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Background: One of the many head and neck features that are distinctly masculine is that of the thyroid cartilage or Adam’s Apple.  A prominent thyroid cartilage 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.

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 tracheal 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 tracheal augmentation procedure. Like much of the face, one wonders if an implant can not be effectively used instead of a cartilage graft.

Case Study: This 35 year-old make 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 trachea augmentation was planned using a Medpor nasal implant. The shape of the nasal implant is like a saddle (inverted v) which seemed like it would create a tracheal 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. Medpor nasal implants come with inserts to place under it for increased augmentation which was also done in its use as a tracheal 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 sutured to the cartilage, the overlying skin flap of fat (to allow more of the framework projection to be seen) and the skin closed.

The combination of chin augmentation, submental reduction and tracheal augmentation produced a more masculine lower face/neck profile. Tracheal augmentation can be done successfully using a properly shaped synthetic implant. The material composition is not an important as its ability to be shaped and secured to the natural thyroid cartilage base.


1) A prominent thyroid cartilage is a male characteristic.

2) Masculinization of the neck can be done by tracheal augmentation.

3) A synthetic tracheal implant can be used to create more projection of the upper V

portion of the thyroid cartilages.

Dr. Barry Eppley

Indianapolis, Indiana

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