Is he or isn’t he morphing into a she?

That’s the question on many Keeping Up With the Kardashians’ fans and tabloid connoisseurs’ minds these days. He/she is former Olympic Gold Medalist Bruce Jenner, the currently estranged husband of Kardashian clan momager Kris Jenner. Rumors have been rampant since Jenner was spotted with manicured nails, long hair, and evidence of gynecomastia. Jenner recently made headlines for allegedly undergoing a laryngeal shave, and some online sources are reporting that (s)he is feeling out some new names for “her” true self–possibly Brigitte or Bruscilla. (Even TV’s Dr. Phil MacGraw weighed in on the rumors, saying that “he looks like someone in transition.”)1424407 10152063099401427 1497176432 n

Plastic Surgery Practice spoke with Jeffrey Spiegel, MD, chief of the Division of Facial Plastic and ?Reconstructive Surgery at Boston University Medical Center, and an expert in facial feminization and masculinization procedures, about the popularity and complexities of chondrolaryngoplasty, its role among transgender patients, and, of course, Bruce Jenner. (Spiegel has not treated Jenner, nor does he read the tabloids.)

PSP: Is facial feminization the only reason a patient would choose to undergo a laryngeal shave procedure?

JS: No. The truth is that we see people from all walks of life that request this procedure. These may include non-transgendered women and men with a large Adam’s apples who don’t like the appearance or who find that it interferes with their ability to wear a shirt or even a helmet.

PSP: Is there an ideal candidate?

JS: There is no real ideal candidate for laryngeal shave procedures. A patient must be otherwise healthy. It can be challenging to remove enough in a very slender person with a large Adam’s apple.

PSP: Do many plastic surgeons routinely perform or specialize in this niche procedure?

JS: It’s done by almost nobody commonly, though there are those who dabble in it. Because of my work in this area, I do several each month.

PSP: How many have you done?

JS: Hundreds, including many revisions on patients whose primary surgeon took out too much or was too conservative.

PSP: Any insights to share with “dabblers”?

JS: The keys are to make your incision high up under the chin in a neck crease so you can hide it, monitor the vocal cords during the procedure, and to take it seriously and order overnight monitoring. It’s a major surgery, although it takes me just 20 minutes to perform.

PSP: Damaging the vocal cords is a known risk of the procedure. How do you prevent this potentially devastating complication?

JS: I use a flexible fiber optic laryngoscope to make sure I have the best possible visualization and no voice complications.

PSP: Any other surgical mine fields with laryngeal shaves?

JS: It’s hard to predict what you are going to find on the inside. After your 20s, the Adam’s apple ossifies and can be difficult to remove in a controlled manner. If you are too young, however, it can be too soft. It’s also important to be prepared for how to handle it if you enter the airway during the procedure.

PSP: Are most patients satisfied with the results of the procedure?

JS: Eighty percent are satisified, and 20% wish they could have had more removed but realize that it was not possible given their anatomy.

PSP: Are the Bruce Jenner rumors helping to increase awareness of or interest in the procedure?

JS: Yes. I suspect people will learn about it this way, and may have never really dreamed it was possible to remove or reduce a protruding Adam’s apple.

PSP: Any thoughts on Bruce Jenner’s recent activities?

JS: I don’t really follow the story, but If Bruce Jenner is looking for assistance in figuring out how to adjust his body, I’d be happy to meet with him.

PSP: Is this the type of “gateway” procedure a person may consider if they were thinking about transitioning from male to female?

JS: Yes. It is a great procedure for people who want to transition, but are not emotionally prepared it do it fully or who don’t have the capabilities to do it fully yet. If you have this done, it will make you feel much better, but no one will notice and think you are transitioning. (Editors note: unless, of course, you are Bruce Jenner, the patriarch of reality TV’s biggest dynasty.)