A tracheal shave, formally known as chondrolaryngoplasty, is a cosmetic surgical procedure designed to reduce the size of the laryngeal prominence, commonly referred to as the Adam’s apple. This prominence is an outward projection of the thyroid cartilage, which protects the vocal cords. The surgery aims to contour this cartilage for a smoother, more feminine neck profile.
Pre-Surgical Planning and Patient Candidacy
The initial phase involves a thorough consultation where the surgeon reviews the patient’s complete medical history and aesthetic goals. This procedure is most frequently sought by transgender women as a component of facial feminization surgery to alleviate gender dysphoria associated with a prominent neck contour. However, any individual, including cisgender women and men, with a naturally enlarged Adam’s apple seeking an aesthetic change may be considered a candidate.
A qualified surgeon will carefully assess the laryngeal anatomy, sometimes using imaging like a CT scan, to determine the extent of reduction possible without compromising the underlying vocal structures. Managing expectations is an important part of this discussion, particularly regarding the voice, as this procedure is solely cosmetic and does not typically change vocal pitch or quality.
The Procedure: Surgical Mechanics
A chondrolaryngoplasty is typically performed under general anesthesia, though local anesthesia with sedation is sometimes used. The procedure usually takes less than 90 minutes. The surgeon begins by making a small, horizontal incision, usually about two centimeters long, in a discreet location such as a natural skin crease beneath the chin. Placing the incision in a pre-existing fold helps to minimize the scar.
Through this incision, the surgeon carefully dissects the soft tissues and muscles to expose the underlying thyroid cartilage. The most projecting part of the cartilage, known as the superior thyroid notch, is identified and reduced. The reduction is performed using specialized instruments, such as a scalpel, rongeur, or a high-speed burr, to precisely shave down the cartilage.
During the shaving process, the surgeon exercises extreme caution to avoid contact with the vocal cords, which attach to the lower aspect of the thyroid cartilage. Some surgeons use a laryngoscope, a small camera inserted through the mouth, to visually monitor the vocal cords from the inside throughout the procedure. Once the desired contour is achieved, the muscle layers and the skin incision are closed using sutures, sometimes with a small drain temporarily placed to prevent fluid accumulation.
Post-Operative Healing and Results
Immediately following the procedure, patients can expect some discomfort, swelling, and bruising in the throat area. Pain is typically managed with medication and most patients report that the initial soreness feels similar to a bad sore throat. It is usually recommended that patients maintain a soft or liquid diet for the first few days and limit strenuous activity to aid the healing process.
Temporary changes to the voice, such as hoarseness, a rough texture, or a slightly weaker voice, are common in the days following surgery due to the swelling around the voice box and irritation from the breathing tube used during general anesthesia. These temporary vocal alterations usually resolve as the swelling subsides over the first few weeks. While permanent voice changes are rare, they are a potential risk if the vocal cord attachments are inadvertently damaged during the cartilage reduction.
The aesthetic results are often noticeable immediately, but the final, smooth neck contour emerges as the post-operative swelling resolves, which typically takes three to four weeks. The incision line will initially be red and visible, but with proper scar care, it will gradually fade and mature over a period of six to twelve months. Other potential complications include prolonged swelling, localized numbness, and the development of thickened or raised scars, such as keloids, which can be managed with specific treatments.