The visible prominence on the front of the throat, commonly known as the Adam’s apple, is a part of the body’s natural anatomy that can be surgically reduced. This procedure is a cosmetic modification sought by individuals who desire a smoother neck contour, often as part of gender affirmation or due to personal aesthetic preference. While the structure cannot be truly “removed” without severe complications, its visible protrusion can be significantly lessened.
Understanding the Laryngeal Cartilage
The Adam’s apple is the colloquial term for the laryngeal prominence, the most visible portion of the thyroid cartilage. This shield-shaped structure is the largest of the nine cartilages that form the larynx, or voice box. Its primary function is to protect the delicate vocal cords housed immediately behind it. The size of this prominence is influenced by testosterone during puberty. In individuals with higher testosterone levels, the thyroid cartilage grows larger and joins at a sharper angle, causing it to jut out noticeably and simultaneously lengthening the vocal cords, resulting in a deeper voice. In others, the structure remains smaller and less visible.
The Tracheal Shave Procedure
Surgical Technique
The surgical procedure to reduce the Adam’s apple is formally known as chondrolaryngoplasty, or more commonly, a tracheal shave. This operation focuses on reducing the anterior projection of the thyroid cartilage to create a flatter profile and typically takes one to two hours. The surgeon usually makes a small, horizontal incision in a natural skin crease of the neck or directly over the prominence to minimize scarring. Once the thyroid cartilage is exposed, specialized instruments are used to shave down the protruding edge.
Protecting the Vocal Cords
The vocal cords, anchored to the interior surface of the cartilage, must be protected from damage during the reduction. Many surgeons use a fiber optic camera, or laryngoscope, inserted through the mouth to visualize the vocal cord attachment point (the anterior commissure) from the inside. This visualization ensures that only the cartilage above the attachment is reduced, preventing destabilization of the vocal mechanism. The surgery is commonly performed under general anesthesia, but local anesthesia combined with intravenous sedation is also an option.
Navigating Pre- and Post-Surgical Care
Pre-Surgical Preparation
The pre-surgical process begins with a consultation and medical evaluation to ensure the patient is an appropriate candidate. Patients are required to stop smoking several weeks before surgery and discontinue the use of certain medications, such as blood thinners and anti-inflammatory drugs, which increase the risk of bleeding. The surgeon will also evaluate the patient’s vocal health, sometimes using a laryngoscopy, to map the precise location of the vocal cords before the operation.
Recovery and Aftercare
Following the procedure, the patient is typically monitored for a few hours before being released, as the surgery is often performed on an outpatient basis. Patients should expect swelling, bruising, and mild throat soreness. Full recovery time varies, but most individuals can return to work and light daily activities within one to two weeks. Post-operative care involves wound management and following specific restrictions to minimize scarring. Patients are advised to consume soft foods, avoid strenuous activity for several weeks, and utilize voice rest immediately after surgery to allow the laryngeal tissues to heal.
Safety Considerations and Potential Side Effects
While the tracheal shave is considered safe when performed by an experienced surgeon, it carries specific risks related to its proximity to the vocal apparatus. The most significant concern is the potential for a permanent change in vocal quality or pitch. If the reduction is too aggressive and affects the cartilage at the vocal cord attachment point, it can lead to a weaker, breathy, or altered voice. Temporary side effects, such as hoarseness, are common immediately after surgery due to swelling or irritation from the procedure. Other general surgical risks include:
- Infection at the incision site.
- Excessive bleeding or the formation of a hematoma (a collection of blood under the skin).
- Scarring, including the development of hypertrophic scars or keloids.
- Insufficient cartilage reduction, potentially requiring revision surgery.