Trachea shave

A trachea shave is one of the most common surgical procedures for transsexuals. The surgeon reduces the cartilage in the throat to make the shape more feminine.

Common names:

  • adams apple reduction
  • tracheal shave
  • thyroid cartilage reduction (TCR)
  • chondrolaryngoplasty

The procedure

This can be done as an outpatient procedure under a local anesthesia in the office or under a general in an operating room. Many women do it in conjunction with other procedures.

If you feel your throat, you will feel several horizontal ridges of cartilage on your trachea. If you feel the prominent part, you'll feel a V-shaped protrusion of cartilage. That's what they reduce.

The surgeon makes a horizontal incision in a crease of skin on the throat. Then the vertical muscles in the throat are separated to expose the cartilage. Then the surgeon shaves off the most prominent part of the notch and the top of the V.

Or if you like technical terms:

The skin, subcutaneous tissue & investing layer of deep cervical fascia are incised & opened transversely. The middle cervical fascia is divided vertically. The sternothyroid & thyrohyoid muscles are retracted laterally to expose the thyroid cartilage. The perichondrium is incised on the superior rim of the thyroid cartilage from one side to the other. Then the perichondrium on outside & inside of laminae is elevated. The prominent outwardly rolled superior rim, the superior notch, the upper part of the laryngeal prominence & the upper portions of laminae are obliquely excised. The two perichondrial flaps are sutured together with dexon 5-0. Hemostasis is made with electric cautery. Subcutaneous tissue & skin are sutured with dexon 5-0. Light compressive dressing on the wound.

In younger people, the cartilage has the consistency of soap, but in older patients, the cartilage can ossify, or get bony and hard.

My experiences

I had a trachea shave done in December 1996 under a general with my forehead work. The incision was made in a crease in my throat just over the area to be shaved. The doctor was fairly conservative in the cartilage removed because I was very concerned about keeping my voice the same. Shaving too much off can affect vocal cords and compromise the stability of your windpipe, so it's wise to find someone with experience. The surgery didn't hurt at all, nor did recovery.

My surgeon used a technique which leaves a ropy scar that settles down as you heal. I had stitches that stayed in for a week. The stitches were all internal, and the suture had a small loop sticking out one end. When it was time to remove the stitching, the doctor cut the loop and said, "Go ahead, pull on it." I gently pulled, and like magic, the whole suture slipped right out. He instructed me to rub and pinch the scar tissue as it healed to break it up. The raised scar settled down after a couple of months so that it was completely unnoticeable. The scar is level, unlike some indented scars I have on my wrist from regular surgical incisions. During the settling process I rubbed the tissue whenever I was watching TV, reading, etc. It actually kind of got to be a nervous habit I had to break. I covered the scar with a bit of face powder as it healed, and it was very hard to see. Coincidentally, a woman at work had thyroid surgery around the same time and had a similar incision, so if you need an excuse, you could say it's that (which is often accompanied by a hormonal imbalance as well). Nobody asked me about it, though.

My trachea is pretty prominent overall, but now that the V-shaped protrusion has been cut away, it doesn't look masculine. He didn't get as much as I was hoping, but he got enough to make it neutral. I have other gender cues which put my face into female range.

Recovery

Bruising and swelling are common and vary greatly by individual. Swelling usually subsides fairly quickly over 2 to 14 days. Bruising is generally heaviest on the throat, but drainage from the site can cause bruising to show on the lower neck and chest. Usually this resolves in one to three weeks.

Most procedures leave you with a prominent red scar that lightens over the next 1 to 3 months. This can usually be concealed with makeup once any stitches or staples are removed. Depending on the procedure, this scar can be a raised ropy scar that will settle without the indentation common to healed incisions. How noticeable it is depends on the surgeon's skill, and your body's formation of scar tissue. Severe cases might require surgical scar revision or flesh colored tattooing.

You may be told to rest your voice following surgery.

Some have a temporary change in vocal quality. This can include weakness, lowering of pitch, raspiness, hoarseness, raising of pitch.The more cartilage removed, the greater the risk.

Some have reported pain and difficulty swallowing, but this is often caused by intubation during general anesthesia instead of the surgery itself.

Most women experience temporary numbness and tightness in the soft tissue, lasting a day to a week.

You will have stitches at the incision, often supplemented by surgical tape or butterfly bandages for a few days. Rarely, they use staples. These usually come out in a week. Stitches and tape must be kept dry, or there is a risk of worsening any scar.

You may have temporary dimpling of the skin along the incision.

You should avoid electrolysis immediately around the incision until your surgeon recommends continuing.

Some surgeons will recommend application of antibiotic ointments, vitamin E oil, or other topical preparations to aid in healing.

You may also be given exercises to break up scar tissue during healing. Follow any instructions from your surgeon.

Complications

Poor cosmetic outcomes include too much or too little revision, uneven revision. You may have excessive scarring. Some have felt that their noticeable scar drew attention to their throat. Remember, no surgery will guarantee you will pass. There are many other factors involved.

Some have a permanent change in vocal quality. This can include weakness, lowering of pitch, raspiness, hoarseness, raising of pitch.The more cartilage removed, the greater the risk.

Rebecca had a trachea shave in December 1995 and writes:

In consultation with the surgeon prior to TCR, I told him I've been a professional vocalist for years with a reputation for excellent tone/control/range (4-1/2 octaves). I'm always able to impersonate/imitate instruments/sound effects & sing male or female parts. Toured/released as lead vocalist for 20 years. Planned to be vocal specialist post-op. I'd changed so successfully that others in transition sought guidance. I repeatedly asked my surgeon to confirm TCR wouldn't affect voice-he assured no voice changes. He maintains he's done many with optimum cosmetic result & no voice problems.

Cosmetically, TCR was successful! After TCR, he instructed wait a month before resuming voice workouts but @ 4 weeks, I couldn't reach above mid-C & the sound was strained & hurtful - I stopped-he advised wait until 8 weeks. Still no improvement-he advised to wait 4 months. It's now 11 months & only minimal improvement. I reach high notes but only for 15 minutes & it's weak, but I've got resonance, vibrato & can hold notes for a long time. After 15 minutes, the cords fibulate back to low range for the rest of day. I can inhale notes that I can't exhale & can constrict folds & screech notes that sound unnatural. Surgeon assures nothing was done to alter folds & is surprised at problems rehabilitatively. Seen 2 pathologists, ENT & 2 endos. No polyps, nodules, fold malalignment discovered & voice production determined proper. Dr. M. Cooper suspects folds malalignment by intubation (anesthetic tube), trauma edema-healing by incorrect production (throat voice) & damage doesn't have to be permanent, if correctly rehabilitated. In summary, I cannot reach upper range/falsetto notes.

More serious complications include hematoma, infection, permanent loss of voice, death.

See my general complications page for more.

Medical literature

Chondrolaryngoplasty for appearance.

Abstract:

Prominent thyroid cartilage (pomus Adamus) is frequently a constant embarrassment to the male transsexual as well as to the asthenic male. The demand for reduction and contouring of the pomus Adamus continues to increase in our societies today. Since our first presentation of this procedure, we have been able to follow 31 patients over a 17-year period. We present a review of our technique of chondrolaryngoplasty, with anatomic details and a follow-up of 31 patients ranging from 4 months to 17 years. The results are effective and satisfying, with few complications. Those which do occur tend to be transient, with the most frequent being a temporary mild voice weakness. We believe this operation has a place among the techniques of plastic surgeons.

Authors

  • Wolfort FG
  • Dejerine ES
  • Ramos DJ
  • Parry RG

Address: Division of Plastic Surgery, New England Deaconess Hospital, Boston, Mass.

Abbreviated Journal Title: Plast Reconstr Surg

  • Date Of Publication: 1990 Sep
  • Journal Volume: 86
  • Page Numbers: 464 through 469 discussion 470
  • ISSN: 0032-1052
  • Article ID: 90349752