A prominent Adam’s apple is often a constant embarrassment to transwomen, which can be solved by a thyroid cartilage reduction.
Gender of the thyroid cartilage
The Adam’s apple is a characteristic feature of adult men. The name says it all: it’s one of Adam’s, the Man´s, attributes.
Male thyroid cartilage
- Projection of the thyroid cartilage (called Adam’s apple)
Female thyroid cartilage
- No projection of the thyroid cartilage (so no Adam’s apple)
The Adams apple is actually a projecting prominence of the thyroid cartilage, a cartilage that forms the voice box, where the vocal cords are located. During puberty, boys develop this cartilage more than girls. This creates a resonance, a deepening of the voice, whereas girls’ voices practically never really change.
Feminizing the thyroid cartilage
A thyroid cartilage reduction (also called trachea shave or Adams Apple reduction) is an effective solution to this problem. The surgeon reduces the cartilage in the throat to make the shape more feminine.
Trachea shave is one of the simplest and swiftest feminisation surgeries, but it must be done by an expert surgeon seeing that a too aggressive shave could weaken the larynx structure or voicebox and permanently alter the vocal quality.
We make a scan of the thyroid cartilage and the vocal cords prior to the operation. This allows us to learn the exact distance between the upper part of the thyroid cartilage and the vocal cords. This way we can remove the maximum amount of thyroid prominence, without risking damage to the vocal cords. It is not always possible to make a large Adam’s apple invisible with this procedure, the intent is then to change it from the masculine 90 degree angle to the feminine 120 degree angle.
Procedure thyroid cartilage reduction
- This can be done as an outpatient procedure with local anasthetic in about 1-2 hours. Many women combine this operation with other procedures under general anasthaesia in the hospital.
- An incision of about 3 cm is placed under the chin, if possible, inside a crease.
- From there a tunnel under the skin is made to the thyroid cartilage. With a bur it’s prominence and upper rim are trimmed.
- The muscles that run along and over the cartilage are united in the middle to cover the remaining prominence.
Recovery of a trachea shave
- Swelling— The evening of the surgery swelling comes up. Swelling will peak during the first 24-48 hours. For some patients this is a threatening feeling because they are afraid they will not be able to breathe. However you do not need to worry a human windpipe is incredibly strong. It would take a swelling the size of a basketball to create enough pressure to close the windpipe. The swelling will completely subside after about 6 weeks.
To see an example of what you can expect as swelling during the first evening of the operation click here.
- Pain— For about 7 to 10 days you will probably have a burning sensation and some difficulty swallowing or talking. Patients report it as being very similar to a simple sore throat.
- Voice— Mild voice weakness may occur in the first few days after surgery, but is normally temporary. In theory vocal cords can be damaged but Dr Bart van de Ven has never had this complication because the position of the vocal cords are visualised by the CT scan.
- Scar—The scar will be red and visible in the beginning. After one year the scar is almost invisible in most patients.
FAQs before surgery
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.
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.
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.
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).
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.
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 surgery
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.