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Tracheal Shave in Facial Feminization Surgery

November 17, 2017

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

Medically, it is also one of the simplest operations many people will undergo as part of their transition, since it can be done as an outpatient surgery using only local anesthesia.

In this post, we’ll talk about why tracheal shaves are so often sought by patients as part of FFS, along with a guide to the procedure, recovery and tips for prospective patients.

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What is a tracheal shave?

There are several different terms used that all refer to the same surgery. Trachea shave, Adam’s apple reduction, TCR (thyroid cartilage reduction) and chondrolaryngoplasty are all names for the same procedure.

When a tracheal shave is used 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, thyroid cartilage is being removed from in front of the larynx.

All people, regardless of gender, have a small amount of cartilage in the throat to protect the vocal cords. During puberty, hormonal changes cause this cartilage to grow and form a sort of bump in people assigned male at birth (AMAB).

When the Adam’s apple increases in size, it causes voice pitch to become deeper. A prominent bump is considered to be a masculine secondary sex 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.

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What the tracheal shave procedure involves

If the tracheal shave is the only surgery that will be performed, it can be done under local anesthesia as an outpatient procedure, or in an operating room under general anesthesia, depending on your doctors’ recommendations.

However, many times the Adam’s apple reduction is done at the same time as other facial feminization surgical procedures (e.g. jaw reduction, forehead reduction, rhinoplasty, etc.). In this case, you will be put under general anesthesia for the operation.

Every surgeon’s technique will be slightly different, which is why it is very important to find a cosmetic surgeon who has specialization in tracheal shaves and FFS in general. The usual method is to make a small, horizontal incision just above the bump that needs to be reduced. The surgeon will fold back the muscles in front of the thyroid cartilage so that they can access it and reduce the size of the most prominent parts. Finally, the whole thing is stitched back up over the now smaller Adam’s apple.

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Scarring and recovery after a trachea shave

For most patients, recovery from the tracheal shave is uneventful and relatively pain free. Unsurprisingly, there will be some redness, swelling and bruising near the incision site. It is important to follow your doctor’s instructions to clean and care for the sutured incision.

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 after the stitches are removed.

Obviously, one of these is out of your hands, but 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 scar to break up the scar tissue.

Possible complications from tracheal shave surgery

With advanced medical techniques, complications from an Adam’s apple reduction are very rare. But it is important to remember that the enlarged thyroid cartilage is what makes voice pitch drop, and there have been cases where patients experienced a voice change of some kind after trachea shave surgery. If it is important for you that your voice does not change, make sure you communicate this to your doctor.

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So long as you seek treatment from a highly qualified surgeon with specialized experience in trachea shave and facial feminization, the chances of vocal cord damage during the operation are very low.

Tips to get the best results from your tracheal shave during FFS:

  • Do your research and find an experienced surgeon to prevent visible scarring and complications, such as vocal cord damage.
  • Follow all post-op instructions (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. Even if the doctor is not able to remove as much thyroid cartilage as you had hoped, other features can balance this out for an overall feminine appearance