Introduction
Tracheal augmentation refers to surgical procedures intended to enlarge, reinforce, or reshape the trachea (windpipe) to improve airflow. As a form of reconstructive airway surgery, tissue or graft material is added to widen the airway or stabilize weak or collapsed segments. It is not typically considered a cosmetic procedure—unlike a tracheal shave, which reduces the laryngeal prominence for aesthetic purposes.
Far less well known is Adam’s apple augmentation, also called laryngeal prominence enhancement. This cosmetic procedure is designed to create or enhance the prominence of the thyroid cartilage, producing a sharper, more masculine contour at the front of the neck. In contrast to a tracheal shave, this procedure increases projection rather than reducing it.
Adam’s apple augmentation may be requested by:
- Men seeking a stronger, more masculine neck profile
- Trans men (FTM) pursuing neck masculinization
- Patients with a naturally small or absent laryngeal prominence
While cartilage grafting is one option for building the prominence, an implant-based method offers an alternative that avoids donor-site morbidity and can produce excellent, predictable results.
Case Study
This patient, an older male undergoing multiple facial masculinization procedures, desired a more visible Adam’s apple.
Under general anesthesia, an incision was placed within a well?defined lower neck crease. The vertical strap muscles were identified and separated in the midline, exposing the thyroid cartilages from the notch superiorly down to the cricoid cartilage.
A porous polyethylene nasal shell implant system was used. A light?blue sizer was inserted first and trimmed along its lateral edges and inferior border to achieve a precise, secure fit. The customized sizer was then transferred to the definitive implant, creating a template for shaping the final implant.
A V?shaped notch was created along the superior edge of the implant before insertion into the pocket. The space beneath this inverted V?shaped contour was filled with a small wafer graft and sutured in place for additional definition.
The strap muscles were closed over the implant, and the remaining tissue layers were closed in multiple layers using resorbable sutures.
The enhanced laryngeal prominence was immediately visible yet maintained a natural appearance.
Discussion
The contour of the neck is a meaningful gender identifying feature. In facial feminization surgery, reducing the laryngeal prominence via tracheal shave creates the flatter contour associated with a feminine appearance. Conversely, neck masculinization involves increasing the prominence of the thyroid cartilage—a procedure performed far less commonly.
Although cartilage grafting can effectively build up the area, an implant?based approach offers important advantages. A thin nasal shell implant conforms well to laryngeal anatomy, can be easily modified, and allows tissue ingrowth for long?term stabilization. When placed in a submuscular position directly over the thyroid cartilages, it provides a safe, reliable, and cosmetically effective method for enhancing the laryngeal prominence.
Key Points
- Masculinization of the neck can be achieved through structural augmentation of the laryngeal prominence.
- A porous polyethylene nasal shell implant placed under the strap muscles creates a natural, enhanced Adam’s apple.
- Long?term stability of the implant is supported by tissue ingrowth.
Barry Eppley, MD, DMD
World?Renowned Plastic Surgeon