Chondrolaryngoplasty

Chondrolaryngoplasty is the surgical name for the tracheal shave: shaving down the front of the thyroid cartilage to reduce the Adam's apple. It changes the shape of the neck, not the sound of the voice.

Where the word turns up

On consent forms, surgeon letters and insurance paperwork. Everyone else calls it a tracheal shave, which is a slightly misleading name, since the cartilage being shaved belongs to the voice box rather than the windpipe. The word breaks down as cartilage (chondro), larynx (laryngo) and reshaping (plasty).

What is done

A short cut, usually placed in a skin crease under the chin or high on the neck so it is hidden, then the prominent front edge of the thyroid cartilage is reduced. It is often done alongside facial surgery, and many surgeons do it under the same anaesthetic as other work.

The voice question

It is not a voice operation, but it happens right next to one. The vocal folds attach to the inside of the thyroid cartilage just behind the part being shaved, and taking too much cartilage near that point can affect the voice. That is why a careful surgeon stops short of the attachment rather than chasing the flattest possible profile, and why some will put a needle through the cartilage or watch the folds with a scope during the operation to find the safe line.

The same logic shapes the order of operations. Voice surgery can shift where the folds sit or leave scar tissue, and a surgeon shaving afterwards can see and allow for that; shaving first means the voice surgeon works on cartilage someone else has already thinned. So the voice work usually goes first or alongside, though some surgeons are comfortable either way. If you are planning both, ask how the surgeon sequences them before you book either.

Who does it

Two kinds of surgeon offer it: facial surgeons, who often add it to facial feminization, and ear, nose and throat surgeons, some of whom specialise in the voice box as a laryngologist. Both can do it well. The difference shows in how they protect the voice. I would ask any surgeon how they find the fold attachment during the operation, and what they do if the scope shows they are close to it. A clear, specific answer is a good sign; "we just take it down carefully" is not.

What it means for you

As operations go, this is a small one. It is usually a day case, and people go home with a sore throat, some trouble swallowing for a few days and a stiff, bruised neck. The voice may sound husky at first from swelling and the breathing tube, and that should settle within days to a couple of weeks. The scar is short and sits in a crease, so it tends to fade well, though it can stay visible for months and some people's skin scars more than others.

What you cannot do is add cartilage back. If too much comes off, or the neck looks wrong afterwards, there is no simple fix, which is a good reason to choose a surgeon who errs conservative.

Common misunderstandings

The first is that it will raise the voice. It will not, and a surgeon who implies it might is worth questioning. The second is that the result is always perfectly flat. How much can safely come off depends on where your folds attach, so on some necks the honest result is a smaller, softer bump rather than none. The third is that insurers will treat it like the rest of gender-affirming care. Most class it as cosmetic, though some US plans that cover facial feminization include it; the insurance and funding page covers where that varies.

← Back to the Glossary