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Background:  The development of the thyroid cartilages are affected by the level of testosterone and associated gender. This explains their prominence in the neck of men which women do not have. It also explains the deeper male voice due to the larger size of the voice box. This is one of the many structural gender differences.

But in some men the thyroid cartilages are very prominent due to either overgrowth or very thin necks with permit too much ‘tracheal show’. These men seek thyroid cartilage reduction to reduce the size of their anterior neck prominence. While many associate the tracheal shave as a transgender or feminization procedure, I see an equal number of men for the tracheal shave as those I see for its reduction as part of an overall facial feminization.

The key in male tracheal reductions is that it is a reduction not a complete elimination. Most men are not looking for a completely smooth neck profile. It is also important to use as small a skin incision as possible. It should also be placed in a skin crease above the prominent where it can heal in a virtual scarless fashion.

Case Study:  This young male was bothered by his pointy and prominent anterior thyroid cartilage projection. The skeleton outline of the union of the two thyroid cartilage halves could clearly be seen through the skin.

Under general anesthesia a small skin incision was made in a horizontal skin crease  above the prominent thyroid point. The thyroid cartilages were exposed and shaved down, creating a 6mm to 7mm reduction.

His immediate intraoperative result showed a significant reduction but not a completely flat neck profile.

Case Highlights:

1) A tracheal shave can be done in men who have very prominent thyroid cartilages.

2) Male tracheal shaves are done through a small skin incision right above the prominence.

3) Male tracheal reduction should leave some semblance of a tracheal bump.

Dr. Barry Eppley

Indianapolis, Indiana

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