Tracheal shave

To make your neck look more feminine.

Tracheal shave

A tracheal shave, also called Adam’s apple reduction, aims at removing the adam’s apple of trans women. 

What is a tracheal shave?

If you compare the profile of a man’s and a woman’s neck, you can clearly see there is a ‘bump’; the Adam’s apple. Because of the increase of testosterone levels in boys during adolescence, the cartilages of the voice box will grow. The mass of muscles will increase. Your vocal folds (which are muscles) will also become thicker. This is why there is a voice change and why your voice will deepen as you are going through puberty.

MtF Tracheal Shave Procedure

The difference between the trachea cartilage of a man and a woman.

The Adam’s apple will become visible because of this increase of the size of the voice box cartilage. This typical feature for (adult) men is called the ‘Adam’s apple’, which gets its name from the first man to walk the earth (according to the Bible) – Adam.

You can have  your Adam’s apple removed by undergoing a procedure that is part of facial feminization surgery, namely: a tracheal shave, also called Adam’s apple removal.

Trachea Shave

  • Important: However, first we’ll have to check how much of the voice box cartilage can be removed without risking to damage the vocal cords, which are located just below the Adam’s apple (see image above). We’ll measure this on CT scan images that will be made the day before your tracheal shave. There are cases where there is so little room anatomically between the Adam’s apple and the vocal cords, that the prominence can’t be removed completely.
  • Note: A tracheal shave is not meant to permanently change the pitch of your voice. If you want to alter the pitch of your voice, our speech therapist Katrien Eerdekens can help you with voice feminization speech therapy. In some cases voice cord surgery will be necessary, also known as voice feminization surgeryOver here, you can read about how to take care of your voice after a tracheal shave.

We will now give you an in-depth explanation about the tracheal shave itself. But first, we will show before-and-after tracheal shave pictures to give you an idea of what your result could be!

Tracheal shave Jackie before and after

Tracheal shave before and after picture frontal

Tracheal shave before and after picture frontal

Tracheal shave before and after picture

Tracheal shave before and after picture

Tracheal shave before and after picture of Jackie lateral

Tracheal shave before and after picture lateral

The tracheal shave procedure: Thyroid chondroplasty – Adam’s apple reduction – Tracheal shave

A tracheal shave is simple: our facial feminization surgeon, Dr Bart van de Ven, reduces the cartilage so that your Adam’s apple no longer protrudes. It is very important that a surgeon specialized in facial feminization surgery performs this procedure. A tracheal shave involves shaving off some of the cartilage which protects your vocal cords. Someone who has little or no experience in a tracheal shave can easily remove too much cartilage, which can lead to permanent damage to your voice. Or they might remove too little cartilage because they are overcautious, meaning that your Adam’s apple is still visible.

The areas that are shaved during a tracheal shave are indicated in dark gray on this anatomical drawing of the trachea.

Trachea Shave

How can our experts at 2pass Clinic ensure that this operation goes smoothly?

First of all, Dr Bart van de Ven is specialized in facial feminization surgery for trans women. He has been successfully performing this operation for years. Secondly, we do everything we can to make the operation as safe as possible. Before the tracheal shave, we perform a CT scan of your Adam’s apple. We do this at the Sint-Augustinus hospital in Antwerp, which is just a five-minute drive from 2pass Clinic. The CT scan is included in your tracheal shave. This scan is important because it’s the only way we can see where your vocal cords are in relation to the cartilage. This way Dr Bart van de Ven can remove exactly the right amount of cartilage during the operation.

MtF Tracheal Shave Procedure

CT scan of the trachea taken before a tracheal shave to measure the distance of the adam’s apple to the vocal cords. This is the maximum that can be safely removed from the trachea without damaging the vocal cords.

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What kind of anaesthesia is used for a tracheal shave?

A tracheal shave is usually combined with other facial feminization surgeries. In such cases, general anaesthesia is used. You can also opt to have Adam’s apple removal surgery as an individual procedure. The tracheal shave is then performed under local anaesthesia. A tracheal shave takes about one hour.

What about the scar after a tracheal shave?

The incision for a tracheal shave l is three centimetres wide and is made under your chin (in a skin fold, if possible). A year after your tracheal shave the only thing you will be able to see is a narrow white line.

How high is the risk that my voice will be permanently damaged?

If the surgeon that will do the tracheal shave does as described above, the chance of damaging the vocal cords is probably zero. However, your voice can be of a lesser quality for a while. You can find information about the recovery of your voice on the page about tracheal shave and voice aftercare and recovery. 

Katrien, our voice therapist, will visit you after your surgery to assess your voice and give you aftercare instructions!


Will a tracheal shave compromise my voice feminization surgery?

No, it will not effect the outcome of your voice feminization surgery. Dr Bart van de Ven knows the techniques used by Yeson and others and has consulted them. If you want to know all about it you can read the blogpost of tracheal shave and voice feminization surgery.

Should I have the tracheal shave or the voice feminization surgery first?

During a surgery in general anesthesia (FFS, SRS, BFS) the patient needs to be intubated. That means a tube will be placed in between the vocal cords to ventilate the patient during surgery. The voice feminization surgery with the best long term results is the Wendler glottoplasty (the technique the Yeson Centre uses). A Wendler glottoplasty will reduce the space in between the vocal cords, which means it will be more difficult for the anaesthesiologist to put a tube in between the vocal cords without damaging them. On the other hand this should be no problem ifs done with care by an experienced anesthesiologist with a small size tube.

So in the end it doesn’t make a lot of difference: first the tracheal shave or the voice cord surgery. But doing the voice cord surgery at the end of your transition will make things easier for the anesthesiologist. It will also make your voice feminization cord surgeon sleep more soundly.

For information about aftercare as well as what to do when the quality of your voice is less good, you can check out this page.

Recovery tracheal shave

Here you can find more information on the recovery of a tracheal shave and aftercare instructions.

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FAQs before a tracheal shave

Sometimes I get asked to model during a photoshoot. How long should I wait to book one after my FFS?

That is a very difficult one. It depends very much upon your healing and we can’t give you any guarantee about how long it takes before you look good enough for a photoshoot.
It could be 4 months, but it could also be a year. Of course it also depends on the amount of work that has been done.

What does this procedure cost?

If you want you can send us good pictures together with your ideas so we can send you a financial and operative proposal. To receive a proposal, please fill in the proposal request online and pay the proposal fee of 50 euro through Paypal.

Of course you are always welcome for a consultation.

Typically how long is it after surgery to get your voice back to “normal”?

The voice cords need about 2-3 weeks to make normal use of the voice possible. We cannot exactly, if you use your voice extensively for professional reasons, when this is 100% back as before. We have no feedback on this matter.

Will a tracheal shave compromise my voice feminization surgery?

No it will not. Dr Bart van de Ven wrote an informative blogpost on a tracheal shave and voice feminization surgery. 



How will the scar be after an adams apple reduction?

All incisions leave a small white line in the end.

As this line is placed in an discrete spot (angle between neck and chin), it will be as good as invisible from most angles.

After two weeks nobody should notice from a distance. After 1 year the scar will be completely healed (white).

How the swelling and the bruise of the tracheal shave looks after 2 weeks?

In general you will hardly notice anything. But occasionaly (1 every 50 patients) there is some postoperative bleeding, which needs about a 6- 8 weeks to completely dissolve.

Will reducing the adam’s apple have any negative effects on my voice?

That is why we plan a CT scan to know exactly where are the vocal cords and how much cartilage can be removed. Until know we didn’t have one patient who had this complication.
It is possible though that oedema (swelling) of the vocal cords caused by irritation by the tube that was introduced by the anaesthesiologist or the surgery itself makes the voice weak and/or coarse for a period of about 2 weeks .

FAQs after a tracheal shave

You still have another question? Feel free to ask! We will answer your question and if generally applicable add it to the FAQ of this page.

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