Adam's Apple Reduction

The Adam's apple, also known as the laryngeal prominence, is a noticeable protrusion in the front of the neck, particularly in males. It is formed by the thyroid cartilage, the largest cartilage of the larynx (voice box). The Adam's apple is more prominent in males due to hormonal differences during puberty, which cause the thyroid cartilage to grow larger and protrude further.

The primary function of the Adam's apple is to protect the vocal cords and assist in voice production. It plays a role in deepening the voice by increasing the length and tension of the vocal folds. The size and prominence of the Adam's apple can vary among individuals, with some males having a more pronounced Adam's apple than others. In females, the Adam's apple is typically smaller and less noticeable.

The Adam's apple is primarily caused by the growth of the thyroid cartilage during puberty. The prominence of the Adam's apple is more pronounced in males due to hormonal changes that occur during adolescence.

During puberty, the larynx (voice box) undergoes growth and development, and the thyroid cartilage, which forms the majority of the larynx, increases in size. This growth is stimulated by the influence of hormones, particularly testosterone. In males, the increased levels of testosterone cause the thyroid cartilage to enlarge and protrude, resulting in a more prominent Adam's apple.

The size and prominence of the Adam's apple can vary among individuals, as it is influenced by factors such as genetics and hormonal levels. It is generally more noticeable in adult males compared to females, although females also have a smaller and less prominent Adam's apple.

Adam's apple reduction, also known as tracheal shave, chondrolaryngoplasty, or thyroid cartilage reduction, is a surgical procedure aimed at reducing the size or prominence of the Adam's apple (laryngeal prominence). This procedure is typically performed for transgender women or individuals seeking a more feminine appearance by reducing the visible prominence of the Adam's apple.

During the procedure, a small incision is made in the natural crease of the neck, and excess thyroid cartilage is removed or shaved down. The surgery is performed under general anesthesia, and the incision is typically closed with sutures. The goal is to create a smoother and less noticeable contour of the neck in the area of the laryngeal prominence.

It is important to note that Adam's apple reduction is a cosmetic procedure and not medically necessary. It is typically performed as part of gender-affirming surgeries for transgender women or individuals seeking a more feminine appearance. The decision to undergo Adam's apple reduction should be made in consultation with a qualified plastic surgeon who can evaluate individual needs and discuss the risks, benefits, and potential outcomes of the procedure.

Adam's apple reduction or tracheal shave is a surgical procedure designed to reduce the prominence of the Adam's apple in individuals who desire a more feminine appearance. This procedure is typically sought by transgender women or individuals with gender dysphoria.

Candidates for Adam's apple reduction are usually transgender women who wish to align their physical appearance with their gender identity. However, it is important to note that not all transgender women opt for this procedure, as it is a personal choice.

It is crucial for candidates to have realistic expectations and understand the potential risks and benefits associated with the surgery. A thorough evaluation by a qualified plastic surgeon or otolaryngologist is necessary to determine if the individual is a suitable candidate for Adam's apple reduction.

Additionally, candidates should be in good overall health, free from any underlying medical conditions that could increase the risks associated with surgery. They should also have stable mental and emotional well-being and be able to provide informed consent for the procedure.

A tracheal shave is generally considered a minor outpatient surgical procedure. It is often performed under local anesthesia with sedation, although general anesthesia may be used in some cases. During a typical Adam’s apple reduction procedure, the following steps are involved:

1. Anesthesia: The patient is given a general anesthetic or local anesthetic with sedation to make them feel no pain during the procedure. 
2. Incision: A small incision is made in the natural crease of the neck, typically in the midline. The precise location and length of the incision may vary based on the individual's anatomy and the surgeon's preference. In the new but less common method, the incision is made inside the mouth (transoral chondrolaryngoplasty).
3. Access to the thyroid cartilage: Once the incision is made, the surgeon carefully separates the skin and underlying tissues to gain access to the thyroid cartilage, which forms the Adam's apple.
4. Reduction of the cartilage: Excess thyroid cartilage is either removed or shaved down using surgical instruments. The amount of reduction depends on the desired outcome and the patient's specific needs.
5. Closure: Once the cartilage has been reduced, the incision is closed with sutures. The sutures used are typically absorbable and do not require removal.
6. Recovery: After the procedure, the patient is monitored in a recovery area before being discharged home. Instructions for post-operative care, such as wound care and activity restrictions, will be provided.

It is important to note that the specific details of the procedure may vary based on the individual's anatomy, surgeon's technique, and the complexity of the case. Consulting with a board-certified plastic surgeon who specializes in Adam's apple reduction is crucial to understanding the specific surgical plan tailored to your needs and ensuring optimal results.

While a tracheal shave is typically performed through incisions made in the neck, doctors at the UCLA Gender Health Program have recently developed a technique to reduce the size of the Adam's apple without leaving a visible scar on the patient's neck. This advancement is particularly significant for transgender women and nonbinary individuals, as a neck scar can expose them to discrimination, hate, and violence. 

The procedure called the "scarless" tracheal shave, involves creating a small, hidden scar on the inside of the patient's lip (transoral incision). Through this scar, the surgeon inserts cartilage-trimming forceps and a polishing tool to shave down the extra cartilage that forms the Adam's apple. 

A study published in Facial Plastic Surgery & Aesthetic Medicine reviewed outcomes for 77 patients who underwent the surgery at UCLA Health facilities and found that the technique is effective, can be performed in 90 minutes by one surgeon, and utilizes equipment already available in most surgical suites. The procedure offers a significant improvement in gender-affirming care and could help reduce the fear and stigma faced by transgender individuals. 

It’s worth noting that since this method is relatively new and in its infancy, not all surgeons make use of it or are highly experienced in it.

Preparing for a chondrolaryngoplasty involves several important steps to ensure a smooth and successful procedure. Here are some general guidelines for preparation:

• Consultation and medical evaluation: Schedule a consultation with a qualified plastic surgeon who specializes in Adam's apple reduction. During the consultation, discuss your goals, medical history, and any concerns you may have. The surgeon will perform a thorough evaluation to determine if you are a suitable candidate for the procedure.
• Follow pre-operative instructions: Your surgeon will provide specific instructions to follow in the days leading up to the surgery. This may include guidelines on fasting, medication restrictions, and avoiding certain substances (such as blood-thinning medications or herbal supplements) that could increase the risk of complications during surgery.
• Medical tests: Your surgeon may request certain medical tests, such as blood work or imaging studies, to evaluate your overall health and assess any potential risks or complications.
• Arrange transportation and post-operative care: Since Adam's apple reduction is performed under general anesthesia, you will need someone to drive you home after the surgery. It is also advisable to arrange for someone to assist you during the initial recovery period, as you may experience discomfort and limited mobility.
• Quit smoking and avoid alcohol: If you smoke, it is important to stop smoking well in advance of the surgery, as smoking can interfere with the healing process. Similarly, it is advisable to avoid alcohol for a period of time before and after surgery, as it can affect anesthesia and increase the risk of complications.
• Plan for recovery: Ensure you have a comfortable recovery area set up at home with necessary supplies, such as ice packs, prescribed medications, and soft foods that are easy to swallow. Follow your surgeon's instructions regarding post-operative care, including wound care and any restrictions on activities or exercise.

It is crucial to closely follow all pre-operative instructions provided by your surgeon. Additionally, maintain open communication with your surgeon, ask any questions you may have, and address any concerns to ensure a successful surgery and smooth recovery.

The recovery process following Adam's apple reduction surgery or tracheal shave typically involves the following:

• Post-operative care: Your surgeon will provide specific instructions on post-operative care, including wound care, medication management, and any restrictions on activities. It is important to follow these instructions carefully to promote proper healing and minimize the risk of complications.
• Swelling and discomfort: Swelling, bruising, and mild to moderate discomfort in the neck area are common after the surgery. Your surgeon may recommend using cold compresses or ice packs to help reduce swelling and manage any discomfort. Pain medication prescribed by your surgeon can also be taken as directed.
• Rest and recovery: Adequate rest is essential for a smooth recovery. Plan to take time off work or other responsibilities to allow your body to heal. Avoid strenuous activities, heavy lifting, and exercise for the initial weeks following surgery, as they can interfere with the healing process.
• Diet and nutrition: Stick to a soft or liquid diet for a few days after surgery to avoid placing unnecessary strain on the incision site. Your surgeon will provide specific dietary recommendations. Stay hydrated and consume a balanced diet to support healing.
• Follow-up appointments: Attend all scheduled follow-up appointments with your surgeon to monitor your progress, remove any sutures if necessary, and address any concerns or questions you may have. Your surgeon will guide you on when it is safe to resume normal activities and provide guidance on scar management.
• Scar management: While the incision for Adam's apple reduction is typically small and discreetly placed, it is important to take measures to optimize scar healing. Your surgeon may recommend scar care techniques such as keeping the incision area clean, applying scar creams or ointments, and protecting the incision from sun exposure.

Recovery timelines can vary depending on the individual and the extent of the surgery. It is important to follow your surgeon's specific post-operative instructions and to reach out to them if you have any concerns or questions during the recovery period.

Like any surgical procedure, a chondrolaryngoplasty carries some potential risks and complications. While complications are relatively rare, it is important to be aware of them. Some potential risks include:

• Bleeding and hematoma: Excessive bleeding or the formation of a hematoma (a collection of blood) at the surgical site can occur. This may require additional medical intervention, such as drainage or, in rare cases, a return to the operating room.
• Infection: Infections can occur at the incision site or in the surrounding tissues. Precautions are taken during surgery to minimize the risk of infection, but if it does occur, antibiotics may be prescribed.
• Scarring: Although efforts are made to place the incision in a discreet location, scarring is a potential risk. Most scars from Adam's apple reduction tend to be small and well-hidden within natural creases of the neck, but individual healing and scar formation can vary.
• Nerve damage: There is a small risk of temporary or permanent damage to nerves in the neck area. This can result in altered sensation, numbness, or weakness. Most cases of nerve damage, if they occur, are temporary and resolve over time.
• Voice changes: In rare cases, there may be temporary or permanent changes in voice quality after the procedure. This can include hoarseness, vocal weakness, or altered pitch. However, with an experienced surgeon, the risk of significant voice changes is generally low.
• Unsatisfactory aesthetic outcome: While efforts are made to achieve the desired aesthetic outcome, individual variations in healing and anatomical factors may affect the final result. It is important to have realistic expectations and discuss your desired outcome with your surgeon during the consultation.

It is crucial to consult with a qualified plastic surgeon who specializes in Adam's apple reduction to assess your individual risks and discuss potential complications. They will provide you with detailed information about the procedure, potential risks, and steps to minimize these risks. By following their guidance and carefully adhering to pre-and post-operative instructions, you can help reduce the likelihood of complications and promote a successful recovery.

The cost of a tracheal shave or chondrolaryngoplasty can vary depending on various factors, including the geographic location, the surgeon's experience and reputation, the complexity of the procedure, and the specific surgical facility or hospital. It is important to note that the following figures are approximate and can vary significantly:

On average, the cost of Adam's apple reduction surgery can range from $3,000 to $8,000 or more. This estimate typically includes the surgeon's fee, anesthesia fee, facility fee, pre-operative consultations, post-operative care, and follow-up appointments. Additional costs may be incurred for medical tests, medications, and other incidental expenses.

It is important to consult with a qualified plastic surgeon who specializes in Adam's apple reduction to obtain an accurate cost estimate. During the consultation, the surgeon will evaluate your specific needs, discuss the surgical plan, and provide you with a detailed breakdown of the costs involved.

It is also worth noting that insurance coverage for Adam's apple reduction surgery can vary. In some cases, if the procedure is deemed medically necessary, such as for transgender individuals undergoing gender-affirming surgery, insurance coverage may be available. However, coverage will depend on the individual insurance policy and the specific circumstances. It is advisable to check with your insurance provider to determine if the procedure is covered and to understand any requirements or documentation needed for potential reimbursement.

Remember that cost should not be the sole determining factor when choosing a surgeon. It is important to prioritize the qualifications, experience, and reputation of the surgeon, as well as their ability to understand and meet your specific needs and goals.

Is Adam’s apple reduction safe?

Adam's apple reduction is generally considered safe when performed by a qualified and experienced surgeon, but all surgeries carry some risks.

Do women have Adam’s apples?

Yes, women have Adam's apples, but they are typically less prominent compared to men due to differences in the size and shape of the larynx.

Does Adam’s apple reduction surgery hurt?

Adam's apple reduction surgery is typically performed under anesthesia, so you will not feel pain during the procedure. After the surgery, it is common to experience some discomfort and swelling in the surgical area. However, your surgeon will prescribe pain medication to help manage any post-operative pain

Does Adam’s apple reduction surgery leave scars?

Traditional tracheal shave surgery typically leaves a small, horizontal scar in the natural neck crease. However, with proper surgical techniques and post-operative care, scars can be minimized and become less noticeable over time. The new ‘scarless’ technique recently developed by doctors does not leave visible scars as incisions are made inside the mouth instead of on the neck. 

Does tracheal shave affect my voice?

A well-performed tracheal shave surgery is generally not expected to affect the voice, as the procedure focuses on the external appearance of the Adam's apple and does not involve the vocal cords or larynx.