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The laryngochondroplasty procedure has been around for a long time for aesthetic structural neck contouring. The larynx is the only visible neck structure that can be manipulated to reduce or even elevate its prominence. It is better known as a tracheal shave which gets its name because the cartilage prominences are literally shaved down in the reductive larygochondroplasty procedure. It has risen to prominence more recently because of the demand for facial feminization surgeries for largely male to female transgender patients. Although in my practice there are an almost equal number of males seeking reduction due to its extreme protrusion in thin necks.

In the April 2023 issue of the journal Plastic and Reconstructive Surgery an article on this topic was published entitled Laryngochondroplasty: A Systemic Review of Safety, Satisfaction, and Surgical Techniques’. In this paper the authors have evaluated the two fundamental techniques used in tracheal shaves, direct visualization (non-endoscopic) and endoscopic-assisted, for safety and effectiveness by analyzing published papers on the topic. Screening of 324 studies on the topic was distilled down to 36 non-endoscopic tracheal shave publications that met the inclusion criteria. This resulted in a total of 214 trans feminine patients  in which was reported a 14% short term complication rate, a 0% long term complication rate and a patient satisfaction of 97%. The most common short term medical complication was hoarseness or a change in voice pitch. The only aesthetic ‘complication’ was a desire for more cartilage reduction. (7%)

Four studies used endoscopic-assisted resection (LMA or ET intubation) showed a short-term complication rate of 3% and a long term complications rate of 0%. Seven studies with ET intubation and anatomically guided resection had a short term complication rate of 41% and long term complication rate of 2%.

In comparing endoscopic-assisted and direct visualization guided resections long term complications rates and patient satisfaction were not significantly different.

This well thought out and executed study demonstrates comparative outcomes regardless of the tracheal shave technique used. It is hard to argue with the endoscopic-visualization method as improved localization of the vocal cords before cartage resection seems anatomically prudent. I suspect the reason the anatomically guided method has similar medical outcomes is that experienced surgeons probably naturally remove less cartilage, decreasing the risks of anatomical instability of the two cartilage halves and lessening risks of vocal cord issues. It is important to always remember in any aesthetic procedure that less than ideal improvement is preferred over having a complication. Patients can easily identify the latter, it is more difficult to have objections about the former. My suspicion would be that the endoscopic-assisted technique allows for greater thyroid cartilage reductions…but this is a premise that defies the ability for accurate scientific comparison.   

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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