Complete shaving of the head is not necessary for surgery. However, patches of hair on top of the head and behind the ear are shaved immediately before surgery when the patient is sedated. Many patients elect to get a short haircut after surgery (must be at least 2 weeks afterwards) so that the hair grows in evenly.
There are generally 3 incisions made on each side for DBS surgery: a 5 cm (2 inch) incision on top of the head, a 2.5 cm (1 inch) incision behind the ear, and a 6 cm (2.5 inches) incision in the chest just under the clavicle. For patients with receding hairlines, a slight scar from an incision will be visible on top of the head, but is not especially prominent. The cap used to anchor the DBS electrode (under the scalp) forms a slight bump, which again may be visible in the case of a receding hairline.
There is often puffiness around the eyes for a few days after surgery, but this goes away rapidly. The local anesthetic given when the frame is placed can cause swelling in the face, around the eyes, usually at its peak of one to three days after surgery.
All parts of the device are internal (under the skin), so there are no wires sticking out. In a thin person, the connecting wire running down the neck may be visible as a slight bulge when the head is turned all the way to the opposite side. The incision for the pulse generator in the chest is closed with particular attention to minimize scar formation; this incision would be visible with the shirt off, or in a swimsuit, or in a low-cut evening gown. In thin persons, the pulse generator itself forms a bulge under the skin in the pectoral area that may be apparent if the area is uncovered, but is not visible through clothing.