Chondrolaryngoplasty (CLP), commonly known as tracheal shave surgery, is a key component of facial feminizing transgender affirming care. Traditionally, tracheal shave surgery reducing the prominence of the thyroid cartilage notch, otherwise known as the Adam's Apple though a skin incision across the neck. While this incision can be placed at inconspicous locations such as in well established skin creases or within the submentum, this incision site can not only result in visible scarring, but can be a source of ongoing dysphoria as a risk for outing and discrimination. As such, to maximize the care of our transgender patients, scarless surgical approach is now a safe and established approach. In this presentation, we will review over 2 years of surgical experience and over 60 patient outcomes to demonstrate the cutting edge approach for tracheal shave. Notably, the described transoral surgical approach avoids the use of carbon dioxide gas (no insulation), avoids dissection or exposure of the mental nerve, and requires a minimum of readily available surgical instrumentation. In addition to comprehensive surgical technique description, the presentation will also discuss pre-operative evaluation, preoperative care, complication rates, and outcomes.