UCLA surgeons develop new technique to reduce

Doctors at 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.

The advance could be an important and welcome one for transgender women and non-binary people, for whom a scar on the neck could be a telltale sign of their surgery — often exposing them to discrimination, hatred and violence.

A study of the surgeons who developed the technique was published in the journal Facial Plastic Surgery and Aesthetic Medicine† Reviewing the results for 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-confirming surgery.

In particular, they found that the procedure — which can be performed by one surgeon in 90 minutes — is effective at removing the Adam’s apple, that it can be performed using only the equipment already available in most surgical suites, in addition to 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 lack of a scar on the patient’s neck, although it actually causes a small, hidden scar on the inside of the patient’s lip. That’s where a surgeon inserts cartilage cutters and a polishing tool to shave away the extra cartilage that makes up the Adam’s apple.

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

Mendelsohn said many transgender people are afraid of going about day-to-day activities because of the threat of being “clocked” or identified as transgender by others, against their will.

“If we live in fear, that’s really not life at all,” Mendelsohn said. “With this original approach, we have the opportunity to surgically treat anxiety, which is an incredibly rewarding aspect of the work we do.”

While there are several gender-confirming procedures that can be addressed through hormone replacement therapy, the Adam’s apple is one of the few anatomical features that can be treated with surgery alone. The traditional tracheal shaving procedure, 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 that procedure can be just as disturbing 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 from 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 limited research on other techniques that claim to reduce the Adam’s apple with minimal scarring. But those previous studies either involved very small numbers of patients or they were done using only cadavers, and they hadn’t shown that other techniques were safe or effective.

The authors of the new study recommend that fellowship-trained plastic and facial 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 independently. .

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

The study found that there were no vocal changes or damage to the vocal cords in the patients, but further research is needed to confirm those results and understand what effects the technique developed by UCLA could have on quality of life and health. mental health of patients.

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