Q: Dr. Eppley, I read on your website that you are able to perform Adam’s Apple Augmentation (as opposed to the usual reduction) and I was wondering what the approximate cost would be for this surgery, and what the cost and recovery differences would be if the patient opts to use the intercostal cartilage rather than synthetic materials?
A: Adam’s apple augmentation or tracheal sugmentation can be done used either a Medpor nasal shell style implant or carved rib cartilage. There are advantages and disadvantages with either approach. An implant is preformed, requires no donor site harvest and easily shaped to overlay on top of the existing thyroid cartilages. Because the implant is performed, the operative time is shorter and this costs less. It is an implant, however, so theoretically the risk of potential infection is higher. (although I have not seen that occur) Rib cartilage requites a donor site harvest, is harder to shape and adapt to the existing thyroid cartilages and costs more to perform. It is, however, a natural material and this would suffer a lower risk of infection.
Dr. Barry Eppley
Q: Dr. Eppley, I am a young girl who is scheduled to have a hysterectomy as part of my conversion to a male. I have seen some postoperative photos of this surgery after one year of healing, and there is a visible scar in most cases. Is it possible to remove this completely, and have you performed a surgery like this? Also, do you do a surgery which will accentuate the adam’s apple for a more male appearance? Thank you for giving me advice in advance.
A: All hysterectomies result on a low horizontal scar. That scar is permanent and there is no such thing as secondary scar removal or complete eradication. Some hysterectomy scars look quite good on their own and others benefit by a subsequent scar revision. Either way, there will be a scar. It is just a question of how diminuitive in appearance it will be. But there is no procedure than can produce a complete scar removal.
In regards to tracheal or adam’s apple augmentation, I have actually performed such a procedure. It is done with a specially-shaped implant that sits on top and in from of the tracheal cartilage. It has a v-shaped upper edge to it to resemble the typical appearance of the shape of the adam’s apple. It appears to work best in necks that are thin without a lot of subcutaneous fat so the new outline of the tracheal can be appreciated as opposed to just a larger neck bump.
Dr. Barry Eppley
Q: I am interested in changing the shape of my neck. I want a visible Adams apple as my neck is too flat and feminine. Can it be done? How would it be done? Imperative to get an answer please!
A: When it comes to tracheal or thyroid cartilage (Adam’s apple) surgery, the standard operation is that of reduction. Known as Adam’s apple reduction (technically reduction chondrothyroplasty) it is done by shaving down the upper v-shaped edges of the thyroid cartilage through a small horizontal incision directly over the thyroid prominence.
Thyroid augmentation is a very rare request but can be just as easily done. Through the same type of horizontal incision, the upper edges of the thyroid cartilages are exposed and built up with a variety of potential materials. Then the strap muscles are closed over the augmentation and the skin closed. Essentially, the reverse of a thyroid cartilage reduction is done. This is a one hour operation done under general anesthesia as an outpatient. There is minimal discomfort and swelling afterwards. There are no restrictions after surgery.
The key element of thyroid augmentation is what type of material to use. Ideally, cartilage is best and the loosely attached ninth rib at the subcostal margin has the right shape and size to be fashioned into a v-shape. But patients are unlikely to want the discomfort of its harvest and the small scar. This leaves a variety of synthetic material choices. Either a Gore-Tex or porous polyethylene (Medpor) block can be carved and secured by sutures to the existing thyroid cartilage framework.