A tracheal shave or Adam’s Apple reduction (technically a thyrochondroplasty) is a well known neck contouring procedure to reduce a thyroid cartilage prominence. While it is most commonly perceived to be a male to female transgender procedure, it is actually done just as commonly for men or women who have a prominent thyroid bulge and are not undergoing a facial feminization procedure.
The tracheal shave is one of those plastic surgery operations that is not really misnamed. In its name is exactly how it is done. The usually soft nature of the thyroid cartilage is exposed and shaved down with a scalpel reducing the laryngeal prominence at the thyroid notch and the anterior rim of the paired lamina. With the scalpel the reduction is shaved down in layers until the desired level is obtained.
But as patients get older the thyroid cartilages become stiffer and partially ossified. Around the age of 50 and older a scalpel will usually not cut into the cartilage and a true tracheal shave is not possible. It becomes necessary to change from the reduction method from a scalpel to a burring technique using a handpiece and drill. This mechanical rotary reduction method allows for a very precise laryngeal prominence reduction and also makes the cartilage edges very smooth.
In older patients a tracheal shave becomes a tracheal burring reduction. The result with mechanical burring is just as effective. Given the need for a handpiece the tracheal reduction is best done through a small overlying skin incision rather than a more distant submental incision higher up under the chin.
Dr. Barry Eppley