The Procedure

What is the procedure ?

Adam’s apple or we know as “Tracheal” is the thyroid cartilages where is the upper part of voice box where is the people can make the voice from and also this can help to protect the pieces of the food falling into the windpipe when you are eating. Many peoples understood that the women don’t have this part of the body. Despite what many people believe, it is sometimes visible in females but in males it can be very prominent which make the man have the lower vocal tone ( bass tone) than the woman. And also, Adam’s apple is a characteristic feature of masculine face which during adolescence, the physical changes generated by testosterone – male sexual hormone – in boys’ bodies is irreversible. So, both of the women with the prominent Adam’s apple or the MTF transgender (female to male) want to cut it out or remove it to improves the feminine facial or sometimes, in the real men with very large laryngeal prominences that have trouble buttoning a shirt or wearing a tie.

So, these are the reasons why the peoples want to get rid of the Adam’s apple or tracheal. And now, the medical procedure can find the way to improve this problem, Adam’s apple shaving surgery or “Chondrolaryngoplasty”. This is the answer for the people who don’t happy or uncomfortable with the size of the Adam’s apple. And this is the popular procedure for the FTM transgender patients who prepare themselves to get the further sex change procedures which mostly start with this procedure. But please understand that Adam’s shaving can’t change the vocal tone in the man or FTM transgender patients. But however, this procedure seems to be a simple operation but carries a higher risk of complications than most other FFS procedures and should always be considered very carefully. Due to this position is very near from the vocal and voice box and windpipe which they have a potential to ne injured if the surgery is done with the unprofessional surgeon. So, it’s very important to find the specialist in this surgery and have a consultation with them before undergo the surgery.

The Method

How the procedure is performed?

The procedure will be started with injection to local Anastasia on you to make you don’t feel pain during the operation (some surgeon can let you take the anti-depress medicine which can make you sleep in the people who is so afraid of the surgery to not remember anything during the surgery). And the surgeon will make a small incision about 3-4 cm in the shadow of your neck fold allows the surgeon to gain access to the thyroid cartilages, whose excess, which generates the swelling in the neck. Because the most of everyone has some semblance of horizontal skin crease near the laryngeal and this can be used for direct access to the reduction. And then, The muscles in the throat are then held apart with forceps, and the protruding cartilage is shaved down with a scalpel, thus making the throat appear smoother and less angular. But this stage needs the professional specialist to reduce only the prominence tracheal.The voice box and vocal cords are directly below these cartilages, so it is important not to over-resect this cartilage which could affect the vocal cords. This will leave a scar but the surgeon usually makes the cut run along one of the natural creases in the skin and that helps minimize the appearance of the scar. And after that, the incision will be closed with the suture and the elastic gauze

And for alternative, the surgeon will make an incision under the chin and insert the instrument to shave the Adam’s apple under the neck skin. The advantage of this technique is the much less scars visible because it’s hidden under the chin. 

What type of Anastasia is necessary for the procedure ?

Local Anastasia

How will the incision look like?

The incision of this procedure will be made along at the neck fold under the chin which almost imperceptible, the length of the incision is about 2-3 cm. The incision red line will mark the incision for about four to six weeks.

Ideal Candidates

Is this procedure suitable for the candidate?

  • The candidate can be both of man and woman but must be in good health.
  • Must be over 18 years old , when the body stop developing 
  • The peoples who have the swollen throat cause of the prominent throat cartilage and want to shave it off
  • The peoples who want to have a refreshed look and natural beautiful as the real woman 
  • The peoples who want to have the appearance a smoother and more feminine neck
  • The who want to have the feminization of the neck contour and face, especially in transgender patient
  • The real woman who is not comfortable with the girth of their Adam’s apple or feel ashamed with the masculine of the neck appearance and want to improve it
  • The real man who have a physical problem because of too big Adam’s shaving such as can’t wear a shirt, can’t wear a tie or even can’t easy shave the hair from the neck area 
  • The peoples who have the stable emotion 
  • The transgender to prepare to undergo the sex change surgery (Female to male surgery). It is likely the most common surgery performed on transsexual women
  • The people with the with little subcutaneous fat in the neck and thyroid cartilage is very visible

What are the results the candidate can expect?

  • The result of the surgery is immediately visible and permanent 
  • The neck looks perfectly smooth and flat 
  • The neck appearance looks more symmetry both in man and woman especially compare to the whole face
  • The appearance looks more feminization in the woman and especially in the female to male transgender
  • The real woman with the big trachea can throw away the ashamed feeling about the masculine face feature like the man and can be more self-confident with the feminization neck 
  • The transgender patient can have the feminization face and go future to another step of sex change surgery 
  • The real man with too big can have more comfort daily routine such you shaving the hair on the neck , wear the shirt or tie and etc.
  • Try to drink water as much as you can, because hydration is very important both of before and after the surgery for safe recovery

Recover/Post-Operative

Length of stay at the hospital and in Thailand

Out-patients, recommend 9 days in Thailand

Pre-operative care

  • Have a consultation with the surgeon, inform the surgeon about the medical problem and condition 
  • Discuss with the surgeon about the surgeon about the expected result, what type of the dimple you would like to create, the position of dimple creation and etc.
  • If you are having a combination of plastic surgery procedures, the surgeon will explain you about this and the surgery will take longer recovery time. You can make a decision to do it or not
  • You will be asked to stop taking Aspirin, ibuprofen, and products containing aspirin and ibuprofen including anti-inflammatory medication and including high dosing any multivitamins/herbal remedies/teas etc before and surgery for 2 weeks , this may inhibit blood clotting and cause bleeding problems during and after surgery
  • Stop drinking alcohol or smoking before and after the surgery 2 weeks, that’s effect to delay wound healing

On the surgery date

  • And on the surgery date, you should stop eating and drinking 6 hours before the surgery
  • Take a bath and wash your hair wash your hair (because after a surgery, you maybe not comfortable to do it for a few days) but without applying the lotion and cream on the body including no makeup
  • Take out all accessories, such as earring and also remove the nail polish before getting the operation room
  • Wear the loose cloths or comfortable, If possible take the shirt with the button in front. 
  • Sleep well before the surgery
  • Make a physical checking up to be sure that you have the normal level of your blood pressure or any disease come up which can’t undergo the surgery or not

Post-operative care

  • You may feel pain , swelling , bruising and uncomfortable which will go away in 1 week
  • The painkiller pill and antibiotics medication is recommended if the pain is extremely and for preventing to get infection during the healing process and continue taking them until they are all gone. 
  • The surgeon will recommend applying the cool pack or frozen peas, this can reduce the swelling and stop bleeding (especially, the first few days is recommended to keep cool pack on your surgery area all the time) and including vitamin A and C is also can help. 
  • After 48 hours, when you stop applying the cool pack on the cheek. Just let it heal by itself and the swelling will fade away in 4-5 days.
  • The surgeon will recommend you lay down in the position with your head higher than body. This will help relieve pressure from your treatment area reducing swelling and pain
  • You may feel numbness and temporary discomfort round the incision for few days. But this can be controlled with the medicine. 
  • Keep all incision and suture lines free of moisture to ensure proper healing, do not allow creams, lotions, or topical arnica into the incision because they can cause inflammation
  • If you have bleeding or oozing come out from the wound, it’s normal from the surgery. Just disregard and it will fade away in a few days 
  • Drink water as much as you can with the straw
  • Do not eat the spicy food , hot food , the food with high acidly, uncooked foods, fresh fruits or vegetable which maybe have the bacteria contained until 4 weeks to prevent getting infection 
  • Avoid abusing your voice such as shouting or singing for 2 weeks after the surgery
  • Avoid the extreme sports or exercise such as jogging, bending, sex, or any activity that increases your blood pressure
  • 5 days after the surgery, you can take out the bandage and 7 days after the surgery, you have to go back to see the surgeon and remove the stitch
  • In the beginner after the surgery, you may feel a little tired because your body heals itself
  • You may feel discomfort while speaking in the beginning , but it’s just for temporarily 
  • Avoid extreme activities or strenuous sport at least if you feel ashamed with the dimpled cheek (even when you don’t smile), you can put the anti-dust mask or put the plaster with the same color with your skin. This can help
  • You can resume light activity the day of surgery. Do not lifting heavy objects and, especially, no bending over to lift objects. Its can caused of raising your blood pressure and heart rate through strenuous which this can slow-down the healing process
  • If your incision is very dry, you can use the moisturizer to apply on it, this can help to heal the wound also
  • And please apply the sun cream on the incision after the surgery until 6 months after the surgery 

What are the possible risks and complications involved?

The common symptoms

After the surgery have done, you may feel giddy from the Anastasia and have a feeling of burning sensation and some difficulties when swallowing or talking or some feeling similar to a simple sore throat, including a reduction in the ability to speak loudly. No worry, it will be better over the time.

Infection

This is quite rare symptom after Adam’s apple shaving surgery because both of before and surgery, the surgeon will let you take the anti-biotic medicine to prevent getting infection which you can notices from the pain around your incision, feel the heat from the wound and also the redness surrounding the incision. In some cases, the people can have the high flu either. And you have to go back to see the surgeon as soon as you can.

Damages to the vocal chords and voice

Normally, after the thyroid cartilage is shaved, may experience a slightly croaky voice immediately afterwards, but it will be better if the vocal chords and voice is not damaged. But if it’s so (which is rare because the position of the vocal cords are visualized by the CT scan), your voice will be permanently hoarse

The breathing problem

These problems can occur from undergo the surgery with less experience surgeon. When the Adam’s apple is shaved too much which you lead to the breathing problem, the swollen thyroid until you can’t breathe by yourself. Or worse, the surgeon will make a small hole on your neck to help you to breathe which is a big concern for the peoples who seeking for this procedure.

Scarring

After the surgery, you will have the incision on the neck which can become scarring if it doesn’t healed well or in the correct way. Even the scar is small but it’s visible, this can be healed with anti-biotic cream from the surgeon or Vitamin E cream can help make it less unsightly. But if the scars are worse, the surgery revision to removes it is necessary.