Hi, I recently went to my surgeon to discuss an adams apple reduction/trach shave. He charges quite a bit and said since mine's not very big I might want to think about it.

He also said that the procdure will leave quite a nasty scar which will probably draw more attention to the area than a small adams apple would. So I don't know what to do....my neck causes me quite a bit of anxiety, I don't wash it in the shower and I am always watching my posture. Any thoughts?

Chrissi

A trach shave is kind of a risky procedure, in that it can lower and/or roughen the voice significantly.  If it were me, I'd consider maybe doing the Femlar procedure that Dr. Thomas does in Portland.  It's a voice surgery that inherently includes a trach shave because it removes and discards the front of the voice box, stretches the chords forward and clips off the excess, and closes the voicebox up at a smaller diameter.  I actually had that procedure even though I had no adams apple.  But maybe you are really happy with your voice and don't want to mess with it.  If you are interested in the Femlar, then I suggest you go to voicedoctor.net and listen to the voice recordings he put up showing before and after results.  I don't know what it costs now, but it was about 7K a few years ago when I did it.  I think I heard it went up a bit.

Well, it depends on you and if it's a problem for you. Sometimes others won't notice it at all, especially if it's small, but if it bothers you a lot and you feel that it would help you psychologically to feel more confident about yourself, then why not. There are risks, of course, so you'll need to weigh those risks against the positives.

Quote from: gothique11 on June 09, 2010, 10:39:29 PM
Well, it depends on you and if it's a problem for you. Sometimes others won't notice it at all, especially if it's small, but if it bothers you a lot and you feel that it would help you psychologically to feel more confident about yourself, then why not. There are risks, of course, so you'll need to weigh those risks against the positives.

The risks are actually quite minimal in the hands of a competent surgeon.  I've read a post from a girl in another forum who had hers done twice--first from Brassard who is very conservative in his approach, second from Ousterhart who is quite aggressive.  She's experienced no problems.

I spoke with a girl in another forum who was a singer and lost her high falsetto--she was/is a singer.  This did not seem to bother her much.

I've not heard of anyone recently who has had voice complications with this surgery

Quote from: glendagladwitch on June 09, 2010, 10:09:28 PM
A trach shave is kind of a risky procedure, in that it can lower and/or roughen the voice significantly.  If it were me, I'd consider maybe doing the Femlar procedure that Dr. Thomas does in Portland.  It's a voice surgery that inherently includes a trach shave because it removes and discards the front of the voice box, stretches the chords forward and clips off the excess, and closes the voicebox up at a smaller diameter.  I actually had that procedure even though I had no adams apple.  But maybe you are really happy with your voice and don't want to mess with it.  If you are interested in the Femlar, then I suggest you go to voicedoctor.net and listen to the voice recordings he put up showing before and after results.  I don't know what it costs now, but it was about 7K a few years ago when I did it.  I think I heard it went up a bit.

Glenda, did you have a successful result from this?  How much higher did your voice go?  Any strain or side-effects?  I've considered having him do mine too.

As for trach shave, I had mine done and the scar isn't that bad.  It's just under the chin, you have to look for it, probably about 3/4" long.  I had no complications and it removed what little I had for an adam's apple.

this is one procedure i can avoid due to the fact that my adams apple is not as noticeable cause it is small

Quote from: Kristyn on June 09, 2010, 11:16:14 PM
... first from Brassard who is very conservative in his approach, second from Ousterhart who is quite aggressive.

This is something I've known about, but I have never really seen it addressed.
More aggressive surgery may cause temporary or even permanent changes to your voice.
I'll add that I believe Dr. Zukowski is also aggressive, at least in his opinions of other surgeons!

If you are very thin, even a moderate Adam's apple will look very pronounced.

Quote from: blackMamba on June 10, 2010, 12:41:38 AM
Glenda, did you have a successful result from this?  How much higher did your voice go?  Any strain or side-effects?  I've considered having him do mine too.

As for trach shave, I had mine done and the scar isn't that bad.  It's just under the chin, you have to look for it, probably about 3/4" long.  I had no complications and it removed what little I had for an adam's apple.

My result was an improvement, especially in the removal of the lower range and change in voice quality.  But I think I only gained a few semitones in average pitch, probably becasue I was generally pretty good at keeping it up before surgery.  Now there's no effort involved in keeping it up, and I can't really slip.  But others gained more pitch increase than I did.  Here's a webpage where I collected some voice recordings for myself and a couple of other people that went to Dr. Thomas, and that are not available on his website.  It's the only place I know to see what his Thyro Hyoid Elevation (THE) surgery can do without a Femlar, what the Femlar can do without the THE, and what can happen if you then add the THE to the Femlar.

http://p11.hostingprod.com/@glendagladwitch.com/Pre_And_Post_Short_List.html

Quote from: blackMamba on June 10, 2010, 12:41:38 AM

As for trach shave, I had mine done and the scar isn't that bad.  It's just under the chin, you have to look for it, probably about 3/4" long.  I had no complications and it removed what little I had for an adam's apple.

Did Dr Brassard do yours?

Quote from: Kristyn on June 10, 2010, 07:32:35 AM
Did Dr Brassard do yours?

Dr O did it a few years ago along with some other stuff. 

Quote from: Renate on June 10, 2010, 06:09:36 AM
More aggressive surgery may cause temporary or even permanent changes to your voice.

I have known someone who did have a permanent lowering of her voice.  So, it's a risk you should be aware of.  It's rare from what I've heard, but it's a risk nonetheless.  I would go with someone who has done lots of these and knows what they are doing.

Quote from: glendagladwitch on June 10, 2010, 07:18:38 AM
Here's a webpage where I collected some voice recordings for myself and a couple of other people that went to Dr. Thomas, and that are not available on his website.  It's the only place I know to see what his Thyro Hyoid Elevation (THE) surgery can do without a Femlar, what the Femlar can do without the THE, and what can happen if you then add the THE to the Femlar.

Thanks glenda!  I will listen to this when I have more time later.

I had my trach shave a year ago with Dr Raphael in Dallas. The scar is barely noticeable, it's mostly concealed by the natural folds in my neck, and is really just a slight red mark on some days, other says not even noticeable. I probably notice it only because I know where it's at. I had no effects on my voice, and I am very pleased with the results. It really comes down to your own comfort with your adams apple. I would agree that you should go to an experienced surgeon who does these on a regular basis. An inexperienced surgeon can be too aggressive and damage the voice.

I'm going to get mine done when I have my srs next year. I think I will just feel better after it is done. I worry about the risks a little but I trust the surgeon will do a good job.

I had mine done when I had the GRS.  She was very careful to make the incision where I have a natural fold.  At seven weeks it is still noticeable but fading.  My adams apple wasn't real big, but I'm fairly thin and I thought it quite prominent although others said no.  The trach shave made a big difference in how I feel.  Now I have no hesitation about wearing low-necked shirts instead of trying to wear turtlenecks or scarves as much as possible.

I agree that you want someone who has a lot of experience.  I've had no change in my voice or other complications.

- Kate

So what is the procedure like, from a patient's perspective?

Chrissi

I had mine done during GRS, so I was already under general anesthetic.  I had a bandage on my throat for a while - 3 days? 4? 5? I don't remember.  I now have a scab that is turning into a scar that isn't real noticeable and will fade over time.  I never felt a thing other than an occasional itching as the scab formed.  YMMV

BTW, I would recommed you have laser/electrolysis on the area before the procedure.  Shaving around the incision has been the only difficulty.

- Kate

Quote from: K8 on June 13, 2010, 03:31:46 PM
I had mine done during GRS, so I was already under general anesthetic.  I had a bandage on my throat for a while - 3 days? 4? 5? I don't remember.  I now have a scab that is turning into a scar that isn't real noticeable and will fade over time.  I never felt a thing other than an occasional itching as the scab formed.  YMMV

BTW, I would recommed you have laser/electrolysis on the area before the procedure.  Shaving around the incision has been the only difficulty.

- Kate

Can the trach shave be done without a general, i.e. with epidural and local?

I was kind of lucky as I never had one or at least its so small its like not only invisible but also if you touch it, it seems like a pea. I heard it can be risky, you have to weigh the pros' and con's of the op but if your consultant doesn't think you need one then perhaps that's a good indicator. I always thought I need ffs but was talked out of it by my consultant so I never did it. The money saved/borrowed can/will be put to other things (like a nice BMW Z4, lol).

At the end of the day though only you can make that decision but make it an informed decision.

Stardust

Quote from: stardust on June 13, 2010, 05:33:20 PM
I always thought I need ffs but was talked out of it by my consultant so I never did it. The money saved/borrowed can/will be put to other things (like a nice BMW Z4, lol).

Me too.  At my consult I asked Dr Brassard  about some additional face work sometime after the surgery and he told me not to bother, that I pass very well and, if we just do one or two parts then that will throw everything off.  We did agree on a future face lift and the trach shave to be done at the time of the surgery.  It's kind of surprising when a plastic surgeon tells you that you don't need face work when all the while you thought you might.

Oh, btw  Congrats on your upcoming surgery and best of luck for a speedy, painless recovery!

[off topic slightly]

Quote from: Kristyn on June 13, 2010, 05:44:24 PM
It's kind of surprising when a plastic surgeon tells you that you don't need face work when all the while you thought you might.

When I went to a plastic surgeon, she asked why I was there.  I said to talk about my nose.  She said: "Why?"  That one word helped me to decide against a nose job.
[/off topic]

We are often our own worst critics.  It is good to get the opinion of someone who is used to looking crtically at faces and necks for their judgement before we plunk down our money.

- Kate

Quote from: Kristyn on June 13, 2010, 03:45:18 PM
Can the trach shave be done without a general, i.e. with epidural and local?

I've never heard of anybody getting an epidural, but spinal anesthetic is common.
(Spinal is a one-time shot, epidural they leave a tube in.)

Yes, they can just give you a local for a trach.

I'd recommend the spinal/local route.

Quote from: Icephoenyx on June 13, 2010, 10:21:14 AM
So what is the procedure like, from a patient's perspective?

It's not very arduous at all. Depending on the surgeon and your age they will either use
a scalpel, rongeurs (hand-held "nippers") or a burr (grinder).
Presuming that they don't attack it very aggressively you will probably forget that
they did it at all during your convalescent period.