The protrusion commonly known as the Adam’s apple is formally termed the laryngeal prominence. This is the most visible part of the thyroid cartilage surrounding the larynx, or voice box. This cartilage structure protects the vocal cords and enlarges significantly during puberty in individuals with testosterone-dominant hormone profiles, creating the characteristic neck bump. For those seeking a smoother neck contour, it is possible to reduce the size of this prominence through a surgical procedure that aims to shave down the projecting cartilage.
The Procedure: Defining the Surgery and Candidates
The surgical procedure to reduce the size of the laryngeal prominence is called a chondrolaryngoplasty, often colloquially referred to as a tracheal shave. The goal of this operation is not the complete removal of the thyroid cartilage, which is necessary for protecting the airway and supporting the vocal cords. Instead, the surgeon carefully reduces and contours the outermost, projecting portion of the cartilage to create a flatter profile.
The primary motivation for seeking chondrolaryngoplasty is often gender affirmation for transgender women and non-binary individuals who desire a more feminine neck contour. The reduction of the Adam’s apple is a common component of facial feminization surgery, helping to alleviate gender dysphoria. The procedure is also sought by cisgender individuals who feel their laryngeal prominence is excessively large for cosmetic reasons.
Candidates must understand that the procedure focuses on aesthetic reduction, leaving the functional parts of the larynx intact. A successful outcome depends on a delicate balance between achieving the desired reduction and maintaining the structural integrity of the voice box. This balance is crucial because the thyroid cartilage is an integral component of the vocal apparatus.
Surgical Technique and Voice Preservation
The operation typically begins with the administration of anesthesia, which can be local with sedation or general. The surgeon usually makes a small, horizontal incision, often about two centimeters in length, placed strategically within a natural skin crease of the neck to minimize scar visibility. Once the incision is made, the surrounding muscles are gently separated to expose the thyroid cartilage beneath.
The protruding cartilage is then carefully shaved down using specialized surgical instruments, such as a scalpel or a bur. The most significant technical challenge is the proximity of the true vocal cords, which attach to the interior surface of the thyroid cartilage at the anterior commissure. If the reduction is too aggressive, the connection point of the vocal cords can be damaged, leading to vocal changes.
To mitigate the risk of voice alteration, many experienced surgeons use an intraoperative technique called direct laryngoscopy. This involves inserting a small camera through the mouth to visualize the exact location of the vocal cords during the shaving process. This visual guidance ensures the surgeon only removes the cartilage above the level of the vocal cord attachment, preserving the integrity of the voice mechanism. If insufficient cartilage is removed, the aesthetic outcome may be unsatisfactory. Conversely, excessive removal risks destabilizing the larynx and causing permanent hoarseness or a lower-pitched voice.
Recovery, Risks, and Final Outcomes
Recovery from chondrolaryngoplasty is generally smooth, with most patients able to return to daily activities within about one week. The procedure is often performed on an outpatient basis, meaning a hospital stay is not required. Following the surgery, patients can expect some soreness and swelling in the throat area, which may feel similar to a common sore throat.
Temporary hoarseness or a slight change in the voice is common due to swelling around the voice box and potential irritation from the breathing tube used during general anesthesia. This temporary voice change usually resolves as the swelling subsides over a few weeks. Postoperative care often includes mild to moderate pain relievers. Patients are advised to limit voice strain, such as yelling or singing, during the initial healing phase.
Like any surgical procedure, there are potential risks, although serious complications are rare when performed by an experienced specialist. Potential complications include infection, hematoma formation (a collection of blood under the skin), and visible scarring. The scar typically fades to a thin, inconspicuous line over a year with proper care. The most significant specific risk is a permanent change in voice quality, such as persistent hoarseness or weakness, resulting from inadvertent damage to the vocal cord attachment site.
Final aesthetic outcomes are typically very satisfying, with the laryngeal prominence significantly reduced to create a smoother neck contour. However, patients must have realistic expectations, as the extent of reduction is limited by the anatomical location of the vocal cords. If the vocal cords attach unusually high, a small degree of prominence may remain even after the maximum safe amount of cartilage is removed.