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A tracheal shave, also called Adam’s apple reduction or chondrolaryngoplasty, aims at removing the Adam’s apple of trans women.
Gender of the trachea
If you compare the profile of a man’s and a woman’s neck, you can clearly see there is a ‘bump’ in the male profile; the Adam’s apple. Because of the increase of testosterone levels in boys during adolescence, the cartilage of the masculine voice box will grow. The vocal folds (which are muscles) will also become thicker. This is why there is a voice change and why a man's voice will deepen as they are going through puberty.
How to feminize the tracheal area?
You can have your Adam’s apple removed by undergoing a tracheal shave, also called Adam’s apple removal surgery.
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, a speech therapist can help you with voice feminization speech therapy. In some cases, voice cord surgery will be necessary, also known as voice feminization surgery. Below you can read about how to take care of your voice after a tracheal shave.
A tracheal shave is a simple procedure. The tracheal cartilage is removed so that your Adam’s apple no longer protrudes.
- 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. We’ll measure this on CT scan images that will be made the day before your tracheal shave. 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 the price for 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. There are cases where there is so little anatomic room between the Adam’s apple and the vocal cords, that the prominence can’t be removed completely.
- Adam’s apple reduction surgery is often performed under general anesthesia, in combination with other procedures. The technique takes approximately 30 minutes. If performed stand-alone local anesthesia can be used.
- An incision is made around 2 cm under the chin, if possible, hidden inside a crease below the chin area.
From there, a small tunnel is created to reach the thyroid cartilage. A year after the procedure the only thing you will be able to see is a narrow white line.
- With a surgical scalpel, the prominence and the superior border is reduced, within anatomically safe parameters.
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 with tracheal shaves 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.
What can you expect after a tracheal shave, and how to take care of yourself and your voice to improve recovery time?
What to expect after your tracheal shave?
- Swelling—There may be swelling 24-48 hours after your tracheal shave. This is normal and can last for up to six weeks. We understand that this can be distressing, as you might think you aren't able to breathe. You really don’t need to worry about this. The trachea is very strong and doesn’t succumb to this temporary pressure.
- Pain—The pain you experience after your tracheal shave feels a bit like a throat infection. It is difficult to talk and swallow, and you have a burning sensation in your throat. This pain can last for about seven to ten days.
- Scar—Initially, the scar will be red and visible. A year after your tracheal shave, all that will be left will be a narrow white line that will hardly be noticeable due to its placement in a natural crease.
- Some air under the skin—Very often it’s unavoidable that a little hole towards the windpipe is created during a tracheal shave. This will, of course, be closed by a suture. But it’s entirely normal that some air will escape from the windpipe during speech or coughing. However, after a few days/weeks this will heal on its own without any treatment.
What is happening with your voice and why?
It’s possible that the quality of your voice lessens after the surgery. This can be caused by the following two things:
- The tube that is placed in between the vocal cords to ventilate the patient during surgery can affect the mucus of your vocal folds.
- There is laryngeal swelling for a few months. This will affect your external laryngeal muscles that can affect your voice range and voice quality.
So it’s normal that after the surgery and during the recovery, you will have:
- A smaller voice range;
- A lesser voice quality: a croaky/hoarse voice;
- A sore throat;
- Tension in your throat/neck area;
- Difficulties swallowing or talking.
What to do:
- Take vocal rest—Take a pause after talking for a while
- Avoid pressure changes—Avoid coughing and clearing your throat with effort, or emitting sounds while performing a physical or muscular effort (for example lifting a weight).
- Yawning—Use the yawn to relax the pharyngo-buccal area.
- Hot steam—Inhale hot steam (inhalator) without aromas that will dry you out (eg eucalyptus, menthol), to recover the mucus of your vocal folds
- Voice relaxation exercises
- Voice flexibility exercises
- Time—Give yourself and your body the time to recover, so the swelling can go down. Stress is an important factor, the more stress you experience, the slower the recovery might be.
Frequently asked questions
What does this procedure cost?
There are 3 options to receive a financial and operative proposal. You can either send us pictures and receive a quote and an FFS simulation, or you can book a Skype or a live consultation with Dr Bart van de Ven during which you will also receive a quote and FFS simulation. Click here if you want to get a general idea of FFS prices.
What happens if there are complications after the procedure and is this covered?
We will correct the complication if surgically possible, without charging any surgical fees. Hospital, material and traveling costs are for the expense of the patient.
Can I get this surgery if I’m a cis woman?
Yes, of course. We perform Facial Feminization Surgery on all women. Every woman is welcome at our clinic!
How long does it take for the final result to be visible and the bruises to disappear completely?
Recovery looks different for every patient, but bruising usually disappears after two to four weeks. The final result can be visible after a few months, but it may also take longer than a year. All information on recovering from FFS can be found on our recovery page.
Could this procedure heighten the pitch of my voice to sound more feminine?
No, it can’t.
Typically how long is it after surgery to get your voice back to “normal”?
The vocal cords need about 2-3 weeks of recovery to make normal use of the voice possible. We cannot say when exactly it would be back to 100% if you use your voice extensively for professional reasons. This page contains useful information on voice recovery after a tracheal shave.
Will a tracheal shave compromise my voice feminization surgery?
It should not. Dr Bart van de Ven wrote an informative blog post on the tracheal shave and voice feminization surgery.
How long does it take to recover fully and do physical activities/sport after an adam's apple reduction?
Less than a week.
What will the scar be like after an Adams' apple reduction?
All incisions leave a small white line in the end. As this line is placed in a 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 occasionally (1 out of every 50 patients) there is some postoperative bleeding, which needs about 6-8 weeks to completely dissolve.
Will reducing the adam’s apple have any negative effects on my voice?
We plan a CT scan to know exactly where are the vocal cords and how much cartilage can be removed, to avoid negative effects on your voice. It is possible though that edema (swelling) of the vocal cords caused by irritation by the tube that was introduced by the anesthesiologist, or the surgery itself, makes the voice weak and/or coarse for a period of about 2 weeks. There is also something to be said for the effect of the structure of the voice box. The remaining cartilage must be strong enough. In this blog post, you can read in detail about the possible effects on your voice.
Should I have the tracheal shave or the voice feminization surgery first?
During surgery under 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 anesthesiologist to put a tube in between the vocal cords without damaging them. On the other hand, this should be no problem when 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 would also make your voice feminization surgeon sleep more soundly.
For more information consult this blogpost on voice feminization surgery and tracheal shave.
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