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Laryngeal Shave

A prominent Adam's apple is a very masculine feature and, consequently, its reduction is one of the first surgical procedures sought in patient's transitioning from male to female.

The laryngeal shave reduces this most prominent part of the laryngeal cartilage (Adam's apple). Since the trachea has no prominences, but is the "windpipe" below the larynx, this procedure should not be called a "tracheal shave". It is generally performed through an incision in the anterior neck over the prominence or higher up. The incision site depends on whether concomitant voice surgery is being performed, the size of the prominence, the skin type and the patients wishes. Contrary to what one might initially think, an anterior neck incision placed in a natural skin crease and closed meticulously usually heals with an imperceptible scar. Since the vocal cords attach approximately halfway down the front portion of the laryngeal cartilage, it is only the upper one half of the cartilage that can be reduced. Fortunately, most of the Adam's apple is in the upper one half. However, even in the most obliquely angled prominences, the results of a laryngeal shave are usually quite satisfying. Finally, since most larynges undergo some degree of calcification after puberty, burring of the prominence with an electric bur is the usual approach rather than shaving down with a scalpel blade.

Beverly Hills facial plastic surgeon Dr. Pincus

Laryngeal Shave (before & after)

Chin and Jawline

Since a strong chin is considered a masculine trait, in many instances it has to be reduced in either the frontal or the profile view. These techniques usually require drilling bone down or, more commonly, cutting through bone with repositioning and fixation. A strong or defined jawline can actually be considered a desired  aesthetic quality and is actually sought after by many modeling agencies. This is true as long as the angles or posterior part of the jawline are not too over-powering or more prominent than the cheeks. If this part of the anatomy is very prominent, a reduction in this area is usually more easily accomplished with Botox injections to reduce the size of the overlying masseter jaw muscle and parotid salivary gland, rather than removing bone. However, that can be done if needed.

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The Telltale Signs of a Bad Rhinoplasty

Having revised thousands of rhinoplasties, I have noticed certain features common to all.

Even a structurally symmetric, aesthetically pleasing nose can be a poor result if it is out of proportion with the other facial features by being too small or too large. However, the real clues to a poor result are the asymmetries, malpositions, disproportions and decreased function that are seen. We can see collapse of the side walls and/or nostrils producing a “pinched look” or asymmetry between the two sides. The bridge can be too low or too high, and the tip can be overly rotated or not rotated enough. There can be too much “nostril show” from aggressive cartilage resection causing upward migration of the nostril rims. Or too much nostril show from failure to raise the columella (area between the nostrils). Also, irregularities or distortions in the nasal tip can occur which can present technical challenges to the revision surgeon. There can be deflections or angulations of the tip or the entire nose. As mentioned above, nostril asymmetries are particularly common with one nostril appearing higher or wider than its companion. Finally, there can be a worsening of breathing , especially if a reductive rhinoplasty was performed. Making a nose smaller has to be accompanied, many times, by measures to assure that the airflow is not compromised. This means correcting any septal deviations and/or turbinate enlargement, as well as maintaining adequate openings through the nostrils and the areas above called the internal valves. I’ve included photos of a nose showing most of these deformities with the subsequent post-operative results, after I corrected them.








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