Chondrolaryngoplasty or tracheal shave surgery is the only structural aesthetic change that can be done on the neck. (since the thyroid cartilage is the only protruding non-soft tissue prominence) While commonly identified with transgender surgery today the tracheal shave procedure can also be performed in cis males who have too much Adam’s apple projection. (Usually associated with thin male necks) The procedure is often done as the name implies, a shaving technique, as the thyroid cartilage has very much the consistency of a bar of soap.
But there are circumstances where the once soft thyroid cartilage becomes less soft and the shaving technique with a scalpel blade is no longer effective. The most common reason cartilage structures in the body become stiffer is age. As one gets older cartilage starts to develop calcifications giving it a more firm consistency and resistant to easily be shaved in a precise manner. The other reason cartilage becomes stiffer is prior surgery. Once its surface has been previously exposed and cut it develops scar just like any other tissue.
In tracheal shaves in which the patient is older or has had prior surgery it becomes necessary to use a different technique for reduction. A high speed drill with a small burr is the effective method for stiffer cartilage similar to that when reducing bone. A small round fluted carbide burr works well but must be precisely controlled in the limited space of the small skin incision.
In most tracheal shave surgeries they are usually ‘one and done’. The first surgery is usually adequate and what can be safely reduced has been done. But when a second attempt at further reduction is warranted one should be prepared to use high speed burring and not a shave technique.
Dr. Barry Eppley
World-Renowned Plastic Surgeon