What are the risk of tracheal shave?

Question

Im a transgender woman, I'm considering getting plastic surgery this year (tracheal shave), however I'm a bit afraid to get it done because my Adam's apple it's too big, what are the risk for complications and will a surgery shave it all? Or just half? I don't want to have something done to still have it , I'm in Florida

Parker A. Velargo, MD, FACS · Answer

Complications following a tracheal shave procedure are relatively rare.  I place my incision under the chin (instead of over the Adam's apple) for a more inconspicuous scar, so scarring is a potential risk.  Another risk is injury to the airway if your surgeon takes too much tissue (rare, especially if performed by a board certified facial plastic surgeon familiar with the anatomy of the larynx).  Lastly, there is a rare risk of vocal pitch lowering resulting from destabilization of the vocal cords from taking too much cartilage where they insert on the cartilage framework.  As a facial plastic surgeon who spent years of training operating on the vocal cords, I minimize this risk by directly visualizing the vocal cords with a camera during the procedure and only removing cartilage above the insertion point.

Bryan Rolfes, MD · Answer

There are several significant risks associated with this surgery, but with an experienced surgeon they are largely hypothetical.  If you take too much of the thyroid cartilage (the structure that created the appearance of an adam's apple) then you can detach the vocal cords and create significant and possibly permanent voice change.  An experienced surgeon will not have any trouble determining how much cartilage they can take.  It's like driving a car, you could do a lot of damage if it's your first time but an experienced and cautious driver is very safe.  There is also a risk of swelling with any surgery around the airway, though this too is rare.  Your surgeon will observe you for a period after your surgery and may even perform an endoscopic exam before sending you home to make sure no swelling is present.  As long as the proper precautions are taken, this procedure is very safe.  Bryan Rolfes, MD

Philip Solomon, MD, FRCS · Answer

Risks of this procedure include bleeding, infection and scarring.  Specific risks to this procedure include the rare possibility of permanent voice alteration. This procedure is safe and performed typically by board certified facial plastic surgeons who have training in Otolaryngology Head and Neck Surgery or plastic surgeons with a subspecialty interest in transgender surgery.

Ross Blagg, MD · Answer

Hi Neowfl, Please make sure that you see a certified plastic surgeon for your procedure, as one of the biggest risks will be going to someone that has little experience with the surgery. Doctors who perform this surgery typically obtain good results. It's probably best to go to a few different consultations and ask about specific risks/complications such as under-correction of the ridge and voice changes post-surgery. I wish you all the best in your journey. You're likely an inspiration to many other transgender individuals, and you should be proud of that. Best, Ross Blagg, M.D.

Vartan Mardirossian, MD · Answer

Hello NeowflThe risks of trach shave are disrupting the vocal folds with change in voice, problems with breathing or insufficient removal of cartilage. The techniques that we use help prevent all three of these complications. The amount of cartilage that can be safely removed is sufficent in almost all cases. Hope this helps, Best Dr M

Sarah Saxon, MD · Answer

Some of the risks of a trach shave are similar to any other procedure such as bruising, scarring, infection, fluid collections, etc. The main unique risk is damage to the vocal cords. I use a technique where I look directly at the vocal cords and mark where they attach to the cartilage that forms the Adam's apple. That location of attachment varies between individuals, and a small number of patients will have a small residual bump if the vocal cords attach at a high level. The risk of using any other technique is that it's guesswork as to whether or not the surgeon damages the vocal cords and leaves you with a raspy and deep voice. This is the main reason to find the right surgeon who is very experienced doing this particular procedure.
Best of luck in your journey,
Sarah Saxon, MD

Rob Knight, MBBS, MD, FRACS(Plast) · Answer

Hi Neowfl
Thanks for getting in touch. There are always risks associated with shaving of the thyroid cartilage considering its location and potential damage that can occur. Having said that, once one has performed the surgery, those risks significantly decrease. The risks can be minor such as scarring, bleeding, pain and recurrence/ uneven shave all the way through to recurrent laryngeal nerve damage and loss of voice and at the extreme compromised airway/ difficulty breathing. Make sure you get someone to do this procedure who is competant and you will be fine! Hope that helps!

Robert H. Hunsaker, MD · Answer

the risks are small in the hands of a surgeon experienced in this. In my experience, the degree of change is variable because of the variability in the position/dimensions of the structure prior to surgery. A better answer can be given after an evaluation.

Michael Eisemann, MD · Answer

Shaving the laryngeal eminence or Adams Apple is done under local anesthesia or with supplemental intravenous sedation. Care  is taken not to disrupt the anterior commissure of the vocal cords or enter the larynx. Nice results are achieved through a small transverse skin crease incision.Michael Eisemann M.D.Plastic SurgeonOtolaryngologistHouston

What are the risk of tracheal shave?

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