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Tracheal Shave Surgery for Gender Affirmation – What to Expect

Medically reviewed by Jennifer Richman on October 2, 2024.

Reducing the size of the Adam’s apple through a tracheal shave is a common goal for patients who undergo facial feminization surgery (FFS). Since it is a relatively quick and inexpensive procedure, patients often elect to undergo it as a stand-alone surgery or alongside other facial surgery procedures. In this article, we discuss the tracheal shave cost, before and after results, scarring and more details about the procedure.

Why Consider a Tracheal Shave for Gender Affirmation?

The Adam’s apple (known medically as the laryngeal prominence of the thyroid cartilage) is a prominent bump or protrusion on the neck that is a result of a growth of thyroid cartilage that covers the larynx. It is a common development of a first, testosterone-dominant puberty and for many patients it is a visual cue associated with masculinity.

For our patients who feel dysphoria around the prominent protrusion on their neck, we offer the Tracheal Shave Surgery (also known as the Adam’s apple reduction). By reducing the size of the trachea, a patient can experience a smoother, conventionally feminine appearance of their neck.

Individuals who have undergone a full, testosterone dominant puberty usually experience an irreversible growth of tracheal cartilage. Given that the prominence of an Adam’s apple cannot be reduced by estrogen hormone replacement therapy (HRT), surgical intervention is the only way to reduce its size.

What is a Tracheal Shave?

The tracheal shave, whose medical term is chondrolaryngoplasty, is a surgical procedure that reduces the prominence of the Adam’s apple to create a more feminine neck contour. If you are interested in undergoing this procedure, you can request a free consultation with one of our board-certified facial surgeons today. Below we summarize the procedure:

Procedure Overview: Under general anesthesia, your surgeon will make a minor incision on the neck. To make the scar more concealable, your surgeon can also make the minor incision under the jaw. Through the incision, your surgeon will scrape away or shave down your thyroid cartilage, avoiding any damage to the vocal cords.

• • Anesthesia: This surgery is usually done under general anesthesia. If you are undergoing multiple FFS procedures at once, your tracheal shave will be done under general anesthesia.
  • Duration: The surgery can last anywhere from 30 to 90 minutes, and is generally completed within an hour.

• In-patient vs. outpatient procedure: Many FFS patients are sent home the same day as their operations. However, depending on the length of your procedure (especially if combined with other FFS procedures)  and/or your medical history, you may need to spend a night in the hospital for close monitoring. In order to be discharged, you will need a support person to pick you up from the hospital or surgical center.

• Recovery: The incision site will be covered for a week after surgery since it is connected to the airway. After this time, the bandage may come off at your post-operative appointment. Scar care will be introduced then.

Benefits of an Adam’s Apple Reduction

The tracheal shave is a medically-necessary gender affirming surgery for many trans, non-binary and gender non-conforming patients. As a result, its costs can often be covered by medical insurance.

Trans women, transfeminine, and non-binary individuals who experience dysphoria in this area, are ideal candidates for this procedure. Several peer-reviewed studies have established that facial feminization procedures like the tracheal shave yield very high satisfaction rates for this patient population. There are many benefits to FFS for our patients who experience gender dysphoria around the Adam’s apple, and our trans-feminine and non-binary individuals report a greater connection to their sense of self, expression, and gender-congruence after the surgery.

The Tracheal Shave Procedure at the Gender Confirmation Center

• • Pre-Surgery Consultation: During your free, pre-surgery consultation at the Gender Confirmation Center you can make a unique, surgical plan tailored to your goals. To make the most out of our time together, you will be asked to fill out our patient information and clinical history form and upload photos of your face onto our secure, virtual platform. We will discuss your goals, expectations, potential risks, and costs during this time so you can make the most informed decision about your gender-affirming surgery.

• Surgical Techniques: Our surgeons carefully shave the thyroid cartilage down to minimize scarring, achieve the desired feminine contour and cause no damage to the vocal cords. Given our surgeons experience and continued education, their precision is of the utmost standard.

• Recovery process: Recovery for this procedure can involve longer medical supervision or a hospital stay. This is because of the proximity of the incision to the airways. You may also find soreness in the throat, which usually resolves after the first week. Similar to all scars, the full healing time is 12-18 months. However, patients should expect to see the redness around the scar fade away about 6 months after surgery.

Please remember that post-operative care is an essential piece of your gender-affirming medical care. Our follow-up visits with you can help us troubleshoot any potential risks and ensure you are recovering smoothly.

Results and Expectations

Unlike most other facial surgery procedures, the results of a tracheal shave are almost immediately apparent. The majority of post-operative swelling subsides a week after surgery. During this time, you can apply ice for a maximum of 20-minute intervals per hour. Most tracheal shave patients who undergo a more extensive FFS procedure will ice the rest of their face and not their neck as swelling to the jaw and around the eyes can be a greater cause of discomfort.

After your first post-operative appointment, you can begin to practice scar massages and silicone therapy to reduce the visibility of your scar. You should protect your scars from UV rays for the first year after surgery, as they can take 12 months to fully mature. If you develop keloids or other scarring complications, you can refer to these treatment options.

What Other Procedures Can I Get with a Tracheal Shave?

Often our patients wonder what other procedures they can undergo simultaneously with a tracheal shave. If an Adam’s Apple reduction is the only facial surgery procedure you wish to undergo, you may be able to undergo a simultaneous breast augmentation, body contouring or, on very rare occasions, potentially even a bottom surgery procedure.

However, most patients undergo a tracheal shave as a part of a larger facial feminization surgery. However, when patients undergo facial feminization surgery with multiple procedures, a simultaneous bottom surgery or breast augmentation procedure is unlikely. This is because undergoing multiple types of gender-affirming surgery at once can be overwhelming for the body and make healing more difficult.

Other facial procedures you can undergo simultaneously are:

• Hairline advancement or lowering
• Brow bone reduction
• Eyebrow lift
• Cheek augmentation
• Rhinoplasty (nose reconstruction)
• Lip augmentation or lip lift
• Jaw and chin contouring

Potential Risks and Considerations

With any surgical procedure, there may be risks we would like you to consider. At the GCC, we work to minimize these risks by working with you to thoughtfully plan your surgery, recovery, and care. The potential risks of the Tracheal Shave Surgery, like any surgical procedure, are as follows:

• Scarring complications: Some patients are predisposed to hypertrophic or keloid scarring. You can read more about our scar care protocol and treatment for scarring complications here.

• Vocal and respiratory complications: Undergoing a tracheal shave with an experienced, board-certified surgeon can reduce the chances of the procedure negatively impacting your airways or vocal cords in the long term. Please note that an initial rough voice and soreness of the throat are normal after surgery.

Frequently Asked Questions (FAQs)

What is the cost of a tracheal shave at the Gender Confirmation Center?

The best way to receive an accurate estimate of the cost of the Tracheal Shave is to book a free consultation with one of our surgeons. Gender-affirming procedures for the lower third of the face––i.e., tracheal shave, genioplasty and mandible contouring––can cost between $4,500 to $50,000. We encourage you to book a free consultation to assess the cost of the tracheal shave surgical procedure if you are interested in it as a standalone surgery.

Will a tracheal shave affect my voice?

No. Some assume that the tracheal shave surgery affects the voice. Because the surgery does not affect the length or shape of the vocal cords but works to remove the excess thyroid cartilage around the trachea, our patients should not be worried about changes in their voice long-term. One temporary postoperative outcome is a weaker voice while healing. This is distinct from a change in pitch, and is due to a sore throat from general anesthesia.

How long does recovery take?

Recovery for this procedure can involve longer medical supervision or a hospital stay. This is because of the proximity of the incision to the airways. You may also find soreness in the throat, which usually resolves after the first week. Scars take about 12 months to fully mature, which is why we encourage patients to closely follow the scar care protocol. However, patients should expect to see the redness around the scar fade away about 6 months after surgery.

Is the procedure covered by insurance?

Coverage for medically-necessary gender-affirming care such as the tracheal shave can vary. While our insurance advocacy team has a 90% success rate in securing coverage for interested patients, coverage can vary by provider. You can learn more about our insurance advocacy team here.

Comparison Table: Tracheal Shave vs. Other Gender-Affirming Surgeries

Patient Testimonials

At the GCC, we take the care we provide to our patients very seriously. We want you to feel supported, cared for, and encouraged to explore all of the possibilities available to you as you pursue gender affirming care.

Camille was a Facial Feminization Surgery Patient of Dr. Facque. Take a look at this excerpt from her testimonial where she describes prioritizing her sense of self over facial-dysphoria others may have considered minor-flaws through FFS surgery with Dr. Facque:

…dysphoria kept cropping up over things others may consider minor flaws or even unnoticeable. To me, they were glaringly obvious. Most notably, my hairline, brow ridge, and the shape of my jaw. I did my best to hide them with camera angles and subtle lighting in pictures, but seeing my face in the mirror reminded me of my flaws. It heightened my fear that others could see them too, regardless of how they would say otherwise. I realized that of all the gender affirming surgeries that I could undergo, I knew I wanted to remedy those areas of my face first before anything else. Thanks to the entire staff of the Gender Confirmation Center and notably Dr. Alexander Facque, every time I see myself in the mirror and pictures, I am overwhelmed with joy that I get to look like this everyday now.

Camille, Auto-Enthusiast

We know that it is important to hear the stories and testimonials of patients who navigate dysphoria, even in ways that may seem minor or negligible. We support our patients as their priorities change to resolve the challenges that come with gender-affirmation surgeries. We recognize that any feeling of discomfort is an opportunity to explore possibilities for change and gender-affirmation. We work alongside you and your goals. You can find more testimonials from our patients here.

How to Schedule Your Tracheal Shave Consultation

If you would like to learn more about the tracheal shave procedure, we encourage you to schedule a free consultation with one of our board-certified surgeons. Facial surgeries at the GCC are done by Dr. Ley (she/her/they) and Dr. Facque (he/him). Both members of the LGBT+ community, Dr. Ley and Dr. Facque have extensive training and experience in gender-affirming facial surgery techniques to support your pursuit of your true and most aligned self.