Q: Dr. Eppley, Do you have experience with facial feminization surgery? Particularly with forehead recontouring, rhinoplasty, adam’s apple shaving, and hair line lowering?
A: I have considerable experience with facial feminization surgery (FFS) procedures, particularly the four that you have mentioned which are some of the most common FFS operations. All can make very successful feminizing effects. The key to the hairline lowering is the density of the frontal hairline where the incision has to be made. If this is adequate then the hairline can usually be lowered in a single stage of up to 2 cms based on one’s natural scalp laxity. Combining forehead/brow bone contouring with hairline lowering is particularly convenient since the pretrichial incision provides direct access to the entire forehead. Adam’s apple reduction (aka tracheal shave) is the simplest of the procedure and how much is can be reduced is dependent on what incisional access is used. (directly over it or the more remote submental incision) Reshaping the nose through a rhinoplasty to create a smoother and less prominent nose result depends on the thickness of the overlying skin. The thicker the skin the less it will contract and the size of the nose will reduce less.
Please send me some pictures of your face for my assessment and computer imaging to see what changes may be possible for you.
Dr. Barry Eppley
Q: Dr. Eppley, I had a lower facelift/necklift that left me with a prominent (at least in profile) Adam’s Apple and showing some platysmal muscles under the chin probably because of lipo done in that area years ago. I’m wondering whether a tracheal shave would be helpful and possibly a resuturing of the platysmal muscles directly under the chin to smooth that area out? Thank you.
A: I suspect that the reason you have the submental hollowing is that either fat was liposuctioned from that area and the platysmal muscles not sewn together (unlikely) or the subplastysmal fat was directly excised and the platysmal muscles that were sewn together separated sometime after surgery. (very likely and most common reason) The thyroid cartilage has become unmasked due to the muscle tightening above it (it is carried down to it but never can be done over it or below it). This pulls the muscles and overlyng neck skin up and back, creating a much better cervicomental angle but not exposing the prominence if the thyroid cartilage. I have seen this complaint from necklift patients numerous times and it is usually thin women that are most predisposed to this potential aesthetic trade-off problem.
I would agree that the best approach is a direct tracheal shave and a limited submentoplasty using a z-plasty approach to overlapping the platysmal muscles. (to lessen the risk of a recurrent submental problem) This is a far easier procedure to go through than your original facelift with a very limited recovery.
Dr. Barry Eppley
Q: Dr. Eppley, Hi. I read article you wrote online. I had a “lifestyle lift” six weeks ago. I had a mild turkey neck. After surgery I had a significant swelling in my mid neck bilaterally. Now much of the swelling is reduced but my previously unseen thyroid cartilage is now revealed. (I am a woman.) In your experience does this ever go away or will I need revision? Thanks so much for any help you can offer.
A: Unmasking of the thyroid cartilage would suggest that you had a very good midline pull and recontouring from the Lifestyle Lift procedure. I don’t know whether you had platysmal muscle plication or not (you would know if there is an incision under the chin), but the lateral pull of the skin and the defatting of a platysmal separation and its reapproximation can create a very improved cervicomental angle. These standard facelift maneuvers can occasionally make the outlines of the thyroid cartilage evident, particularly in the thin patient with little subcutaneous fat.
There is no way to undo the lift to camouflage the thyroid cartilage again. Continued aging will eventually cover up the thyroid cartilage again bit that is obviously going to take time and there is no guarantee that it will do so. An alternative suggestion is to do a simple thyroid cartilage reduction (tracheal shave). This is a common procedure to reduce the jutting and prominent thyroid cartilage.
Dr. Barry Eppley
Q: I am inquiring as to whether you perform tracheal shaves? I have been bothered by the bulge in my neck caused by my Adam’s apple. As a female, it does not give my neck a very nice profile and looks too manly. I have read that the protruding cartilage can be shaved down. Is there much scarring and what is the recovery like?
A: A tracheal shave, known medically as a chondrolaryngoplasty reduces the size of the thyroid cartilage through a small horizontal incision in the neck. While often thought of as only a transgender procedure (facial feminization), I have performed more of these procedures on men and women who are merely just uncomfortable with the prominence of their Adam’s Apple.
The procedure is actually fairly simple and does truly consist of shaving down the protruding cartilage with a scalpel. Through a small horizontal incision in a favorable or prominent skin crease near the thyroid cartilage, the vertical strap muscles are separated to get direct access to the protruding cartilage. It is shaved down as much as possible to get a throat line that appears smoother and less angular. One must be careful to not take too much cartilage away which can de-stabilize the attachments of the underlying vocal folds, risking potential hoarseness after surgery. While the goal is as smooth a neckline as possible, sometimes it can merely be reduced significantly but not made completely flat. The small neck incision will go on to heal very nicely with little scarring.
Recovery is quite quick with minimal discomfort. I do not place patients on any type of restrictions after surgery. There are no sutures to remove. There is some mild swelling and bruising which goes completely away in two weeks. There may be some temporary discomfort on swallowing. Usually, there is little to no change in the pitch of a patient’s voice. There are some topical scar treatments that can be done beginning three weeks after surgery to optimize the fading of the fine line scar.
Dr. Barry Eppley