A prominent feature commonly known as the “Adam’s Apple” can be surgically reduced in size. This modification is a form of cosmetic or gender-affirming surgery sought by individuals who desire a smoother, less pronounced neck contour. The procedure, which involves carefully reshaping the throat anatomy, is a common step in facial feminization for many transgender women.
Understanding the Laryngeal Prominence
The structure referred to colloquially as the Adam’s Apple is formally called the laryngeal prominence. This prominence is the most outwardly visible part of the thyroid cartilage, which is the largest of the nine cartilages that make up the larynx, or voice box. The thyroid cartilage functions like a protective shield, encasing the anterior portion of the larynx and safeguarding the delicate vocal cords housed within.
The thyroid cartilage is shaped like a half-opened book, with its two sides, or laminae, meeting at an angle in the front of the neck. This junction forms the prominent ridge. The degree of this angle determines how much the structure protrudes.
The prominence becomes much more noticeable in individuals assigned male at birth during puberty due to increased testosterone. This hormone causes the larynx to grow larger, increasing the size of the thyroid cartilage and lengthening the vocal cords. This growth makes the cartilage angle more acute, causing the laryngeal prominence to project further outward and deepening the voice. In individuals assigned female at birth, growth is less dramatic, resulting in a less visible prominence.
The larynx serves multiple functions beyond sound production, including acting as a gatekeeper for the airway during swallowing. The vocal cords attach to the inner surface of the thyroid cartilage, just below the point of maximum projection. This close proximity of the vocal mechanism to the area being modified necessitates a specialized surgical technique.
The Chondrolaryngoplasty Procedure
The surgical procedure to reduce the laryngeal prominence is called Chondrolaryngoplasty, often referred to as a “tracheal shave” or “Adam’s Apple reduction.” This operation is typically performed under general anesthesia and generally takes about one to two hours to complete. The goal is to carefully shave down the most prominent part of the thyroid cartilage to create a smoother neck contour.
The surgeon begins by making a small, horizontal incision, usually about one to two centimeters long, in a natural skin crease of the neck just above the prominence. This placement is chosen to help conceal the resulting scar. Through this opening, the surgeon accesses the thyroid cartilage and carefully exposes the area to be reduced.
The precise reduction of the cartilage is done using specialized tools to shave down the protruding section. Care must be taken to stop the reduction before reaching the anterior attachment point of the vocal cords, which lies on the inner surface of the cartilage. Damage to this attachment can lead to changes in voice quality, such as hoarseness or a permanent lowering of the pitch.
To mitigate the risk of vocal cord damage, experienced surgeons often use direct visualization of the larynx, sometimes with an endoscope, or preoperative imaging to map the distance to the vocal cords. This guidance ensures the maximum amount of cartilage is removed for an aesthetic result while preserving the integrity of the vocal mechanism. Once the desired contour is achieved, the incision is closed with sutures.
Post-Operative Care and Considerations
Following Chondrolaryngoplasty, patients typically return home the same day, though some may stay for observation. Immediate post-operative experience involves expected discomfort, swelling, and bruising in the neck, peaking within the first 48 hours. Surgeons prescribe pain medication to manage this mild discomfort, which is often comparable to a sore throat.
During initial recovery, patients are advised to keep their head elevated to reduce swelling. Minimizing throat use is encouraged, as talking or swallowing may be difficult for the first couple of days. Most people can return to normal daily activities, excluding strenuous exercise, within one to two weeks. Sutures are typically removed between seven and fourteen days post-operation.
Potential risks include bleeding, infection, and minor scarring. Scar care is important for long-term recovery, ensuring the incision line fades into a fine, inconspicuous line, which may take up to a year. A significant consideration is the potential for unintended voice changes, such as temporary hoarseness or a weak voice, which usually resolves within a few weeks. Permanent vocal changes are rare, emphasizing the need for a highly skilled surgeon who prioritizes preserving the vocal cord attachments during the reduction process.