The Adam’s apple is the common term for the laryngeal prominence, a visible bulge in the neck formed by the anterior portion of the thyroid cartilage. This structure houses and protects the voice box and becomes more pronounced in some individuals due to hormonal changes during puberty. The surgical procedure to reduce this feature is known as chondrolaryngoplasty, often called a tracheal shave. This operation contours the thyroid cartilage, creating a smoother neck profile while preserving the functionality of the underlying vocal structures.
Understanding the Tracheal Shave Procedure
The goal of the chondrolaryngoplasty procedure is to surgically reduce the most protruding part of the thyroid cartilage without compromising the integrity of the airway or the vocal cords. The surgery is typically performed under general anesthesia, though some surgeons use local anesthesia with sedation. The surgeon makes a small, horizontal incision, often strategically placed within a natural neck crease to minimize scar visibility. Once the thyroid cartilage is exposed, the surgeon carefully reduces the excess cartilage by shaving it down with specialized instruments.
This process requires precision because the vocal cords, which are attached just behind the cartilage, must remain intact. The surgeon must avoid removing too much cartilage at the point where the vocal folds attach to prevent permanent voice changes. Some surgeons employ a fiberoptic scope through the mouth to visualize the vocal cords in real-time during the reduction, ensuring safety. This direct visualization helps determine the safe limit of cartilage removal to achieve the desired contour while maintaining structural support for the larynx.
Following the reduction, the incision is closed with fine sutures. The procedure is often completed within one to two hours, frequently as an outpatient surgery.
What to Expect During Recovery
Immediately following the procedure, patients experience mild to moderate swelling, bruising, and soreness in the throat area. This discomfort is often described as feeling like a sore throat, sometimes exacerbated by the breathing tube used during the operation. Pain is usually minimal and managed effectively with non-narcotic pain relievers.
A temporary change in voice, such as hoarseness, is common due to swelling around the larynx, but this resolves within the first week. Patients are advised to rest their voice and consume a soft-food or liquid diet until swallowing feels comfortable. Most individuals can return to work and light activities within one week. Strenuous exercise should be avoided for several weeks to prevent strain on the neck.
The final aesthetic results become apparent as post-operative swelling diminishes over the first few weeks. The scar will continue to mature and fade over six to twelve months. Surgeons provide specific instructions for scar management, such as applying topical treatments or gentle massage. Adhering to these post-operative instructions is important for a smooth recovery and the best cosmetic outcome.
Potential Surgical Risks
While chondrolaryngoplasty is generally considered a low-risk procedure, specific complications are associated with operating in this delicate area. The most significant concern is the potential for voice alteration, manifesting as chronic hoarseness, a deepened pitch, or loss of the upper vocal range. This complication, though rare with experienced surgeons, can occur if the vocal cord attachment points are damaged or destabilized during reduction.
Other risks include general surgical complications like infection, bleeding, and the formation of a hematoma (a collection of blood under the skin). Patient dissatisfaction often stems from the aesthetic outcome, such as the appearance of a noticeable scar. Furthermore, there is a risk of either insufficient cartilage removal, leaving a residual prominence, or excessive removal, which can compromise the structural integrity of the larynx.
Excessive cartilage removal can lead to dislocation of the anterior commissure—the point where the vocal folds meet—requiring a complex revision procedure. Patients must discuss all these possibilities with their surgeon. Managing expectations about the degree of reduction achievable is a necessary part of the pre-operative consultation.
Patient Considerations for Reduction
The decision to undergo a tracheal shave is highly personal, driven by the desire for a more harmonious neck contour. While most frequently sought by transgender women as gender-affirming care, it is also performed on cisgender individuals who feel their Adam’s apple is too large. The procedure’s primary function is to align physical appearance with a desired aesthetic.
A thorough pre-operative consultation is required to assess the individual’s anatomy and discuss realistic expectations for the outcome. Because of the delicate nature of the surgery and its proximity to the vocal mechanism, it is important to select a board-certified plastic surgeon or an otolaryngologist with specific experience. The surgeon should be able to demonstrate a clear understanding of laryngeal anatomy to minimize the chance of complications.
The consultation covers the patient’s medical history and psychological readiness for the surgery. Counseling is often recommended to ensure the patient has fully considered the implications, though formal psychological clearance is not universally mandated. Choosing a surgeon with a track record of successful chondrolaryngoplasty results is the most important factor for achieving a safe and satisfactory outcome.