The visible protrusion on the front of the neck, commonly called the Adam’s apple, is the thyroid cartilage. This is the largest piece of cartilage forming the larynx, or voice box. The prominence becomes notably larger in some individuals following puberty due to hormonal effects. While this structure protects the vocal cords, its size can be surgically altered through an elective procedure. This specialized cosmetic modification effectively reduces the laryngeal prominence, creating a smoother, less noticeable neck contour.
Understanding the Procedure
The surgical procedure to reduce the Adam’s apple is formally known as chondrolaryngoplasty, though it is often referred to as a tracheal shave. The goal of the operation is to carefully shave down the most prominent, anterior portion of the thyroid cartilage. This aesthetic modification is performed under general anesthesia, though local anesthesia with sedation may be used.
To begin the process, the surgeon makes a small horizontal incision, typically two to three centimeters long. This incision is placed within a natural skin crease on the neck or high under the chin. This strategic placement helps to camouflage the resulting scar once it has matured. Once the incision is made, the surgeon carefully separates the soft tissues and muscles to expose the thyroid cartilage.
The most delicate part of the procedure involves reducing the cartilage without damaging the vocal cords. The vocal cords are attached to the inner surface of the thyroid cartilage at a point called the anterior commissure. The surgeon must carefully identify this precise location to ensure the reduction does not compromise vocal function. Specialized techniques, sometimes involving endoscopic visualization, are used to safely mark the limit of the resection.
Using a scalpel or a specialized instrument called a rongeur, the surgeon meticulously reduces the upper and anterior edges of the cartilage. The amount of cartilage removed is carefully calculated to achieve the desired aesthetic reduction while maintaining the structural integrity of the larynx. The entire operation typically takes between one and two hours to complete, after which the incision is closed with fine sutures.
Motivations for Reduction
The primary group of individuals who seek Adam’s apple reduction surgery are transgender women undergoing gender affirmation. For this population, the prominent laryngeal cartilage is a distinctly masculine secondary sex characteristic that can cause significant distress or gender dysphoria. Reducing this feature helps to align their physical appearance with their internal gender identity, contributing to a more feminized neck and facial profile.
For many, this procedure is a profoundly affirming step in their transition, allowing them to feel more comfortable and confident in their appearance. The surgery addresses a physical trait that often makes it difficult for them to be perceived by others in a way that matches their gender. Reducing the prominence can be a powerful psychological relief that improves their overall quality of life.
The procedure is also sought by cisgender men and women who feel their laryngeal prominence is too large or disproportionate to their overall neck and face structure. Some individuals are self-conscious about a naturally prominent Adam’s apple, even if it is not related to gender identity. For these patients, the motivation is purely cosmetic, seeking a smoother neck contour for aesthetic reasons.
Recovery and Potential Complications
Following the procedure, patients can expect some swelling, bruising, and mild soreness in the throat and neck area. Most chondrolaryngoplasty procedures are performed on an outpatient basis, allowing the patient to return home the same day. An overnight stay may be required if the procedure is combined with other surgeries. Pain is generally manageable with medication, and discomfort often subsides significantly within the first few days.
A common temporary side effect is a change in the voice, such as hoarseness or a temporary loss of vocal strength, due to post-surgical swelling near the vocal cords. Surgeons advise patients to rest their voice as much as possible for the first week to prevent unnecessary strain. Most patients are able to return to work and light daily activities within one week of the operation.
As with any surgery, there are risks, including infection and the formation of a hematoma, which is a collection of blood under the skin. A specific risk of this procedure is the potential for permanent voice alteration if the vocal cord attachment, the anterior commissure, is inadvertently damaged. This can result in a change in voice pitch or chronic hoarseness, which highlights the importance of surgical precision.
The typical recovery timeline involves avoiding strenuous activity, heavy lifting, or intense exercise for about four to six weeks. During this period, the majority of the internal healing takes place, and most of the noticeable swelling resolves. Patients are often given instructions for scar care, such as gentle massage, to help the incision site heal as discreetly as possible.
Long-Term Outcomes and Expectations
The aesthetic results of a tracheal shave are considered permanent because the thyroid cartilage that is removed does not grow back. The final neck contour becomes evident after the post-operative swelling has fully dissipated, which can take several months. Most patients see a significantly reduced or virtually absent laryngeal prominence, resulting in a much smoother neck profile.
The voice is generally stable in the long term, as the procedure is primarily a cosmetic alteration of the external cartilage and does not target the vocal cords themselves. While subtle changes in vocal resonance may occur, the procedure is not intended to raise the fundamental pitch of the voice. Long-term studies show a high rate of patient satisfaction regarding the aesthetic appearance of the neck after the surgery.
The appearance of the scar continues to mature and fade over the course of six to twelve months, eventually blending into the natural lines of the neck. Achieving the optimal aesthetic outcome depends heavily on the individual’s anatomy and the surgeon’s skill. Patients should understand that the extent of the reduction is limited by the underlying anatomy to ensure safe and stable vocal function.