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

February 5, 2020
Reading Time: 4 minutes

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), and vice versa. Also referred to as a “tracheal shave,” this is a surgical procedure where the thyroid cartilage is shaved, not to be confused with the thyroid gland. On the other hand, voice feminisation is a surgery, usually performed by an Ear-Nose-Throat surgeon, which makes changes in the space between the vocal chords.

Here, our experts give advice on the time to wait and the recommended sequence of these two different surgeries.

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

FACIALTEAM and Yeson Voice Center, as part of the Trans Health 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, after recovering from Adam’s apple removal:

  1. 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 Adam’s apple shaving is performed with close attention to detail with diamond burs, since they are very effective for sculpting the cartilage without doing unnecessary damage to the adjacent soft tissue, including the delicate vocal chords 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 more delicate if the vocal chords have been recently operated.

In conclusion, it is best to begin with a tracheal shave, after which 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 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.

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

Answer: The size of the Adam apple varies. Some people have larger larynxes. Plastic surgery offers reliable techniques to get your adam’s apple removed within safe parameters, although it’s not always possible to make it totally flat. To protect the trachea, only the most prominent tip of the thyroid cartilage on the trachea 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.  Unfortunately, there is no way to complete a significant Adam’s apple reduction without surgery.

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

Answer: FACIALTEAM performs an anatomically safe and precautionary 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.  Ask your plastic surgeons where they plan to leave a scar with your Adam apple surgery.

Question: What is a tracheal shave voice change?

Answer: There have been cases in which an 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.

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 which the size of the breathing tube used should be smaller than average.
  • During a trachea shave, ask your surgeon to avoid a direct access approach 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 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.

Adam’s apple reduction: before and after procedure photos

 

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