High patient satisfaction rates after 'Adam's apple' reduction surgery

Cosmetic surgery to reduce the masculine appearance of the "Adam's apple" has a high patient satisfaction rate, according to a study in Plastic and Reconstructive Surgery—Global Open, the official open-access medical journal of the American Society of Plastic Surgeons (ASPS).

But plastic surgeons performing this procedure must balance the cosmetic results against the need for caution to prevent irreversible voice changes, according to the outcomes study by Jeffrey H. Spiegel, MD, and colleagues of Boston University Medical Center. Their study presents a new questionnaire for use in assessing the cosmetic outcomes and quality-of-life impact of Adam's apple reduction surgery in transgender and other patients.

Most Patients 'Very Satisfied' with the Results of Adam's Apple Reduction

The researchers evaluated patient satisfaction after Adam's apple reduction surgery. Known to plastic surgeons as aesthetic chondrolaryngoplasty, the procedure is sometimes called "tracheal shaving." The Adam's apple, developing during puberty from an increase in the size of the larynx and thyroid cartilage, is more prominent in males than females.

Chondrolaryngoplasty is performed in patients who want to decrease the masculine appearance of the Adams apple. It is most often performed in transgender women as part of facial feminization surgery, but may be requested by other patients as well. Since 2006, Dr. Spiegel has performed over 600 chondrolaryngoplasty procedures.

The procedure involves reducing the most prominent part of the thyroid cartilage. Ideally, the surgeon would completely remove the forward-projecting cartilage. However, if surgery is too aggressive, there's a risk that the larynx and vocal cords could be affected, resulting in permanent voice changes.

"This is particularly devastating in transgender females, in whom lowering the voice can be especially traumatic and a difficult handicap to overcome," Dr. Spiegel and colleagues write. "The aesthetic results must be balanced with the goal of minimizing the risk of over-resection and voice change."

The researchers created a seven-item questionnaire to assess physical, emotional, and social quality of life after chondrolaryngoplasty, assessing. The researchers contacted Dr. Spiegel's first 112 patients, 45 of whom responded to the questionnaire.

Sixty percent of patients indicated that they were "very" or "completely" satisfied with the appearance of their neck and Adam's apple. Only 13 percent said that they were "not at all" satisfied; 15 percent felt that the results limited their social or professional appearance.

About 55 percent of patients felt that the appearance of their neck/Adam's apple was the "best that it could be," while only 25 percent said they were interested in further surgery. None of the patients experienced any long-term voice changes.

Dr. Spiegel and colleagues also performed an additional anatomical study to evaluate the potential for refining the tracheal shave technique in feminization procedures. The results suggested it might be possible to carry the incision lower so as to further reduce the prominence of the tracheal cartilage. However, at least until further research is carried out, the researchers conclude that this maneuver poses "too strong of a risk."

Meanwhile, the new outcomes study, using a procedure-specific questionnaire, will be helpful to plastic surgeons in informing patients about the expected results of Adam's apple reduction surgery. "We can tell them that three-quarters of patients have adequate reduction in the size of the thyroid cartilage, and that the majority are very satisfied with their outcome," Dr. Spiegel and coauthors write.