Tracheal shave. Adam’s apple reduction. Smooth neck. Longer neck.
These are common names for a procedure I perform often for both males with very prominent Adam’s apple and also for trans-female patients. Toronto and its surrounding communities have a strong transgender community, so the tracheal shave is a common request at my practice.
When MTF (male-to-female) transgender surgery patients are looking at various options for feminizing their faces and bodies, a tracheal shave is often on their list for “FFS,” or facial feminization surgery, along with nasal tip refinement, brow lift, frontal bossing reduction, lip and cheek enhancement, and jawline contouring.
Shaving of the Adam’s apple is also a common request from men with very prominent thyroid cartilage. A small amount of cartilage is a masculine feature for alpha males, but a very large Adam’s apple in a male with thin neck is not necessarily considered very attractive.
For trans-female patients, a thick and prominent thyroid cartilage is an unfortunate reminder of their past, and for this reason, I commonly will recommend shaving and softening the cartilage so the neck is nice and smooth, also giving the illusion of a longer and more feminine neck.
The incision for the tracheal shave is under the chin. I prefer to hide the small scar under the chin as opposed to over the cartilage itself so the final small scar is not visible when facing someone. Via this small incision, I can dissect down to the cartilage, carefully retracting the neck veins and also the small strap muscles needed for swallowing. Once I reach the cartilage, I gently carve, sculpt, and shave the prominent part of the Adam’s apple. With the help of a small surgical burring drill, I also polish all the edges for a very smooth result.
Care is required as to not over-resect the cartilage as the airway and the vocal cords are on the other side. I find it important to have a CT scan on hand to address the variable thickness of this cartilage and to safely guide me for the optimal amount of shaving. I also commonly request images of the frontal bones with the same CT examination as frontal bossing reduction is also a very common FFS procedure.
A tracheal shave is a very gratifying procedure for our patients who feel self-conscious with a large, prominent, and often masculinizing thyroid cartilage. If you have questions about this transformative procedure, leave them in a comment below.