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What is a tracheal shave?

Tracheal Shave in Facial Feminization Surgery

March 3, 2021
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Tracheal shave

The tracheal shave, widely known as Adam’s apple reduction surgery, is one of the procedures that’s most commonly included in facial feminization surgery..

Medically speaking, a tracheal shave is also one of the simplest operations many people will undergo as part of their gender transition. In this post, we’ll talk about why tracheal shaves are so often sought by patients as part of facial gender surgery.

We’ll also guide you through the procedure, tracheal shave recovery and tips for prospective patients.

What is a tracheal shave?

There are several different terms used that all refer to the same surgical procedure.

Trachea shave, Adam’s apple reduction, TCR (thyroid cartilage reduction) and chondrolaryngoplasty are all names for the same procedure. You might even hear the term “trach” or trach shave used as verbal shorthand.

When a tracheal shave is done as part of facial feminization, the goal is to give the neck and throat a more feminine appearance by reducing the prominence of the Adam’s apple.

In technical terms, tracheal shaving is the burring of the thyroid cartilage in front of the larynx.

Regardless of gender, all of us have a small amount of cartilage in the throat to protect the vocal cords. During puberty, hormonal changes cause this cartilage to enlarge, forming a bigger bump in people assigned male at birth (AMAB).

As the Adam’s apple increases in size, it causes the pitch of the voice to become deeper. A prominent bump is a typically masculine characteristic.

This is why AMAB trans patients often choose to undergo a tracheal shave operation. Along with other facial gender markers, having a less noticeable Adam’s apple can help patients feel more comfortable with their appearance.

What does the trachea shave procedure involve?

We recommend this procedure be performed under general anesthesia, although some centers may offer a local anesthesia, outpatient option.

The Adam’s apple reduction is often done at the same time as other facial gender affirming surgical procedures (e.g. jaw reduction, forehead reduction, rhinoplasty, etc.). If this is the case, you will be put under general anesthesia for the tracheal shaving operation.

Every surgeon’s technique will be slightly different. That’s why it’s very important to find a surgeon who specialises in tracheal shaves specifically and facial gender confirming surgery (FGCS) in general.

The best trachea shave method is to make a small, horizontal incision hidden in a skin crease under the chin or jaw, from which a small tunnel to the trachea is created to avoid visible and problematic adhesions later.

The surgeon will move the muscles in front of the thyroid cartilage aside so that they can reduce the volume of the most prominent parts, for a smaller Adam’s apple.

Trachea shave: cost involved

Cost shouldn’t be the primary criteria you use when choosing a surgeon for your tracheal shaving procedure. But we understand that price is decisive for many patients.

As a ballpark figure, the cost may range from a few hundred euros to several thousand.

Some of the most important factors influencing the cost of the surgery are:

  • The surgeon’s level of qualifications and experience. Highly specialized doctors offering consistent, quality work and care services are generally higher priced than less experienced practitioners. It is important, however, to consider the potential costs that could result from any post-op complications if you choose a less qualified surgeon without less adequate aftercare services.
  • The type of anesthesia used. Many surgeons still strongly recommend general anesthesia for this procedure, which requires an anesthesiologist, extra convalescence time and so raises the cost. Although general anesthesia is almost always more comfortable for the patient, some centers offer a less expensive “day surgery” option.
  • “Bundling” with other facial feminization surgeries. Some doctors will reduce the price of an Adam’s apple reduction when done at the same time as other procedures. These might be a jaw reduction or forehead reconstruction.
  • Geographic location. Healthcare costs in general vary widely from country to country, and this will also influence tracheal shave cost. Surgeons in the US, UK and Australia usually charge the most, while prices in Spain and Thailand are often cheaper. It’s important to weigh these reduced costs against the standards of care for that country.

Scarring and recovery after a trachea shave

For most patients, tracheal shave recovery is uneventful and relatively pain free.

Not surprisingly, there will be some redness, swelling and bruising near the incision site. It’s important to follow your doctor’s instructions to clean and care for the stitch.

You will probably have some difficulty swallowing after your surgery, so you might want to take that into account when planning meals beforehand.

Whether you are left with a noticeable scar from your tracheal shave depends on several things: Mainly the surgeon’s skill level, your biological tendency to form scar tissue, and how you care for the scar.

You can significantly reduce your risk of a trachea shave scar by choosing your specialist carefully and following all the post-op instructions you are given.

For example, your doctor might recommend that you apply topical ointments and gently massage the area to break up the scar tissue during tracheal shave recovery. Nowadays, there are a multitude of cosmetic treatments that help reduce the appearance of inevitable scars, such as laser and micropigmentation techniques.

Possible complications from tracheal shave surgery

With advanced medical techniques, complications from an Adam’s apple reduction are very rare.

But it’s important to remember that the enlarged thyroid cartilage is what makes voice pitch drop. There have been cases in which patients experienced a voice change of some kind after trachea shave surgery.

If it’s important to you that your voice remains the same, make sure you communicate this to your doctor.

So long as you seek services from a highly qualified surgeon with specialized experience in trachea shave, the chances of vocal cord damage due to the operation are very low. Read our blog for more information about tracheal shaves and voice surgery.

Tips to get the best results from your tracheal shave

  • Do your research and find an experienced surgeon to prevent visible scarring and complications, such as vocal cord damage.
  • Follow all post-op instructions carefully (scar care, voice rest, etc.).
  • Avoid electrolysis for hair removal around the incision until your doctor says it is okay for you to do so.

Have realistic expectations and remember that the Adam’s apple is just one of many facial gender markers. Remember that the doctor might not be able to remove as much thyroid cartilage as you had hoped.

Tracheal shave in facial feminization surgery