The Adam’s apple, or laryngeal prominence, is a visible protrusion of the thyroid cartilage surrounding the voice box (larynx). This structure protects the vocal cords. This natural prominence can be surgically reduced through an elective cosmetic procedure. This surgery is often sought by individuals who feel their neck contour does not align with their personal gender identity or aesthetic goals.
Anatomical Context and Procedure Name
The Adam’s apple is formed by the angle of the thyroid cartilage. Its prominence is determined by hormonal factors, primarily testosterone, during puberty. Increased testosterone causes the laryngeal structure to grow and tilt forward, resulting in a more pronounced bump and a deepening of the voice. This feature is typically more noticeable in individuals assigned male at birth.
The surgical procedure to reduce this prominence is medically termed chondrolaryngoplasty, often referred to as a tracheal shave. This operation is a common component of facial feminization surgery for many transgender women. The goal of the procedure is purely aesthetic, creating a smoother, softer contour in the neck area.
The Surgical Process
Chondrolaryngoplasty is performed by specialized surgeons, typically taking less than an hour under general anesthesia. The surgeon makes a small, horizontal incision in the neck, often placed within a natural skin crease to minimize scar visibility. Through this incision, the surgeon exposes the thyroid cartilage.
Once the cartilage is visible, the surgeon must precisely identify the location of the vocal cords, which attach to the inner aspect of the cartilage. Modern techniques often involve using an endoscope to visualize the vocal cords from the inside. This direct visualization guides the surgical reduction and prevents accidental injury to the vocal cord attachments. Specialized tools are then used to carefully shave down the most protruding part of the thyroid cartilage until the desired reduction is achieved.
The reduction is performed with caution, as removing too much cartilage can compromise the structural integrity of the larynx or damage the vocal cords. The goal is to remove the anterior projection while leaving enough cartilage to maintain a safe and functional airway. After the contour is smoothed, the muscles and skin layers are sutured closed. Placing the incision in a natural fold helps the scar heal inconspicuously.
Post-Operative Care and Potential Complications
Following the procedure, patients can expect a few days of mild discomfort, often described as a sore throat. Swelling and bruising around the neck are common for the first week, and the voice may be temporarily hoarse or fatigued. Patients are advised to rest their voice and consume soft foods for the first 24 to 48 hours to aid healing. Swelling gradually subsides, with a significant reduction visible within the first month.
Recovery involves meticulous scar care, including avoiding sun exposure on the incision site to prevent hyperpigmentation. Although the procedure is generally safe, potential complications exist, most notably those related to vocal function. Permanent voice changes, such as hoarseness or alterations in pitch, are rare but can occur if the vocal cord attachments are inadvertently disturbed during the reduction.
Other risks include infection, hematoma formation (a collection of blood), and visible scarring, especially if the patient is prone to keloids. Sometimes, a patient may experience a contour irregularity or feel the Adam’s apple was under-corrected, resulting in a residual prominence. Experienced surgeons take careful measures, including preoperative imaging and intraoperative visualization, to minimize these risks and ensure the best possible aesthetic and functional outcome.