Background: The one gender difference between a male and female neck contour relates to the thyroid cartilages or the Adam’s apple. In women a smooth neck contour is seen while in men a more prominent thyroid cartilage creates variable amounts of visibility. The thyroid cartilages in men are bigger due to hormonal influences which also accounts for the difference in voice. A bigger thyroid cartilage allows for what lies inside, the vocal cords, to similarly be bigger in size.
While visible thyroid cartilages are aesthetically acceptable in men, it is possible that they can be too prominent. There is no exact measurement that determines when the thyroid prominence is unacceptable. But it appears that when the ‘thyroid cartilage angle’ starts to become less obtuse and the cervicomental angle is disrupted by a sharp bulge that it can be an aesthetic concern for men. In my experience this always presents in the male who has a thin neck and lean body frame.
While tracheal reduction or tracheal shave is often perceived as being a transgender male to female surgery, it can be equally applied to the cis-male. The surgical techniques are the same bu the desired end result is slightly different.
Case Study: This male presented for tracheal reduction with a prominent superior thyroid notch and visible V outline of the cartilages.
Under general anesthesia and through a 2.5cm incision in an existing horizontal skin crease, the thyroid cartilages were esposed. The prominence of the anterior thyroid cartilage protrusion was shaved n what was felt to be an adequate but safe reduction. The skin was closed in a subcuticular fashion.
As the name implies a tracheal shave procedure literally involves the shaving removal by a scalpel of the cartilage protrusion. In young people the cartilage is soft much like a bar of soap. The cartilage is shaved down to the point of not compromising stability between the two halfs of the thyroid cartilages.
Unlike trying to feminize the neck, the goal in a male is not to create a completely flat profile. Having some semblance of a tracheal bump is aesthetically acceptable and desired.
1) A prominent thyroid cartilage in a male is typically a combination of a thin neck and and cartilage over development.
2) Direct incisional access in a nearby horizontal skin crease allows for the most effective reduction to be done.
3) The goal in male tracheal shaves is to still leave a bit of residual neck bump.
Dr. Barry Eppley