery explained (VFSRAC)

Vocal Folds Shortening and Retrodisplacement of the Anterior Commissure surgery is known as voice feminization surgery or VFSRAC.
This technique is unique in that it perfectly modifies the male vocal folds to mimic the female ones by removing 1/3 of the vocal folds membrane and internal tissue. They are then sutured with permanent material using micro-instruments.

Through this surgery, which involves no skin incisions, it’s possible to naturally increase the base voice frequency, giving transgender women a permanently feminized voice.

What should come first: voice feminization or tracheal shave?

Facialteam and Yeson Voice Center, joined together to establish a protocol and mutual philosophy regarding this frequently asked FFS question.

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

This is because our specialists believe that voice surgery will be more stable if there is no work done on the cartilage after voice feminization.

Also, FFS requires oral intubation (a breathing tube inserted during surgery), requires more delicacy if the vocal cords have been recently operated on.

If they have, then patients should make sure that surgeons and anesthesiologists are aware. An extra small tube is then employed to avoid pressure on the voice box.

So, it’s best to begin with a tracheal shave. After that you should wait a minimum of 3 months before undergoing voice feminization surgery.

FAQs about Adam’s Apple Reduction and Voice Feminization

Q: 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?

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

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

Answer: The size of the Adam’s apple varies. Some people have larger larynxes. Plastic surgery offers reliable techniques to minimize your Adam’s apple within safe parameters. However, it’s not always possible to make it totally flat.

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 size of 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. Unfortunately, there is no way to complete a significant Adam’s apple reduction without surgery.

Q: Does an Adam’s apple reduction leave a scar?

A: Facialteam carefully performs an anatomically safe shaving of the Adam’s apple prominence via an incision placed in the fold under your chin. This prevents obvious scarring or scar adhesions between the thyroid cartilage and the overlying tissue layers.

Ask your plastic surgeons where they plan to leave a scar with your Adam’s apple surgery.

Q: What is a tracheal shave voice change?

A: There have been cases in which Adam’s apple reduction surgery has resulted in voice changes.

This is due to the fact that the safe anatomical parameters were not respected, resulting in a weakening of the voice box.

Key takeaways: Adam’s apple reduction and voice feminization
A tracheal shave should ideally be performed before voice feminization surgery. 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.

The breathing tube used should be smaller than average.
During a tracheal shave, ask your surgeon to avoid a direct access approach to the thyroid cartilage (preventing unsightly visible scarring).

Careful diamond burring is used to minimize the Adam’s Apple, always taking care not to damage the attachment area of both vocal cords.

Voice feminization surgery does not involve external skin incisions (intraoral approach), so you will not have any visible scars after this procedure.
Voice surgery should be the last step in the feminization sequence in order to protect the delicate work carried out. This could be compromised if you have surgery in the same area too quickly.

Adam’s apple reduction: before and after photos

Take at look at some of our tracheal shave before and after photos to get a realistic idea of the results you can expect from your surgery.