As a patient undergoing surgery, you may wonder if the surgical team will shave the surgical site. Shaving the surgical site used to be standard practice to help reduce infection risk and improve visibility. However, more recent research has led many surgeons to move away from routine shaving in favor of a more selective approach.
Quick Overview
In most cases today, surgeons will not automatically shave patients before surgery. Shaving is only done when hair will genuinely interfere with the operation. Some key points:
- Shaving too soon before surgery can increase infection risk by causing microscopic cuts in the skin.
- Shaving is avoided for minimally invasive surgeries where the incision site is small.
- Any required shaving is done as close to surgery time as possible, often in the operating room.
- Trimming long hair may be done rather than completely removing hair.
- Waxing or laser hair removal well in advance of surgery are alternatives to shaving.
Evolution of Shaving Practices
Up until the 1990s, most surgical patients were shaved prior to almost any invasive procedure. This was thought to reduce surgical site infections by removing bacteria on the skin’s surface and allowing better visualization of the surgical field. However, subsequent research led to major changes in this standard practice.
Studies found that shaving a surgical site too soon before surgery can actually increase postoperative infection rates. Removing hair irritates the skin and causes microscopic nicks and cuts. These create points of entry for bacteria. The longer the time between shaving and surgery, the more potential there is for bacteria to colonize these small wounds.
One study compared infection rates in patients who were shaved just prior to surgery to those shaved the night before. The infection rate was significantly higher in the group shaved the night before. Based on such evidence, preoperative hair removal shifted closer to surgery time.
Current Recommendations
Today’s guidelines emphasize a restrictive approach to shaving. The key considerations are:
- Shaving should only be done right before surgery where hair will genuinely interfere with the procedure or wound healing. Routine shaving is no longer recommended.
- For small incisions and minimally invasive techniques, shaving is often unnecessary.
- When hair removal is required, electric clippers are preferred over razors.
- If razors are used, a wet shave with a clean disposable razor reduces irritation.
- Only the minimum amount of hair for adequate exposure should be removed.
Specific Procedures
Open Surgery
For major open surgery with a large incision, shaving may still be warranted. However, it is done selectively and only to the extent needed. Trimming long hair around the incision site is generally sufficient. Complete removal of all hair on the body area is avoided unless the surgical field would be obscured. Any shaving is performed immediately before surgery once the patient is in the operating suite.
Laparoscopic/Minimally Invasive Surgery
With laparoscopic and other minimally invasive techniques, only small incisions are made. Hair rarely interferes or impedes visibility. Preoperative shaving is typically not required and provides no clinical benefit.
Orthopedic Surgery
As orthopedic procedures often involve implants and hardware, avoiding infection is critical. However, most orthopedic surgeries utilize relatively small incisions around joints, muscles and bones. Routine shaving is not indicated. Fragile skin around the incision area may be gently clipped if excess hair is present.
Neurosurgery
Neurosurgery focuses on delicate brain and nerve tissues where preventing infection is vital. But even here, shaving the scalp or other areas is only done where dense hair growth would directly obstruct the surgeon’s access and vision. Trimming or local clipping rather than complete shaving is preferred.
Cardiac and Vascular Surgery
Open heart and vascular surgeries require large chest and leg incisions. Shaving may be utilized to ensure the surgeon can clearly view and access blood vessels. However, the trend is toward more selective localized hair removal rather than total area shaving.
Patient Preferences
Patients should discuss any concerns about preoperative shaving with their surgeon. Some key points to cover:
- Verify if shaving will be necessary for your specific procedure.
- Understand the extent of hair removal required.
- Ask when and where shaving will occur if needed.
- Communicate any skin sensitivities or prior shaving problems.
- Consider laser hair removal or waxing well in advance to avoid shaving.
Being informed puts patients at ease and allows them to partner in decisions about hair removal. Surgeons are increasingly mindful of patient sentiments and avoid unnecessary shaving.
The Bottom Line
The era of routine, extensive preoperative shaving is over. With few exceptions, shaving is selective and conservative based on actual procedural needs. Patients should be reassured that shaving is minimized. When done properly and only as needed, the risks are low.
Frequently Asked Questions
Why did surgeons used to shave all surgical patients?
In the past, removing all hair from the surgical area was thought to lower infection risk by eliminating bacteria on the skin and improving visibility of the surgical field. However, it was discovered that the microscopic cuts caused by shaving can actually increase infections.
When is preoperative shaving appropriate?
The only time shaving should occur today is when hair will clearly interfere with the surgery. This may include large incision procedures on hairy parts of the body. But shaving should be restricted only to where needed.
What are the risks of shaving before surgery?
Shaving irritates skin and creates microscopic nicks and cuts that allow bacteria to enter. Shaving long before surgery provides more time for bacteria to colonize these defects. close to surgery as possible reduces this risk.
What are alternatives to shaving before surgery?
Options to avoid shaving include trimming long hair, laser hair removal or waxing several weeks before surgery. Removing only the minimal hair necessary is another alternative.
When should shaving be done relative to surgery?
Any required shaving should occur as close to surgery time as possible, generally in the operating room after anesthesia is administered. This minimizes the opportunity for bacteria to enter microscopic wounds.
Key Takeaways
- Routine, extensive shaving before surgery is no longer standard practice.
- Shaving is only done selectively when hair interferes with the procedure.
- Shaving too far in advance of surgery increases infection risks.
- Alternatives like trimming, waxing, or laser hair removal avoid shaving.
- Any shaving is done right before surgery once the patient is under anesthesia.
Conclusion
The days of simply shaving all surgical patients are over. Surgeons now employ a restrictive, tailored approach and only remove hair when it will genuinely impede the operation. Patients should be informed if shaving is necessary for their procedure and can help guide decisions on hair removal techniques and timing.
References
Seropian R, Reynolds BM. Wound infections after preoperative depilatory versus razor preparation. American Journal of Surgery. 1971;121(3):251-254. doi:10.1016/0002-9610(71)90288-4
