Cosmetic-Oriented Deep Brain Stimulation: A No-Shave Cranial and Trans-Axillary Fossa IPG Implantation Technique

Background: Deep brain stimulation (DBS) is an established therapy for movement disorders. However, conventional DBS often involves complete scalp shaving and a visible subclavicular incision for implantable pulse generator (IPG) placement, which may cause cosmetic and psychological burden, particularly in younger or female patients. To address these issues, we developed a cosmetic-oriented DBS technique combining a no-shave cranial approach with trans-axillary fossa IPG implantation. Methods: In this single-center retrospective series, we analyzed 60 consecutive patients who underwent DBS implantation using a no-shave cranial approach with trans-axillary fossa IPG placement. Procedural characteristics and postoperative complications were reviewed retrospectively. Results: Sixty patients underwent DBS implantation with this cosmetic-oriented protocol. Mean age at surgery was 50.4 ± 14.7 years and mean follow-up was 31.6 ± 18.3 months. Mean operative time including IPG placement was 159.1 ± 64.4 min (range 70–353). Early postoperative infection occurred in 2 patients (3.3%), both confined to the axillary IPG pocket within 1 month; no cranial infections or hematomas were observed. Non-infectious complications occurred in 3 patients (5.0%) (one cervical extension foreign-body reaction, one cranial insertion-site reaction, and one lateral IPG displacement requiring revision). Mild transient axillary tightness was reported in 10 patients (16.7%) and resolved without intervention. Conclusion: This cosmetic-oriented DBS method demonstrated a low infection rate and consistent concealment of cranial and axillary incisions, with no apparent signal of increased risk in this series. The approach appears technically feasible across different ages and in both sexes, although patient satisfaction was not formally evaluated.