Facial feminization surgery / Neck
Tracheal Shave
A tracheal shave reduces the prominence of the Adam's apple by contouring the cartilage at the front of the neck. It is not a routine part of facial feminization surgery with Dr. Ovadia; it may be part of your surgical plan when it is something you and he have discussed.
Overview
What the Adam's apple is
The Adam's apple is the front edge of the thyroid cartilage, the shield-shaped cartilage that sits in front of the voice box. It is more prominent in people who went through a testosterone-driven puberty, because the cartilage grows larger and sits at a sharper angle.
A tracheal shave flattens that prominence. It does not change the voice box itself or the vocal cords, and it does not change the pitch of the voice.
How it works
What happens in surgery
A small incision in a neck crease
The incision is short and is placed in one of the natural horizontal creases of the neck, where it is least noticeable once healed, rather than directly over the Adam's apple.
Reaching the thyroid cartilage
The thin muscles at the front of the neck are gently separated to expose the thyroid cartilage, the shield-shaped cartilage whose front edge forms the Adam's apple.
Reducing the prominence
The most prominent part of the cartilage is shaved down to flatten the profile of the front of the neck. How much is removed is limited by where the vocal cords attach to the inside of the cartilage.
Closure
The muscles are brought back together and the skin is closed. There is no change to the airway or the vocal cords.
Deciding
When it is part of the plan, and when it is not
It is not done for everyone
A tracheal shave is not a routine part of Dr. Ovadia's facial feminization surgery. It may be part of your surgical plan when it is something you and Dr. Ovadia have discussed and it fits your goals.
It is done when it will make a difference
How much a tracheal shave changes depends on how prominent the cartilage is to begin with. In some patients the Adam's apple is barely visible, and there is little to gain from reducing it further. It is planned when it matters to you and when the anatomy means it will show a real change.
The voice sets the limit
The vocal cords attach to the inside of the thyroid cartilage. The amount of cartilage that can be removed is limited by where that attachment is, so the goal is a flatter profile, not the complete removal of the prominence at any cost.
On its own or with other procedures
When it is part of the plan, a tracheal shave can be done in the same operation as other facial feminization procedures, or on its own.
Recovery
What to expect afterward
Recovery from a tracheal shave on its own is shorter than from the bone work of facial feminization surgery. When it is done together with other procedures, the overall recovery follows theirs; the full guide is on the recovery page.
Swelling and soreness at the front of the neck
Swelling is normal and expected. The front of the neck is sore and swollen in the first days, and swallowing can feel uncomfortable at first. As a general guide, about half of the swelling settles by 6 weeks and the rest by 6 months.
The incision
The scar sits in a neck crease. It is pink at first and fades over the following months.
Voice
Mild hoarseness can occur in the first days from swelling around the area and from the breathing tube used during anesthesia. The vocal cords themselves are not operated on.
Sutures
We typically use some sutures that come out after 5 to 7 days.
Normal swelling comes on slowly. A rapid increase in swelling is something to watch for, and it should be brought to your physician's attention right away. See the recovery after FFS page for the complete guide.
Your surgeon
A conversation, not a default
Dr. Ovadia builds each surgical plan around the individual. A tracheal shave is part of the plan when the Adam's apple matters to you and the anatomy means reducing it will make a visible difference. When the cartilage is not prominent to begin with, there is little to gain, and it is left alone.
Dr. Ovadia is fellowship-trained in craniofacial surgery and in gender-affirming surgery, is board certified by the American Board of Plastic Surgery, and sees patients in New York City and in Jersey City and Millburn, New Jersey. Read more on the facial feminization surgery page.
Questions
Common questions about tracheal shave
What is a tracheal shave?
A tracheal shave, also called chondrolaryngoplasty or Adam's apple reduction, reduces the prominence of the Adam's apple by contouring the thyroid cartilage at the front of the neck. It is done through a small incision placed in a natural crease of the neck.
Is a tracheal shave part of facial feminization surgery?
It can be. A tracheal shave may be part of your surgical plan. It is not done for every patient. It is included when you and Dr. Ovadia have discussed it and it fits your goals.
Will a tracheal shave change my voice?
The vocal cords are not operated on in a tracheal shave, and the amount of cartilage removed is limited by where the vocal cords attach inside the cartilage, in order to protect them. Mild hoarseness in the first days is usually from swelling and from the breathing tube used during anesthesia. A tracheal shave does not raise the pitch of the voice; that is a separate procedure.
Where is the scar?
The incision is short and is placed in one of the horizontal creases of the neck rather than directly over the Adam's apple, so that once it has faded it sits where a natural line already is.
Can the Adam's apple be removed completely?
The goal is a flatter, smoother profile at the front of the neck. How much of the prominence can be reduced depends on where the vocal cords attach to the inside of the cartilage, which varies from person to person. Dr. Ovadia goes over what is realistic for you at your consultation.
Can a tracheal shave be done with the rest of my surgery?
Yes. When it is part of the plan it can be done in the same operation as other facial feminization procedures, or as a procedure on its own.
Next step
Start with a consultation
If the Adam's apple is something you want to change, bring it up at your consultation. Dr. Ovadia will examine the front of your neck and explain what a tracheal shave can and cannot do for you.
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