The Prominent Thyroid cartilage known as the “Adam’s Apple” is one of the most telling of male secondary sex characteristics. Although its presence is a testosterone-induced structure, its’ prominence has more to do with the length of the vocal chords, neck architecture and resonance of the airway than it does the actual size of the Thyroid cartilage. When noticeable on profile or extension of the neck, a protruding Adam’s Apple can be a telltale sign of male history. However, it is not invariably present among males nor MTF’s and can seemingly disappear by speaking in a higher resonance as some MTF’s are able to do. The Adam’s apple can also be seen in adult natal females on occasion as witnessed by the several Tracheal shaves Dr. Bowers has performed on natal females. Its prominence can also be avoided by the avoidance of male puberty. However, when present in the MTF female, it can present a daunting challenge to someone trying to blend into a female world.
The Tracheal Shave (TS) is a delicate surgical procedure, normally performed under general anesthetic either as an outpatient procedure or a part of Genital Reassignment Surgery (GRS) as a part of the Gender Confirmation process. It can also be performed with FFS (Facial Feminization Surgery), particularly if jaw work is a part of the FFS, thereby avoiding any appreciable neck scar. Most MTF patients, however, do not require major jaw work as a portion of successful transition, thus requiring some sort of surgical scar in shaving the Adam’s Apple. That procedure, the TS, was first described by Dr. Stanley Biber at the 2nd Harry Benjamin International Dysphoria Association (HBIGDA, now WPATH) meeting in San Diego in 1976. Dr. Bowers acquired Dr. Biber’s skill in performing Tracheal Shaves after succeeding him in practice in 2003.
The procedure, although not complex in design, is a highly delicate operation whose success is measured by the absence of a prominent thyroid cartilage (so-called female neck profile) in the presence of a scarcely visible scar (small and neatly tucked beneath the mandible) without injury to the vocal chords. With the final result the Adam’s apple should be invisible—and the neck as flat as North Dakota. The only exception to this is a Grade V Thyroid cartilage prominence, which is rare.
The final scar, after one year, should be barely visible and well-hidden. Some of the results show scars that are hidden beneath the jaw, which is our preferred site. The others show scars which are hidden within an already existent neck fold. This is done for a variety of reasons but both approaches yield a wonderful result–in our hands–virtually always.
“Of all the surgical procedures I perform, the Tracheal Shave is one of my very favorite procedures. It is short, relatively inexpensive but highly precise and can make a huge impact in a woman’s self confidence and ability to present as unmistakably female. It can be combined with most other procedures or performed solely as an outpatient surgery. In my practice, I see many Tracheal Shaves not well performed (poor scar, poor placement or failing to take enough cartilage) elsewhere so have taken it upon myself to implore others to excellence or simply insist that I perform the procedure.”
Recovery is minimal as all stitches dissolve, pain is only slight and complications are nil. Resting of the voice after TS is recommended for 3 weeks or so.
Scheduling is possible by calling Robin to arrange. This procedure can be combined with other procedures such as labiaplasty or GRS or as an entirely outpatient procedure. Arrive in Burlingame one day prior to surgery for Pre-op visit. A 3 night stay is recommended if done as a sole procedure including pre-op visit and day of surgery.