The structure commonly known as the Adam’s apple can be surgically reduced in size, a procedure typically sought for aesthetic reasons. This surgery is often performed as part of facial feminization for transgender individuals seeking to align their physical appearance with their gender identity. It is also an option for cisgender individuals who feel self-conscious about a naturally prominent neck contour. Surgical reduction is the only reliable method to achieve this cosmetic change, as the underlying cartilage structure does not diminish with hormone therapy or other non-surgical means.
Understanding the Laryngeal Prominence
The visible protrusion in the neck is formally called the laryngeal prominence, which is the anterior meeting point of the two plates of the thyroid cartilage. This cartilage is the largest structure of the larynx, or voice box, and its primary function is to shield the vocal cords located just behind it. The prominence is a secondary sex characteristic that develops during puberty due to the influence of testosterone.
This hormonal surge causes the laryngeal framework to grow larger, which lengthens the vocal cords and deepens the voice. In individuals who undergo a testosterone-dominant puberty, the angle where the two cartilage plates meet becomes more acute, resulting in the characteristic outward projection. Reducing this prominence surgically requires careful recontouring of the thyroid cartilage itself.
The Tracheal Shave Procedure
The surgical operation to reduce the laryngeal prominence is medically termed chondrolaryngoplasty, though it is more commonly known as a tracheal shave. The goal is to carefully shave down the protruding cartilage to create a smoother, less noticeable neck profile. The procedure is typically performed under general anesthesia or local anesthesia with sedation, and it often takes between 30 to 90 minutes.
The surgeon makes a small, horizontal incision, often placed within a natural neck crease or beneath the chin to minimize scar visibility. Through this incision, the surgeon exposes the thyroid cartilage, taking care to identify the point where the vocal cords attach to the interior surface. Using specialized instruments, the exposed cartilage is meticulously shaved and recontoured to reduce its projection.
Precision is paramount because removing too much cartilage can compromise the structural integrity of the larynx or damage the vocal cord attachment point. The procedure is a reduction, not a complete removal, ensuring that the airway and vocal function are preserved. Once the desired contour is achieved, the incision is closed with fine sutures, and a dressing is applied.
The Recovery Process
Following the tracheal shave procedure, patients can expect immediate swelling, bruising, and discomfort in the neck area. Many experience a temporary sore throat and mild difficulty or pain when swallowing (dysphagia or odynophagia) for the first few days. It is often recommended to maintain a soft diet until the throat feels comfortable with regular food.
Stitches are typically removed about one week after the surgery, though this timeline varies depending on the suture technique used. Most patients are able to return to work and resume normal daily activities within one to two weeks. While initial improvement is visible right away, significant swelling can take up to four to six weeks to resolve. The final aesthetic result, with the scar fading, may take several months, sometimes up to nine months.
Surgical Risks and Voice Preservation
As the procedure is performed directly on the larynx, the most significant risk involves potential changes to the voice. Since the vocal cords anchor to the thyroid cartilage at the anterior commissure, excessive removal of cartilage can cause permanent hoarseness or a change in vocal pitch and strength. Surgeons must take great care to avoid damaging this attachment point to ensure vocal integrity.
Other potential complications include an unsatisfactory cosmetic result, such as a noticeable scar or continued prominence, sometimes requiring revision surgery. Infection and the formation of a hematoma (a collection of blood under the skin) are risks inherent to any surgical procedure. A pre-surgical evaluation, often including a laryngoscopy to visualize the vocal cords, helps the surgeon plan the reduction safely. Consulting with an experienced surgeon who specializes in this delicate area is advised to minimize the risk of long-term vocal complications.