A tracheal shave is a type of facial feminization surgery. It’s used primarily by trans women and non-binary trans people who wish their faces to appear more feminine. It may also be done on cisgender women who want the same effect.

This procedure is commonly referred to as Adam’s apple reduction surgery. It’s also known as chondrolaryngoplasty, or thyroid cartilage reduction.

A large Adam’s apple is an obvious, male secondary sex characteristic. For people who are transitioning from male to female, having a tracheal shave can be liberating and empowering.

A tracheal shave can, however, be expensive, and isn’t without risk. In this article we’ll go over how a tracheal shave is done, the results you can expect, how much it costs, and possible side effects.

A tracheal shave is a surgical procedure that’s often performed on an outpatient basis, under general anesthesia.

It’s done to reduce the size of the laryngeal prominence, which is located on top of the thyroid gland in the middle of the throat. The laryngeal prominence is more commonly referred to as an Adam’s apple.

During a tracheal shave, thyroid cartilage is removed from the front of the larynx. The role of thyroid cartilage is to protect the vocal cords from damage or strain.

In people assigned male at birth, hormones such as testosterone increase the size and volume of the larynx and thyroid cartilage during puberty. The vocal cords also get longer during this time.

These changes cause the voice to deepen. They also cause the formation of a prominent bump in the front of the throat.

Since people assigned female at birth don’t usually acquire this bump during puberty, removing it helps make the entire face appear more feminine.

Some people opt to have a tracheal shave simultaneously with other facial feminization procedures, such as:

  • chin reduction
  • jaw reduction
  • lip augmentation
  • cheek augmentation
  • forehead contouring
  • rhinoplasty

Your doctor will medically evaluate you for this procedure. They’ll have you take some diagnostic tests to determine if you’re healthy enough for surgery. These include an electrocardiogram (EKG) and blood tests.

Your doctor will also want to know about any medications or over-the-counter supplements you take.

Before the procedure

Prior to the procedure, you’ll be told to stop taking aspirin, or any medications which might cause bleeding, or inhibit blood clotting. If you smoke or vape, your doctor will ask you to stop for at least several days before surgery.

You’ll also receive written instructions that indicate when you should stop eating and drinking before the procedure.

During the procedure

A tracheal shave is typically done under general anesthesia. It takes about 30 minutes to 1 hour, from start to finish.

  1. Your surgeon will make a small, horizontal incision under your chin or jaw, in a skin crease. This ensures that the scar won’t be visible later on.
  2. A tiny camera will be inserted into the incision. It’s used to locate the thyroid cartilage, and the vocal cords.
  3. The thyroid cartilage and its borders will be shaved down, and removed.
  4. Your surgeon will take care to avoid touching the vocal cords.
  5. Once completed, the incision will be sutured closed.

After surgery

After surgery, you’ll be taken to a recovery room and observed for a period of time before being discharged.

If you have several facial feminization procedures done at once, you may be required to stay for a night in the hospital.

As with any surgery, you’ll need to have someone pick you up and take you home. It’s recommended that you rest for a day or two. It’s also suggested that you avoid vigorous activity and singing or speaking loudly.

You can expect to feel some discomfort after a tracheal shave for several days following surgery. Your surgeon will recommend that you rest your voice as much as possible during this time.

You should eat soft foods or a liquid diet until your throat feels comfortable when you swallow. Follow your doctor’s instructions for cleaning the area, and for having any stitches removed.

Post-surgery side effects

Post-operative side effects include:

  • slight pain
  • swelling
  • bruising
  • sore throat
  • weak voice
  • difficulty swallowing

If you continue to feel discomfort, icing the area and taking over-the-counter pain medication should help.

If you experience any of these symptoms, call your doctor:

  • fever
  • severe pain at the incision site
  • chest pain
  • shortness of breath
  • erratic heartbeat
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Once the initial swelling subsides, the results of a tracheal shave should be immediately apparent. You should see a smoother neck with a non-existent, or less-noticeable Adam’s apple.

The incision scar shouldn’t be visible unless you lift the skin crease within which it was made. The scar will become less red over time.

If you routinely have facial hair removed from your neck or chin through procedures such as laser hair removal, waxing, or electrolysis, ask your doctor when you can resume treatment.

It’s important to choose an experienced surgeon to perform this procedure. This will help reduce the potential for risk. It’ll also help you set realistic expectations for the surgery.

In some instances, a very large Adam’s apple can’t be removed completely, or diminished significantly. An experienced surgeon will be able to assess the results you can realistically expect, eliminating disappointment later on.

As with any surgery, there are certain risks associated with having anesthesia. These include:

  • Post-operative delirium and breathing problems. Meeting with the anesthesiologist prior to your procedure will help to significantly minimize these risks.
  • Removal of too much thyroid cartilage. If this occurs, your voice may be permanently altered.
  • A too-prominent scar. The formation of fibrous tissues or skin adhesions on or near the incision area can cause a scar to form. Let your doctor know if you’re prone to keloid scarring.

In addition to potential risks from surgery, it’s important to speak with your doctor in order to understand the purpose of this procedure, and to clarify the results you’re hoping to obtain.

A tracheal shave isn’t done to raise or change voice pitch permanently. If a higher-sounding voice is part of your feminization goal, talk to your doctor about a separate procedure known as voice cord or voice feminization surgery.

If you don’t have health insurance that covers this procedure, you can expect your out-of-pocket cost to be around $3,000 to $4,000. Some health insurance companies cover the cost of facial feminization surgeries, but this isn’t the norm.

Talk to your health insurance company to see if they’ll cover the cost of a tracheal shave. Since the procedure is considered elective, or cosmetic, your insurance company may not give you the answer you’re hoping for.

If you’re transitioning and wish to contest your health insurance company’s decision, you may be able to find pro bono or low-cost legal representation to help you pursue coverage. You can access an attorney through the National Center for Transgender Equality’s Trans Legal Services Network Directory.

If you’re employed, talking to your HR department about the type of coverage they supply to employees may also make a difference.

It’s very important that you find a highly-experienced, qualified surgeon who has done this procedure many times before.

You can find a plastic surgeon through the American Society of Plastic Surgeons or a gender surgeon through Trans Healthcare.

You should have confidence in the surgeon you choose, and be comfortable asking them questions.

Things to ask include:

  • How often do you do tracheal shaves?
  • Do you routinely perform this procedure on people of my age/weight/ethnicity?
  • How much will this procedure cost?
  • Are pre-op and post-op appointments included in the cost?
  • Who will my anesthesiologist be? Can I meet them prior to surgery?
  • What are the risks I can expect from this procedure?
  • Do you recommend that I have additional feminization procedures done in addition to a tracheal shave?

Tracheal shave is a type of facial feminization surgery that’s used to reduce the size of the Adam’s apple. It may be done on trans women, non-binary trans people, and cisgender women.

This procedure is typically done on an outpatient basis.

It’s important to use a highly-skilled surgeon to avoid risks to the vocal cords or scarring.