Trach Shave

Chondrolaryngoplasty is a surgical procedure to reduce the size of the laryngeal prominence, also known as the “Adam’s apple”. In this surgery, the cartilaginous prominence is removed and shaved down on the neck to provide a smooth, flattened appearance. While chondrolaryngoplasty can be transformative aesthetically, it will not change vocal pitch. This surgery is typically lumped together under FFS as it contributes to the overall feminization of facial features.

The procedure is typically performed under general anesthesia and involves the following steps:

• A small, well-concealed incision is made in a natural skin crease either just below the chin or high on the neck, depending on the patient’s anatomy and preferences regarding scar location.
• The strap muscles of the neck are gently separated to provide access to the anterior surface of the thyroid cartilage.
• Using precision instruments, the most prominent portion of the cartilage is carefully shaved or contoured to reduce the projection while preserving the integrity of the vocal cords and airway.
• In select cases—particularly when the prominence lies close to the insertion of the vocal ligaments—bronchoscopic guidance may be used. This involves inserting a small camera through the airway to visualize the location of the vocal cords from within, ensuring that the cartilage is reduced safely without compromising voice function.
• Once the desired contour is achieved, the incision is closed in layers to minimize scarring, and a small dressing is placed.

Chondrolaryngoplasty can be performed on its own or in combination with other facial feminization procedures. When done in conjunction with a face or neck lift, the tracheal shave may be approached through the same incisions used for those procedures.

The best candidates for chondrolaryngoplasty are individuals who have very prominent laryngeal cartilage on their necks. A patient’s general health, expectations, and surgical goals will be considered during the consultation to determine the suitability for surgery.

The first step in chondrolaryngoplasty is to meet with Dr. Marano or Dr. Keith for a private consultation at GAMMA in New York City or New Jersey. During this time, you will discuss your goals and medical history with our team, who will then create a customized treatment plan according to your unique anatomy, comfort levels, and goals. Prior to consultation, you should ensure the following:

• Provide Mental Health Letter – Many insurance providers and surgical guidelines require a letter from a qualified mental health professional confirming a diagnosis of gender dysphoria and the patient’s readiness for surgery. This letter should follow WPATH (World Professional Association for Transgender Health) standards and address the patient’s understanding of the procedure and its implications. Our team will assist in ensuring the proper language is used and the provider is appropriately credentialed
• Quit Smoking – Nicotine constricts blood vessels and significantly increases the risk of complications, including poor wound healing and tissue loss. Patients must stop using all nicotine products—including cigarettes, vapes, nicotine patches, and gum—at least 4-6 weeks before and after surgery.
• Manage Medications – You may be asked to discontinue certain medications that increase surgical risks.
• Well-Controlled Medical or Mental Health Issues / Medical Clearance – To ensure safe surgery and recovery, patients with underlying medical conditions such as diabetes, high blood pressure, or psychiatric conditions should have them well-managed. Medical clearance from a primary care provider or specialist is required.
• BMI Cutoff – There is no strict BMI cutoff for FFS at GAMMA. Every patient is evaluated individually, considering overall health and surgical goals rather than BMI alone.
• Insurance Coverage – GAMMA works with various insurance providers to help patients access gender-affirming surgery. Our team assists with insurance verification, prior authorization, and necessary documentation. Patients should check with their insurance carrier regarding coverage criteria, including mental health letters and medical clearance requirements.
• Complete Your Consultation – You will undergo a detailed consultation with Dr. Marano or Dr. Keith to ensure your expectations are realistic and your health supports the treatment process. Our team will discuss the risks and benefits, recovery and results, of FFS.

Recovery time varies for each patient and depends on several factors, including the individual’s healing ability, the specific techniques utilized, and whether chondrolaryngoplasty is combined with other treatments or procedures.

• Hospital Stay: Although this is an outpatient procedure if performed alone, most patients will spend 1-2 nights in the hospital after surgery if additional FFS procedures are performed.
• Swelling & Bruising: Expect swelling and bruising around the neck, which will peak within 2-3 days and gradually improve over 2-3 weeks. Final swelling may take several months to resolve.
• Activity Restrictions: You will need to avoid strenuous physical activity for 2-4 weeks, especially lifting and bending, which could increase swelling or put stress on the healing tissues. It is important to sleep with the head elevated, either in a recliner or with multiple pillows, to limit facial swelling.
• Final Results: The final aesthetic results of chondrolaryngoplasty may take up to 12-18 months to fully manifest, as swelling continues to subside and tissues heal.

Recovery time varies for each patient and depends on several factors, including the individual’s healing ability, the specific techniques utilized, and whether chondrolaryngoplasty is combined with other treatments or procedures.

• Hospital Stay: Although this is an outpatient procedure if performed alone, most patients will spend 1-2 nights in the hospital after surgery if additional FFS procedures are performed.
• Swelling & Bruising: Expect swelling and bruising around the neck, which will peak within 2-3 days and gradually improve over 2-3 weeks. Final swelling may take several months to resolve.
• Activity Restrictions: You will need to avoid strenuous physical activity for 2-4 weeks, especially lifting and bending, which could increase swelling or put stress on the healing tissues. It is important to sleep with the head elevated, either in a recliner or with multiple pillows, to limit facial swelling.
• Final Results: The final aesthetic results of chondrolaryngoplasty may take up to 12-18 months to fully manifest, as swelling continues to subside and tissues heal.

Insurance carriers will typically cover gender affirmation surgery, including facial feminization surgery, when it is performed to treat gender dysphoria, a condition in which the patient’s outer traits do not reflect their authentic gender identity. You’ll need a letter from a mental health provider detailing your decision to undergo FFS. Our team can go over the insurance requirements in greater detail during your consultation.

• Resources – For patients traveling to NYC for surgery, GAMMA provides recommendations for LGBTQ+ friendly accommodations, post-op caregivers, and recovery services. Our team can also assist with logistics such as medical transport and aftercare arrangements.
• Requirements – Out-of-town patients must plan to stay in NYC for at least two weeks after surgery to ensure proper healing and attend necessary post-operative appointments. We encourage having a trusted friend, family member, or professional caregiver for the first few days post-surgery.

Our team at Gender Affirming Medical and Microsurgical Associates (GAMMA) in New York City and New Jersey is known for providing the highest-level care in an affirming environment. We utilize today’s most progressive and cutting-edge techniques to provide the highest level of service possible. Our goal is to help transgender, nonbinary, and gender nonconforming individuals achieve their unique appearance goals and thrive with confidence, security, and peace of mind.

Dr. Drew Marano

Dr. Drew Marano is a fellowship-trained plastic and reconstructive surgeon who is considered a pioneer in the evolving field of gender affirmation surgery. After graduating at the top of his class with honors from Rutgers New Jersey Medical School, Dr. Marano completed a six-year Integrated Plastic and Reconstructive Surgery Residency at Columbia University/Cornell University in New York City. He was the first-ever Harvard University Complex Gender and Microsurgery Fellow, receiving exhaustive training in today’s most cutting-edge techniques. Dr. Marano is also a prolific author and lecturer and has lent his insights to over 40 publications and presentations at regional and national meetings. He is proud to provide MTF patients with support, encouragement, and life-changing results as they navigate the exciting journey of transitioning.

Dr. Jonathan Keith

Dr. Jonathan Keith is a fellowship-trained and board-certified plastic surgeon known for his consummate skill and artistry in the realm of microvascular surgery. He is a member of the World Professional Association for Transgender Health and the founder of the Rutgers Center for Transgender Health. In 2018, Dr. Keith established the first multidisciplinary clinical program for transgender patients in New Jersey and was the first provider in the state to perform a female-to-male phalloplasty for gender confirmation. He completed a demanding seven-year residency at the University of Pittsburgh, one of the most prestigious plastic surgery training programs in the United States. Today, Dr. Keith is considered one of the most accomplished surgeons in the country who performs DIEP flap surgery for breast reconstruction, vaginoplasty, and phalloplasty.