It is possible to surgically alter or reduce the projection of the structure commonly called the Adam’s apple. This procedure is generally sought for cosmetic reasons to create a smoother, less prominent neck profile. The surgery is most often performed as part of gender-affirming care for transgender women, but it is also an option for anyone who feels their neck contour is too pronounced. The goal of this elective surgery is to feminize the appearance of the throat.
Understanding the Adam’s Apple
The Adam’s apple is not a separate, removable organ, but the visible outward projection of the thyroid cartilage, which is formally known as the laryngeal prominence. This structure is the largest of the nine cartilages that make up the larynx, or voice box. The thyroid cartilage protects the delicate vocal cords and other soft tissues within the larynx.
The prominence forms where the two sheets of the thyroid cartilage meet at an angle in the anterior midline of the neck. This angle is typically sharper and more acute in individuals assigned male at birth (around 90 degrees) compared to individuals assigned female at birth (approximately 120 degrees). The growth and resulting sharper angle of the cartilage are influenced by hormonal changes during puberty, making the laryngeal prominence significantly more visible in males. The increased size and angulation also contribute to the lengthening of the vocal cords, which results in a deeper voice.
The Surgical Process of Reduction
The surgical procedure used to reduce the laryngeal prominence is called chondrolaryngoplasty, often referred to as a tracheal shave. The operation is focused on carefully shaving down the most prominent part of the thyroid cartilage to lessen its projection and achieve a smoother neck contour. The surgeon begins by making a small, horizontal incision, often strategically placed within a natural skin crease of the neck to minimize the visibility of the resulting scar.
The surgeon gently dissects through the soft tissues to expose the underlying thyroid cartilage. Using specialized instruments, the anterior and superior portions of the cartilage are shaved or excised. Advanced techniques may incorporate intraoperative visualization, such as a flexible laryngoscope, to precisely identify the location of the vocal cords and the anterior commissure where they attach. This precision is paramount because the goal is reduction, not complete removal, which is necessary to maintain the structural integrity of the larynx and protect the vocal mechanism.
Once the desired reduction is achieved, the surgeon closes the incision with sutures. The procedure is typically performed on an outpatient basis under local or general anesthesia and generally takes between one and two hours. Some newer techniques avoid a neck scar entirely by performing the reduction endoscopically through a small incision placed under the chin or even inside the mouth.
Protecting the Voice: Risks and Considerations
The delicate proximity of the laryngeal prominence to the vocal cords makes voice preservation the primary concern during chondrolaryngoplasty. The vocal cords attach to the interior surface of the thyroid cartilage at a point called the anterior commissure. Removing too much cartilage in this area can destabilize this attachment, potentially leading to vocal changes.
Excessive removal of the cartilage can weaken the structural support of the voice box, which may result in a weakened voice, hoarseness, or a permanent change in pitch or vocal quality. Surgeons must use caution and specialized techniques, such as intraoperative needle localization, to ensure they do not accidentally nick the vocal cords or disrupt their attachment point. Such complications, while rare, can cause significant vocal impairment, requiring further surgical intervention to correct.
Choosing a surgeon with specific experience in head and neck procedures or facial feminization surgery is important due to the intricate anatomy of the larynx. Beyond voice-related concerns, the procedure carries the general surgical risks of infection, bleeding, and poor wound healing. Nerve damage to the surrounding structures, such as the superior laryngeal nerve, is another risk that could impact sensation or muscle function in the throat area.
Recovery Timeline and Long-Term Outcomes
Following the chondrolaryngoplasty procedure, patients can expect some immediate swelling and bruising in the neck area. It is common to experience a sore throat or some temporary hoarseness, which is often due to the swelling around the vocal mechanism. Patients are frequently advised to limit strenuous activity and may be asked to rest their voice for a period to aid in the initial healing.
The initial healing phase typically lasts about one to two weeks, and most patients feel comfortable enough to return to work and light daily activities within the first week. Sutures, if external, are usually removed around seven to ten days after the operation. While the initial results of a smoother neck are often apparent immediately after the swelling begins to subside, the final aesthetic outcome may take several months to fully realize.
The long-term aesthetic outcome is a permanently smoother, less prominent neck profile. Scars are usually minimal and designed to be hidden in a natural neck crease, though they will fade over six to twelve months. Patients should understand that the amount of cartilage removed is limited by safety considerations to protect the voice, meaning a small, residual prominence may remain to ensure vocal integrity.