Background: One of the many head and neck features that are distinctly masculine is that of the thyroid cartilage or Adam’s Apple. Greater projection of the thyroid cartilage or laryngeal prominence creates a distinct bump in the neck that is associated and aesthetically acceptable in men. While it is often reduced in facial feminization surgery as a tracheal shave procedure in the male to female transgender patient, the reverse has not yet been described for necl masculinization.
How to build a more prominent thyroid cartilage has only recently been described for masculinization in a female to male transgender patient. In this solitary description onlay cartilage grafts from the rib were used for laryngeal prominence augmentation. Since the Adam’s Apple is a cartilaginous structure it is logical that cartilage grafting would be an effective technique.
But not every such patient may want a rib graft harvested for a laryngeal augmentation procedure and the volume of cartilage needed to do so is significant. Like much of the face, one wonders if an implant can be effectively used instead of a cartilage graft.
Case Study: This male wanted to improve the shape of his chin and neck. He had a mild short chin, submental fullness and a smooth neck contour. He had a first stage procedure of chin augmentation and a submentoplasty (liposuction and direct defatting with muscle plication) Afterwards he inquired about making his Adam’s Apple more prominent.
In a second procedure the laryngeal augmentation was planned using a porous polyethyene nasal shell implant. The shape of the nasal implant is like a saddle (inverted v) which seemed like it would create increased lartngeal prominence and could be secured onto the front edge of the tracheal cartilage. A v-shaped notch was made in its upper portion to replicate the natural shape of the thyroid cartilage. Such nasal implants come with inserts to place under it for increased augmentation which was also done in its use as a laryngeal onlay implant. This gives it more outward projection from the anterior surface of the natural thyroid cartilage. Through a small skin incision, the synthetic framework was placed on top of the thyroid cartilages, the strap muscles closed over it and the skin closed.
The combination of chin augmentation, submental reduction and laryngeal augmentation produced a more masculine lower face/neck profile. Laryngeal prominence augmentation can be done successfully using a properly shaped synthetic implant. The material composition is important and porous polyethyene is well known to allow for tissue ingrowth for long term implant stabilization.
Highlights:
1) A laryngeal prominence is characteristic of a male neck.
2) Masculinization of the neck can be done by implant augmentation of the thyroid cartilages.
3) A porous polyethyene implant can be used to create more projection of the upper portion of the thyroid cartilages creating a more visible Adam’s Apple.
Dr. Barry Eppley
Indianapolis, Indiana