Media speculation about reality TV’s Keeping Up with the Kardashian’s Bruce Jenner having a sex change had us ask some of our LocateADoc.com doctors about the procedures used for the process.
The reports about the Olympian stem from a surgery Jenner had last month called a tracheal shave to smooth out the Adam’s apple with many stories stating this is the first step in the sex change process. However, the LocateADoc.com doctors we spoke with said this isn’t necessarily the case.
“Tracheal shave surgery (‘Adam's apple reduction’) can be one of the procedures undertaken by transgender patients undergoing transition from male to female,” Minneapolis Plastic Surgery's Dr. Richard Tholen told us. “I do this surgery frequently as part of facial feminization, but would hasten to add that I also perform this procedure for male patients who simply want less prominent Adam's apples. Thus, having undergone tracheal shave surgery does not imply in any way that Mr. Jenner is considering, initiating, or proceeding with male-to-female transition.”
Usually, hormone therapy is the first step in the male-to-female transgender process, followed by breast implants, according to Dr. Tholen.
Daniel A. Medalie, MD, Assistant Professor of Plastic Surgery at the Metrohealth Medical Center in Cleveland, Ohio, said the face is the initial area of focus for transgender patients.
“For male to female transgender patients one of the primary concerns is to be able to ‘pass’ in public so to speak,” Medalie said. “Thus the first surgeries that interest them are facial feminization procedures as well as breast augmentation. The tracheal shave procedure is a fairly minor surgery used to reduce the prominence of the apex of the thyroid cartilage (also known as the adam's apple). In genetic males, the cartilage tends to be larger and more defined than in genetic females (though there exists wide variation).”
The procedure Jenner had involves a small incision at the level of the cartilage, according to Medalie. The overlying muscle is retracted out of the way and then the apex of the cartilage is reduced via scalpel, scissors or another instrument so that it lies flat and in line with the surrounding laryngeal cartilage.
“While the operation is very safe, there is some concern about the vocal cords which attach on the inside of the cartilage,” Medalie said. “For this reason, some practitioners like to perform the tracheal reduction with a small scope inserted into the airway to directly visualize the vocal cords as the cartilage is being reduced. I personally don't do this (because it is more invasive) and have never had a vocal cord injury. I perform this type of surgery under local anesthesia in my clinic procedure room.”
Dr. Medalie added the other facial feminization procedures include rhinoplasty, cheek and lip augmentation, brow lifting and scalp advancement, forehead and jaw contouring.
“Genital surgery is both major and irreversible, and therefore is a well-considered step undertaken only when an expert genital transgender surgeon has been selected,” Dr. Tholen said. “Facial feminization may involve forehead lift, frontal bone reduction, jaw, chin, or facial bone reconstruction to a more feminine form, laser hair removal, hair transplantation or scalp advancement, and other procedures such as rhinoplasty, laser resurfacing, or tracheal shave.
“So as you can see, tracheal shave is neither "first" nor even a major component of the transgender process--it is simply one of many possible steps. Just as undergoing rhinoplasty may be undertaken by any male who wishes nasal reduction (perhaps also including some transgender patients), it would be inappropriate to describe rhinoplasty as "one of the first steps" in the transgender process.”
To learn more, contact Dr. Medalie or Dr. Tholen and visit our extensive resource guides on the various procedures including breast augmentation, rhinoplasty and laser resurfacing.