A prominent Adam’s apple can be reduced in size with chondrolaryngoplasty, also known as Tracheal shave surgery.

Tracheal shave surgery, also known as chondrolaryngoplasty, diminishes a protruding Adam’s apple. This kind of procedure is typically performed on transsexual patients for facial feminization purposes, but is also a suitable option for men who prefer a less noticeable Adam’s Apple.

This method is known by several names, including:

  • Tracheal shave surgery
  • Chondrolaryngoplasty
  • Plastic surgery of the voice box, or larynx
  • Thyroid cartilage reduction (TCR)
  • Adam’s apple reduction

What Makes Up The Adam’s Apple?

The laryngeal prominence is a part of the voice box cartilage, also known as thyroid cartilage, that protrudes outward and forms what is commonly called the Adam’s apple.

The size of the laryngeal prominence depends on the person. Men often have a more visible Adam’s apple than women because testosterone contributes to the development of the laryngeal cartilage throughout puberty.

Many factors determine the size and appearance of the laryngeal prominence. Those with excessive amounts of laryngeal prominence cartilage would have a more visible Adam’s apple.

Weight is also a contributing factor because people who have relatively thin necks and small amounts of body fat may have a more conspicuous laryngeal prominence than individuals who weigh more and have thicker necks.

What Does Tracheal Shave Surgery Involve?

Adam’s apple reduction can be performed in the clinic under local anesthesia, or in the operating room under general anesthesia. Surgeries in the operating room are typically recommended for those seeking more extensive reductions or for patients who have more calcified thyroid cartilage. In either case, the doctor makes a horizontal incision at the mid-line of the neck. The doctor opts to make this incision higher on the neck instead of directly over the Adam’s apple, which creates a less visible scar.

The doctor then separates the vertical muscles in the neck, which exposes the Adam’s apple. Excessive cartilage is trimmed to minimize how much the Adam’s apple protrudes outward. Because thyroid cartilage stiffens as we age, sometimes it is necessary to use more advanced surgical techniques to address this issue. This is due to the fact that the more calcified tissue seen in older patients cannot be trimmed as easily as regular cartilage.

The doctor then sutures neck muscles back together and uses layers of sutures to close the incision. The site of the incision is then covered with a compressive dressing.

How Much Tracheal Reduction Is Possible?

One major challenge that comes with reducing the appearance of thyroid cartilage is the potential risk of injury to the vocal cords. Vocal cords insert into the laryngeal cartilage, which is positioned just beneath the Adam’s apple. An overly aggressive reduction could damage the insertion point.

Avoiding Injury To The Vocal Cords During Tracheal Shave Surgery Using Needle Localization

Performing a needle localization procedure is one way to decrease the odds of damaging vocal cords during Adam’s apple reduction. This is usually performed in an operating room setting. This method involves placing a needle through thyroid cartilage at the site where the cartilage will be shaved. Then the needle’s end is localized from the inside of the airway to ensure it is positioned safely above the point where the vocal cords insert into the laryngeal cartilage. This practice indicates to the surgeon that the thyroid cartilage above this area is safe to trim down.