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CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0045-1811713
Original Article

Impact of Preoperative Hair Removal on Self-Esteem after Brain Tumor Surgery

Authors

  • Thara Tunthanathip 

    1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand

  • Natthanee Pisitthaworakul

    1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Abstract

Background

While surgical outcomes for brain tumors have traditionally focused on neurological and functional recovery, cosmetic and psychosocial factors such as hair shaving are increasingly recognized for their impact on patient well-being. This study aimed to evaluate the association between the extent of preoperative hair shaving and postoperative self-esteem, and to identify factors associated with low self-esteem following brain tumor surgery.

Materials and Methods

A retrospective cohort study was conducted among 179 patients who underwent brain tumor surgery. Patients were categorized into three groups based on shaving extent: no shaving, partial shaving, and total shaving. Postoperative self-esteem was assessed using the Rosenberg Self-Esteem Scale (RSES). Functional outcomes (Karnofsky Performance Status, Barthel Index, and Glasgow Coma Scale) and quality of life were routinely recorded. Analysis of variance (ANOVA) and logistic regression were used to assess associations between clinical variables and self-esteem.

Results

The median RSES score was highest in the no shaving group (22.5, interquartile range [IQR] 6.0) and lowest in the total shaving group (19.0, IQR 4.5). One-way ANOVA revealed a significant difference in self-esteem scores among the shaving groups (p < 0.001). Multivariable logistic regression identified total shaving as an independent predictor of low self-esteem (adjusted odds ratio = 9.54; 95% confidence interval: 1.12–80.78; p = 0.04). Functional and neurological scores were not significantly associated with self-esteem outcomes.

Conclusion

Total head shaving is significantly associated with lower postoperative self-esteem in brain tumor patients. Minimizing shaving when clinically feasible may enhance psychological outcomes and support holistic recovery.

Keywords

brain tumor surgery - self-esteem - hair shaving - psychosocial outcomes - patient-centered care

Authors' Contributions

T.T. and N.P. conceived the study and designed the method. T.T. supervised the completion of the data collection. N.P. undertook the recruitment of participating centers and patients and managed the data, including quality control. T.T. provided statistical advice on the study design and analyzed the data, while N.P. drafted the manuscript, and all authors contributed substantially to its revision. T.T. and N.P. take responsibility for the paper as a whole.


Ethical Approval

A human research ethics committee of the Faculty of Medicine, Prince of Songkla University, approved the present study (REC 68-322-10-1) on September 5, 2025.




Publication History

Article published online:
17 September 2025

© 2025. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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