UCLA surgeons are developing a new technique to reduce

image: Photos of a patient before (top row) and after (bottom row) surgery at UCLA to reduce the size of Adam’s apple with no visible scar.
see After

Credit: UCLA Gender Health Program

The doctors of the UCLA Gender Health Program have developed a technique to reduce an Adam’s apple bump without leaving a scar on the patient’s neck.

This breakthrough could be important and welcome for transgender women and non-binary people, for whom a neck scar can be a telltale sign of their surgery, often exposing them to discrimination, hatred and violence.

A study of the surgeons who developed the technique has been published in the magazine Facial plastic surgery and aesthetic medicine. Reviewing the outcomes of 77 people who underwent the surgery at UCLA health facilities, the authors concluded that the procedure is an effective way to optimize care for people undergoing gender-affirming surgery.

Specifically, they found that the procedure – which can be performed in 90 minutes by a surgeon – is effective in removing Adam’s apple, that it can be performed using only equipment already available in most theaters. plus a few other inexpensive tools. , and that it could be easily adopted by plastic surgeons and throat surgeons.

The procedure is called a “scarless” tracheal shave, thanks to the absence of a scar on the patient’s neck, although in reality it creates a small scar hidden inside the patient’s lip. This is where a surgeon inserts cartilage cutters and a polishing tool to shave off the extra cartilage that forms the Adam’s apple.

“There will always be a scar with any surgery, but this procedure creates a scar that only a dentist would see,” said Dr. Abie Mendelsohn, associate professor of head and neck surgery at the David Geffen School of Medicine at UCLA,and the lead author of the study. “This represents a massive shift in the ability to provide optimal gender-affirming patient care.”

Mendelsohn said many transgender people fear going about the activities of daily living because of the threat of being “clocked” or identified as a trans person by others, against their wishes.

“When we live in fear, it’s really no life at all,” Mendelsohn said. “With this novel approach, we have the ability to surgically treat fear, and that’s an incredibly rewarding aspect of the work we do.”

Although there are several gender affirmation procedures that can be treated with hormone replacement therapy, Adam’s apple is one of the few anatomical features that can only be treated with surgery. The traditional tracheal shaving procedure, which was developed in the mid-1970s, involves making an incision in the neck and then using stitches to close it. But for some transgender people, the scar created by this procedure could be as painful as the presence of the Adam’s apple itself.

Founded in 2016, the Gender Health Program provides comprehensive medical and surgical care to transgender and gender-diverse patients in Los Angeles and across the country. It is led by Dr. Amy Weimer and Dr. Mark Litwin. The surgeries analyzed in the new study were performed by surgeons affiliated with the program between November 2019 and April 2022.

There has been little research on other techniques that claim to reduce Adam’s apple with minimal scarring. But these previous studies involved very small numbers of patients or were conducted only on cadavers, and they had not shown other techniques to be safe or effective.

The authors of the new study recommend that facial plastic surgeons and surgeons specializing in laryngology or throat surgery adopt the new technique, and they suggest that surgical fellows perform about 20 supervised procedures before attempting to operate on their own. .

“This is a significant enhancement to the gender-affirming standard of care that we hope other surgeons in the field will incorporate into their own practices,” said study co-author Dr. Justine Lee. , Bernard G. Sarnat Professor of Craniofacial Biology at UCLA, and Associate Professor of Surgery at the Geffen School of Medicine.

The study found that there were no voice changes or vocal cord damage in the patients, but more research is needed to corroborate these findings and to understand the effects that the technique developed by UCLA could have on patients’ quality of life and mental health.

The study’s first author is Dr. Michael Eggerstedt of Rush University Medical Center in Chicago. The authors received no extramural funding for the study.

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