Can a Tracheal Shave Affect Your Voice?

A tracheal shave is not designed to change your voice, and for most people it does not. Temporary hoarseness is common and usually settles within one to two weeks; a lasting change to the voice is rare. The operation reduces the outer, forward-projecting part of the thyroid cartilage (the Adam’s apple) and leaves the vocal cords, which sit inside the cartilage, untouched. A lasting voice change happens mainly when too much cartilage is taken from the lower part of the Adam’s apple, where the vocal cords are anchored.

Voice is one of the biggest worries people have before a tracheal shave, whether they are having it on its own or as part of facial feminisation surgery. This guide explains why the voice can be affected, what the research shows about temporary hoarseness and lasting change, whether a tracheal shave can make your voice lower or higher, and what you can do to protect your voice during recovery. If you want to know how much of the cartilage can be taken away in the first place, our guide to whether you can remove an Adam’s apple covers that in detail.

Does a Tracheal Shave Change Your Voice?

For most people, no. The best evidence comes from studies that measured the voice before and after surgery rather than relying on memory. A 2026 study of 35 operations in The Laryngoscope ↗ found that 18 patients (51.4%) noticed no change in their voice and 17 (48.6%) noticed a short-lived change that returned to normal^[1]. Patients’ own voice questionnaires, expert listener ratings and 11 acoustic measures, including pitch, all showed no significant change after surgery. The authors concluded that the operation improved the neck contour without measurably changing voice quality.

Earlier work points the same way. In a 2018 survey of 112 patients, no patient had a permanent voice change and more than 90% had no significant voice change of any length; every voice change reported was temporary^[2]. These results come from experienced surgeons using techniques that protect the vocal cord attachment, which is the factor that matters most.

Does Removing Your Adam’s Apple Change Your Voice?

To see why a tracheal shave can affect the voice at all, it helps to know how the voice box is built.

The Adam’s apple is the front of the thyroid cartilage, a shield-shaped cartilage made of two plates that meet at the front of the neck. The vocal cords (vocal folds) are two bands of muscle and ligament inside it. At the back, each cord is attached to a small movable cartilage. At the front, both cords join the inner surface of the thyroid cartilage at a single point called the anterior commissure. When you speak, the cords are pulled tight between these two anchor points and vibrate as air passes between them. Their length, thickness and tension decide the pitch and quality of your voice.

The visible bump of the Adam’s apple sits above the anterior commissure, around the V-shaped notch at the top of the cartilage. Shaving the bump does not touch the cords themselves. The risk arises only if cartilage is removed down to, or below, the level where the cords are anchored.

A 2025 study of 105 trans women in The Laryngoscope ↗ measured exactly where that anchor lies. The anterior commissure was attached 6 to 10 mm above the lower border of the thyroid cartilage, most often at 8 mm, and within about 2 mm of the midpoint of the cartilage’s front height^[3]. The authors advised leaving a safety margin of 2 to 3 mm above the estimated level when it is not located directly during surgery. This is why surgeons limit how much cartilage they remove: the upper part that forms the bump can be reduced, but the lower part that holds the vocal cords has to stay. Our article on whether a woman can have an Adam’s apple explains why the cartilage is more prominent in some people than others.

What Are the Voice Risks of a Tracheal Shave?

There are two quite different kinds of voice change after a tracheal shave, and it is worth keeping them apart.

Temporary hoarseness

This is common and expected. Swelling and bruising around the larynx after surgery can make the voice husky, weaker or quicker to tire for a short time, and swallowing can feel tight or sore. A 2019 systematic review of 69 patients found hoarseness in 36.2% and pain on swallowing in 20.3%, and 96% of the hoarseness had settled within 20 days^[4]. A 2026 study that looked inside the larynx with a camera one week after surgery in 32 patients found small bruises on the false vocal folds (the folds that sit just above the true vocal cords) in 37.5%; all settled without treatment, and none affected patients’ own voice scores^[5]. No patient in that study had damage to the anterior commissure or the true vocal cords.

Lasting voice change

This is rare, but it is the most serious specific risk of the operation. A 2026 systematic review of 20 studies and 760 patients in OTO Open ↗ found voice changes reported in 12.6% of patients overall, and much less often when the surgeon located the vocal cords during a neck-incision operation (2.8%) than when they did not (29.6%)^[6]. Most of the studies relied on patients’ own reports rather than objective voice measurements.

When lasting problems do happen, the usual cause is cartilage removed too low. In the 2025 study above, among patients seen after a chondrolaryngoplasty performed elsewhere, the vocal cords were found to have come away from the cartilage in 29%, in cases where cartilage had been removed down to or below the anterior commissure^[3]. Those patients were attending a specialist voice surgery service, so this figure reflects people who already had problems and is not a measure of overall risk. A published case report describes a patient whose pitch, vocal range, loudness and voice quality all changed after a tracheal shave in which the level of the vocal cords had not been identified^[7].

Other voice-related risks are uncommon: a brief spasm of the vocal cords (laryngospasm) around the time of the anaesthetic was reported in 1.4% of patients in the 2019 review^[4], and a collection of blood (haematoma) or swelling in the neck can press on the larynx in the first day or two. Our general guide to the risks of cosmetic surgery covers the risks that apply to any operation.

Can a Tracheal Shave Lower Your Voice?

It can, but only if something goes wrong, and this is rare. The vocal cords need a firm anchor at the front to stay under tension. If cartilage is removed down to the anterior commissure, or the attachment is disturbed, the cords can lose some of that tension and become slack. A slacker vocal cord vibrates more slowly, so the voice tends to drop in pitch. People in this situation often also describe a rougher or breathier voice, a weaker voice that tires quickly, and difficulty reaching their higher notes^[7].

For trans women and non-binary people, a lower voice is the opposite of what anyone wants from facial feminisation surgery. That is why the reduction is deliberately conservative. A small remaining bump is a far better trade-off than a voice that has dropped, and your surgeon will explain at consultation how much reduction your anatomy allows. If a lasting change does occur, it should be assessed by a laryngologist (a voice specialist ENT surgeon), as specialist voice surgery can sometimes help.

Can a Tracheal Shave Raise Your Voice?

No. A tracheal shave does not raise your pitch or make your voice sound more feminine. It changes the outside of the cartilage, not the length, thickness or tension of the vocal cords, which are what set your pitch. People are sometimes disappointed to find that their voice sounds the same after their neck looks different, so it is worth being clear about this before surgery.

If a higher or more feminine voice is one of your goals, the options are separate from a tracheal shave:

• Voice therapy with a speech and language therapist experienced in gender-affirming voice work. It trains pitch, resonance, intonation and speech patterns, and it is usually the first step.
• Voice feminisation surgery, such as glottoplasty, which shortens the vibrating part of the vocal cords. This is a different operation performed by laryngologists. Centre for Surgery does not offer voice feminisation surgery.

A 2025 systematic review and meta-analysis of 24 studies found that both voice therapy and voice surgery raised speaking pitch and improved voice-related quality of life in trans women, with surgery giving larger pitch gains^[8]. Feminising hormones do not raise the pitch of a voice that deepened during puberty either; our article on hormone therapy before facial feminisation surgery explains what hormones can and cannot change. If you are planning voice surgery elsewhere as well as a tracheal shave, tell both surgeons, as some voice surgeons prefer to plan the two operations together.

Will I Lose My Voice After a Tracheal Shave?

No. You will be able to speak straight after the operation. You may sound hoarse, husky or quieter than usual for the first week or two, and your voice may tire more quickly, but losing your voice altogether is not an expected effect of a tracheal shave. The hoarseness comes from swelling around the larynx, not from damage to the vocal cords, and it does not mean anything has gone wrong.

How Long Does Hoarseness Last After a Tracheal Shave?

Usually one to two weeks. In the 2019 systematic review, 96% of people with hoarseness had recovered within 20 days^[4], and in the 2026 voice study every patient who noticed a change returned to their usual voice^[1]. Swelling continues to settle for some weeks after that, and the final neck contour is visible at three to six months.

A voice that is still hoarse after about four weeks, or one that is getting worse rather than better, should be checked. Your surgeon may arrange for a voice specialist to look at your vocal cords with a small camera. Our guide to recovery after cosmetic surgery covers the general principles of healing well.

Can You Talk After a Tracheal Shave?

Yes. You can talk normally on the day of surgery, and there is no need for complete voice rest. While your voice is hoarse, it makes sense to use it gently:

• speak at a comfortable, normal volume and take breaks if your voice tires;
• avoid shouting, singing, loud environments and long phone calls until the hoarseness has settled, unless your surgeon tells you otherwise;
• avoid whispering for long periods, which can strain the voice more than soft speech;
• keep well hydrated, and do not smoke or vape: stop all nicotine for four weeks before and four weeks after surgery.

Most people return to desk-based work after five to seven days. If your job involves heavy voice use, such as teaching, call-centre work or performing, plan a little longer and discuss it at your consultation.

How Is Your Voice Protected During a Tracheal Shave?

At Centre for Surgery, a tracheal shave is carried out through a 2 to 3 cm incision in a natural crease under the chin or high on the neck, usually under TIVA (total intravenous anaesthesia), or under local anaesthetic with oral sedation where your surgeon advises it. The surgeon exposes the thyroid cartilage and shaves its forward-projecting part under direct vision with a surgical burr or scalpel. The key technical point is keeping to the correct plane: the reduction stops short of the vocal cord attachment on the inner surface of the cartilage, and the vocal cords themselves are never approached. The incision is closed with dissolvable stitches, and you go home the same day.

Centre for Surgery does not offer transoral (through-the-mouth) tracheal shave or any voice feminisation surgery. In published studies, surgeons judge the level of the anterior commissure in different ways, from measured anatomical landmarks with a safety margin to direct localisation during the operation^[3]. Whichever surgeon you see, it is reasonable to ask how they will protect the vocal cord attachment in your operation and how much reduction they think is safe for your anatomy.

Should Singers and Professional Voice Users Have a Tracheal Shave?

Many can, but it is worth extra thought. Singers, actors, teachers and others who rely on their voice notice small changes that other people would not, and the upper range is the part most likely to be affected if the vocal cord attachment is disturbed^[7]. If your voice matters to your work:

• tell your surgeon at consultation, so the plan can be as conservative as needed;
• consider a voice assessment, and a recording of your speaking and singing voice, before surgery so any later change can be measured against a baseline;
• allow time off from singing or performing until the hoarseness has fully settled;
• accept that a slightly smaller reduction may be the right trade-off for protecting your voice.

When Should You Call Your Surgeon About Voice Changes?

Contact the clinic without delay if you have:

• any difficulty breathing or noisy breathing;
• neck swelling that is rapidly increasing;
• a voice change that is getting worse rather than better;
• a fever above 38°C or discharge from the wound.

In the first 24 hours you have your surgeon’s direct number; after that you can call us on 020 7993 4849, 9am to 6pm, Monday to Saturday. Out of hours, call NHS 111, or 999 in an emergency. You have a wound check at one week, a surgeon review at six weeks and an assessment at three months, and these are good times to mention any concerns about your voice.

Frequently Asked Questions

Tracheal Shave in London

Tracheal shave at Centre for Surgery is performed by GMC-registered surgeons at our CQC-regulated Baker Street hospital, rated Good overall by the CQC. Your surgeon reduces the forward-projecting part of the thyroid cartilage through a small incision in a natural neck crease and stops short of the vocal cord attachment to protect your voice. It is a day-case operation under local anaesthetic with optional sedation, or under TIVA, and it can be done on its own or as part of facial feminisation surgery. No diagnosis, GP referral or gender clinic letter is needed, and the consultant who assesses you at consultation is the consultant who performs your surgery. We recommend a two-week cooling-off period between your consultation and surgery. Your initial consultation fee is redeemable against the cost of surgery if you go ahead. Finance is available, subject to status; see our finance options. You can read more about the operation on our tracheal shave surgery page.

Phone: 020 7993 4849 | Address: 95–97 Baker Street, Marylebone, London W1U 6RN
Contact us to schedule a consultation

References

1. Dwyer CD, Fein M, Kridgen S, Winston J. Chondrolaryngoplasty: vocal considerations, outcomes, and effects on acoustic measures of voice. The Laryngoscope 2026;136(9):3887–3894. doi:10.1002/lary.70557 ↗
2. Cohen MB, Insalaco LF, Tonn CR, Spiegel JH. Patient satisfaction after aesthetic chondrolaryngoplasty. Plastic and Reconstructive Surgery Global Open 2018;6(10):e1877. doi:10.1097/GOX.0000000000001877 ↗
3. Jahnavi, Thomas JP. Anterior commissure position relative to the thyroid cartilage for safe chondrolaryngoplasty. The Laryngoscope 2025;136(5):2278–2283. doi:10.1002/lary.70325 ↗
4. Therattil PJ, Hazim NY, Cohen WA, Keith JD. Esthetic reduction of the thyroid cartilage: a systematic review of chondrolaryngoplasty. JPRAS Open 2019;22:27–32. doi:10.1016/j.jpra.2019.07.002 ↗
5. Stevenson LA, Song PC, Franco RA, Naunheim MR. Subjective voice outcomes and intralaryngeal findings after transcervical chondrolaryngoplasty. Ear, Nose and Throat Journal 2026. doi:10.1177/01455613261454227 ↗
6. Abu Bandora E, Chaushu H, Icht M, et al. Transgender women’s voice outcome after laryngochondroplasty: a systematic literature review. OTO Open 2026;10(3):e70264. doi:10.1002/oto2.70264 ↗
7. Strickland L, Sussman KA, Madden LL. Vocal quality complication following chondrolaryngoplasty: a reported case. Journal of Voice 2022;39(3):856.e9–856.e11. doi:10.1016/j.jvoice.2022.11.011 ↗
8. Lanham K, Melnick BA, O’Connor MJ, et al. Efficacy and patient satisfaction in voice feminization procedures: a systematic review and meta-analysis. Otolaryngology–Head and Neck Surgery 2025;172(5):1521–1538. doi:10.1002/ohn.1173 ↗

Related Articles

• Can You Remove an Adam’s Apple?
• Is It Possible for a Woman to Have an Adam’s Apple?
• Do I Need Hormone Therapy Before Facial Feminisation Surgery?
• Can Cisgender Women Have Facial Feminisation Surgery?