There is little controversy over the necessity of reduction of a prominent Adam's apple in the transgender patient.
The laryngeal cartilage of the male is characteristically more prominent than that of the female and makes no contribution to attractiveness. Therefore, tracheal shave is one of the more often recommended and performed facial feminization procedures.
The photo reproduced here was in a shampoo ad that appeared in Allure magazine in April 2002.
Look at the mandible, the chin, the nose, cheeks and hairline.
- Are any of these features typically female? Do any features tend toward the masculine?
- Do the feminine characteristics add value to the face?
- Do the masculine features detract?
- If you were a surgeon, what would you recommend for this patient?
- Would your recommendations be different if this were a transgender patient versus a genetic female?
The many components of face, especially an attractive face, will vary on the scale of masculine to feminine. In spite of the statistics, there are no easy rules to apply when it comes to recommending surgery. This model has a high (masculine) hairline placement, but surgery would be inappropriate, transgender or not. Her mandible is feminine, and although her chin is narrow and relatively pointed (feminine) it is also "tall" (masculine). Diminishing its height is a reasonable option, but its benefits would be purely subjective.