A tracheal shave is a surgical procedure that reduces the visible bump on the front of the throat commonly known as the Adam’s apple. Formally called chondrolaryngoplasty, it involves shaving down the thyroid cartilage to create a smoother, flatter neck profile. The procedure is most commonly sought by transgender women as part of facial feminization, though anyone bothered by a prominent Adam’s apple can be a candidate.
What the Surgery Involves
The Adam’s apple is formed by the two plates of thyroid cartilage that meet at an angle in the front of your throat. In people who went through testosterone-driven puberty, this angle tends to be sharper and more pronounced, creating a visible bump. During a tracheal shave, a surgeon carefully removes or shaves down the cartilage at this peak to flatten the contour.
The procedure is typically performed under local anesthesia with sedation, or sometimes general anesthesia, and usually takes under an hour. Surgeons make a small incision either directly over the Adam’s apple area, often placed in a natural skin crease, or under the chin (called a submental incision). A direct incision gives the surgeon better visibility of the cartilage, while a submental incision hides the scar more effectively but makes the dissection slightly more complex. Once the cartilage is exposed, the surgeon shaves it down to the desired flatness and closes the incision.
Why Vocal Cord Safety Matters
The thyroid cartilage isn’t just a cosmetic structure. Your vocal cords attach to its inner surface, meeting at a point called the anterior commissure right behind where the Adam’s apple protrudes most. Several important ligaments also anchor to this cartilage, including structures that support the epiglottis (the flap that keeps food out of your airway) and the vestibular folds above the vocal cords.
This is the central challenge of the procedure: the cartilage the surgeon needs to reduce is the same cartilage your vocal cords attach to. Experienced surgeons work in a plane about 1 to 2 millimeters above where the vocal ligaments insert, removing as much cartilage as possible while preserving that attachment. If the surgeon goes too deep and detaches the anterior commissure, the consequences can be severe and potentially permanent, including a lower voice pitch and chronic hoarseness. This is why choosing a surgeon who performs the procedure regularly is critical.
Who Can and Can’t Have It
Most healthy adults with a prominent Adam’s apple are good candidates. Before scheduling surgery, you’ll have a consultation where the surgeon evaluates your throat, discusses realistic expectations, and takes photos for planning and comparison.
A surgeon may advise against the procedure if you have a history of voice disorders or prior neck surgery, a severe chronic condition like heart disease or uncontrolled diabetes, a body mass index greater than 35, a large neck circumference, or if you smoke. Smoking impairs healing and increases complication risk, so you’ll be asked to stop for at least several days before surgery. You’ll also need to stop taking aspirin and any blood-thinning medications or supplements beforehand.
Recovery and What to Expect
In the first few days after surgery, expect soreness, swelling, a hoarse voice, and possibly some difficulty swallowing. These symptoms are normal and resolve relatively quickly. Voice rest is strongly recommended during early recovery because the swelling sits so close to your vocal cords, and unnecessary strain could cause damage while tissues are healing.
Most people return to work and normal activities within about a week, as long as their job doesn’t require heavy voice use. Full recovery takes two to four weeks, depending on individual healing. Once the initial swelling goes down, the results are visible right away.
Results and Limitations
A tracheal shave is permanent. The cartilage that’s removed doesn’t grow back. For most people, the result is a noticeably smoother throat profile that looks natural from all angles.
That said, there are limits. A very large Adam’s apple sometimes can’t be removed completely or reduced as much as you might hope, because the surgeon has to leave enough cartilage to protect your vocal cord attachments. The procedure also does not change your voice pitch. If voice feminization is a goal, that requires a separate surgery. In older patients, thyroid cartilage can partially calcify and become more bone-like, which may affect how much material can be safely removed.
Risks
Tracheal shaves are considered low-risk overall, and serious complications are rare when performed by an experienced surgeon. The most catastrophic possible complication is detachment of the anterior commissure, where the vocal cords meet. This can cause permanent voice changes including a deeper pitch and chronic difficulty speaking clearly. Other potential risks include bleeding, infection, scarring, and uneven results that might require revision.
The small incision typically heals well and becomes difficult to spot over time, especially when placed in a natural skin crease or under the chin. Choosing between incision locations is worth discussing with your surgeon based on your anatomy and how much reduction you’re hoping for.
Cost and Insurance
A tracheal shave generally costs between $3,000 and $6,000 when paid out of pocket, though prices vary widely depending on the surgeon, geographic location, and whether it’s combined with other procedures. When performed as part of gender-affirming care, some insurance plans now cover it, though coverage criteria vary by insurer. You’ll typically need documentation that the procedure is medically necessary rather than purely cosmetic. If you’re pursuing insurance coverage, check whether your plan requires a letter from a mental health provider or a specific diagnosis code before approving the surgery.