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Tracheal Shave in Facial Feminization Surgery

May 27, 2019

Tracheal shave

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, a trachea shave 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, 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 surgery. 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 shave used as verbal shorthand.

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, tracheal shaving is the removal of thyroid cartilage 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.

What the tracheal shave procedure involves

If the trachea 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 tracheal shaving 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.

Tracheal shave cost

Although it should not be the primary criteria used to choose a surgeon for your tracheal shaving procedure, we understand that price is relevant for many patients. Unfortunately, it is difficult to give an exact cost for a trachea shave because so many factors affect the price. As a ballpark figure, we could say that the cost can 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 with a reputation for quality work are in greater demand, and therefore their prices are generally higher than less experienced practitioners. It is important, however, to consider the potential costs that could arise from any post-op complications with a less qualified surgeon.
  • The type of anesthesia used. When performed by itself, a trachea shave can be done using only local anesthesia. Many surgeons still strongly recommend general anesthesia for this procedure, however, which requires the services of an anesthesiologist. This can raise the cost of the tracheal shave rather dramatically, but if there is no medical contraindication for it, general anesthesia is almost always more comfortable for the patient.
  • “Bundling” with other facial feminization surgeries. Some doctors will reduce the price of an Adam’s apple reduction when it is done at the same time as other procedures, such as 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, Brazil and Thailand are often cheaper. It is important to weigh these reduced costs against the standard of care for that country; although it may be possible to get a very inexpensive surgery in Thailand, many patients feel more comfortable paying a bit more to have the quality assurance that comes with medical care in a European country.

Scarring and recovery after a trachea shave

For most patients, tracheal shave recovery 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. You will probably have some difficulty swallowing after your surgery, so you may want to plan on having soft foods on hand.

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 during tracheal shave recovery.

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.

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.

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