Volume 75, No.1: 2023 Siriraj Medical Journal
https://he02.tci-thaijo.org/index.php/sirirajmedj/index
13
Original Article
SMJ
Supisara Wongdama, M.D.*, Arunotai Siriussawakul, M.D.**,***, Woraphat Ratta-apha, M.D.****, Pudit Suraprasit,
M.D.*, Kanawat Kanjanapiboon, M.D.*, Chayanan anakiattiwibun, M.Sc.***, Rattapon uangtong, M.D.*
*Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, ailand., **Department of Anesthesiology, Faculty
of Medicine Siriraj Hospital, Mahidol University, Bangkok, ailand., ***Siriraj Integrated Perioperative Geriatric Excellent Research Center, Faculty
of Medicine Siriraj Hospital, Mahidol University, Bangkok, ailand., ****Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol
University, Bangkok, ailand.
Effects of Music on Preoperative Anxiety in Patients
Undergoing Hair Transplantation: A Preliminary
Report
ABSTRACT
Objective: To study the eects of music on anxiety in patients undergoing hair transplantation.
Materials and Methods: is randomized controlled trial enrolled patients undergoing hair transplantation. e
patients were randomized into a music group, who listened to music for 15 minutes during the preoperative period,
and a control group, who were not exposed to music. Two scales were used to measure anxiety. One was the State-
Trait Anxiety Inventory (STAI), comprised of a state anxiety scale (STAI-S) and trait anxiety scale (STAI-T). e
other was the Visual Analog Scale for Anxiety (VASA). Demographic and physical parameters (blood pressure,
heart rate, and respiratory rate) were recorded.
Results: e 26 patients had a mean age of 40.8 ± 10.4 years. Twenty-three (88.5%) were men. e 2 groups had no
signicant dierences in their STAI-S or VASA scores, or physical parameters before and aer intervention. e
STAI-S score of the control group signicantly increased with time (P = 0.027). Additionally, a signicant decrease in
the VASA score was observed aer the intervention for the music group (P = 0.039). No adverse events were noted.
Conclusion: Listening to music is an easy, eective, and safe method of reducing preoperative anxiety in patients
undergoing hair transplantation. e method should be employed during the preoperative period for patients
undergoing hair transplantation. It may also be considered for use in similar procedures.
Keywords: Anxiety; hair transplantation; music; state-trait anxiety inventory; preoperative (Siriraj Med J 2023; 75:
13-19)
Corresponding author: Rattapon uangtong
E-mail: rattaponthuangtong@yahoo.com
Received 18 May 2022 Revised 15 November 2022 Accepted 27 November 2022
ORCID ID:http://orcid.org/0000-0001-5639-8984
http://dx.doi.org/10.33192/Smj.2022.3
All material is licensed under terms of
the Creative Commons Attribution 4.0
International (CC-BY-NC-ND 4.0)
license unless otherwise stated.
INTRODUCTION
e preoperative period is a worrying event for
patients and creates emotional, cognitive, and physiological
responses.
1
Waiting for surgery or invasive procedures
has been reported to create stress and anxiety, which
aggravate and aect physiological and psychological
parameters.
2
Preoperative anxiety is a major concern in
patients undergoing surgery. It may be attributed to a
fear of complications, unfamiliar environments, needles,
injections, pain, bleeding, or separation from friends and
family.
3
Anxiety has a considerable impact on surgical
outcomes. It is associated with an increased requirement
for postoperative pain control, a prolonged recovery
time, and an increase in postoperative complications.
4
Volume 75, No.1: 2023 Siriraj Medical Journal
https://he02.tci-thaijo.org/index.php/sirirajmedj/index
14
Wongdama et al.
Pharmacological and nonpharmacological interventions
have been employed to alleviate preoperative anxiety.
Pharmacological interventions, such as sedatives and
anti-anxiety drugs, are widely used, easy to administer,
and eective.
5
However, these drugs frequently cause
adverse events like drowsiness and respiratory depression,
and they may impair decision-making. As well, patients
should not drive as the drugs can aect their judgment.
5,6
Because of the various drawbacks, a pharmacological
intervention may not be appropriate for ambulatory
surgery. In comparison, nonpharmacological interventions,
such as preoperative education and the use of relaxation
techniques and music, are being increasingly used.
7
In
particular, music is a safe, easy, and noninvasive method
of reducing anxiety. Additionally, listening to music has
proven to decrease anxiety suciently to allow the total
dose of sedatives to be reduced.
8
Hair transplantation, an outpatient procedure
performed under local anesthesia, is a treatment option
for patients who have failed to respond to standard
medical treatment.
9
Although hair transplantation is
a minimally invasive surgery, patients have reported
severe anxiety levels before the procedure.
10,11
Since
preoperative anxiety has substantial adverse inuences
on postoperative outcomes and given the ease of use, low
cost, and safety of music, this study aimed to evaluate
the eects of music in reducing preoperative anxiety in
patients undergoing hair transplantation. is study used
the State-Trait Anxiety Inventory (STAI) questionnaire
and the Visual Analog Scale for Anxiety (VASA) to
evaluate the eects of music on preoperative anxiety in
patients undergoing hair transplantation.
MATERIALS AND METHODS
is prospective, single-blind, randomized controlled
trial was conducted at the Hair Clinic, Outpatient
Dermatology Unit, in a tertiary hospital in ailand
between February 2018 and August 2021. e study
protocol was approved by the Institutional Review Board
(COA no. Si 077/2018) and was registered with the ai
Clinical Trials Registry (TCTR20210820004). All patients
gave their written informed consent.
Participants
e study enrolled patients aged 18 years or older
who underwent hair transplantation with the follicular
unit transplantation or follicular unit excision technique
and had a waiting time of at least 45 minutes before
surgery. Exclusion criteria were patients with any
psychological disease, regular use of antidepressant or
anxiolytic drugs, an inability to read and understand
ai, a visual impairment or hearing loss that impaired
their ability to communicate, and an unwillingness to
participate or listen to music. e patients were divided
into 2 groups using a simple random sampling method.
Participants in a music group received a preoperative
music intervention for 15 minutes, whereas those in a
control group did not receive the music intervention.
Data collection
Demographic and clinical data were collected using
face-to-face interviews. Anxiety levels in the patients were
assessed using an STAI questionnaire and a VASA. e
STAI is a 40-item, self-report questionnaire developed
by Spielberger et al that uses a 4-point Likert-type scale
for each item.
12
It comprises 2 parts: a state anxiety scale
(STAI-S), which measures the current state of anxiety
(“state anxiety”); and the trait anxiety scale (STAI-T),
which assesses the general state of anxiety (“trait anxiety”).
Each scale has 20 items. e score for each item ranges
from 1 (“not at all”) to 4 (“very much”), and the total score
for each part ranges from 20 to 80 points. Higher scores
indicate a greater severity of anxiety.
12,13
e STAI was
translated into ai by Nonthasak and colleagues.
14
e
reliability of ai STAI has been documented (Cronbach’s
alpha = 0.89).
15,16
With regard to the VASA, it uses a
10-cm horizontal line with a scale ranging from 0 to 10,
indicating “not anxious at all” and “extremely anxious,”
respectively. e scores are categorized to indicate mild
(≤ 3), moderate (4–6), and severe (≥ 7) degrees of anxiety.
17
Patients were instructed to indicate their level of anxiety
on the line. e distance was then measured and noted.
Intervention
All patients were requested to answer the STAI
questionnaire (both the STAI-S and STAI-T components)
and rate the VASA independently before the intervention.
Nursing sta also recorded the physical parameters of
each patient: heart rate, systolic blood pressure, diastolic
blood pressure, and respiratory rate. Aer that, members
of the music group were invited to listen to music on
YouTube via headphones through mobile telephones
that were made available to them. ey were allowed
to choose 1 set of classical music from a list using the
keyword “relaxing instrumental music” and listen for
15 minutes during the preoperative period. e volume
of the music was modied by each patient according
to their personal preference. In contrast, the members
of the control group were instructed to wait in a silent
room and were not allowed to listen to any music for
15 minutes. Subsequently, all patients independently
redetermined their STAI-S and VASA scores, and the
Volume 75, No.1: 2023 Siriraj Medical Journal
https://he02.tci-thaijo.org/index.php/sirirajmedj/index
15
Original Article
SMJ
RESULTS
A total of 30 patients were evaluated for eligibility.
Four were excluded: 2 had a waiting time less than
45 minutes, 1 regularly used anxiolytic drugs, and
1 declined to participate (Fig 1) erefore, 26 patients
were included in the study (control group, n =14; music
group, n = 12). e mean age of the patients was 40.8
years, and 23 of the 26 (88.5%) were men. Most of the
patients (96.2%) were diagnosed with androgenetic
alopecia, and 1 (3.8%) had scarring alopecia from burns. All
patients had educational levels higher than primary school
grade 9. e mean trait anxiety scores of the control and
music groups were 46.2±4.5 and 47.5±2.7, respectively.
ere were no statistically signicant dierences in any
of the demographic parameters of the groups, except
age and marital status. e demographic data of the 26
patients are detailed in Table 1.
nursing sta remeasured their physical parameters. e
patients then had a 5- to 15-minute wait before the hair
transplantation procedure commenced. All processes
were performed before the surgery and were completed
in a single visit.
Statistical analyses
Demographic data were calculated using descriptive
statistics. Categorical data are presented as numbers
(percentages). Continuous data with normal distributions
are shown as the mean±SD and were compared by
an independent t-test. e Wilcoxon signed-rank test
was used to determine the dierences between each
group before and aer the intervention. Spearman’s
rank correlation coecient was used to calculate the
association between pairs of variables. Data were analyzed
using PASW Statistics for Windows (version 18; SPSS
Inc., Chicago, IL., USA).
Fig 1. Flowchart outlining patient enrollment, randomization, follow-up, and analysis.
Volume 75, No.1: 2023 Siriraj Medical Journal
https://he02.tci-thaijo.org/index.php/sirirajmedj/index
16
TABLE 1. Demographic data of patients undergoing hair transplantation.
Characteristic
Total Control group Music group
(N, 26) (n, 14) (n, 12)
P value
Sex
Male 23 (88.5) 12 (85.7) 11 (91.7) 1.000
Female 3 (11.5) 2 (14.3) 1 (8.3)
Age (years) 40.8 ± 10.4 45.0 ± 9.8 35.9 ± 9.1 0.022*
Age onset (years) 24.2 ± 10.0 25.1 ± 12.5 23.1 ± 6.0 0.609
Body mass index (kg/m
2
) 23.5 ± 2.2 23.3 ± 2.4 23.7 ± 2.0 0.653
Marital status
Single 14 (53.8) 5 (35.7) 9 (75.0) 0.045*
Married 12 (46.2) 9 (64.3) 3 (25.0)
Living
With family 20 (76.9) 12 (85.7) 8 (66.7) 0.365
Alone 6 (23.1) 2 (14.3) 4 (33.3)
Previous hair transplantation
No 12 (46.2) 4 (28.6) 8 (66.7) 0.052
Yes 14 (53.8) 10 (71.4) 4 (33.3)
Hair transplantation in this visit
FUE 19 (73.1) 10 (71.4) 9 (75.0) 1.000
FUT 7 (26.9) 4 (28.6) 3 (25.0)
Trait anxiety score 46.8 ± 3.8 46.2 ± 4.5 47.5 ± 2.7 0.395
e data are presented as mean ± SD or number (%)
*, statistically signicant (P <0.05)
Abbreviations: FUE: follicular unit excision; FUT: follicular unit transplantation
Wongdama et al.
Although patients in the music group were 10 years
younger than those in the control group, age was not
associated with the baseline STAI-S scores of the music
and control groups (r = 0.049; P =0.812). Similarly, while
most of the patients were single, there was no dierence in
the baseline STAI-S scores of single and married patients
(P = 0.413). At baseline, the mean state anxiety scores,
mean VASA scores, and physical parameters of the 2
groups were similar. Aer the intervention, there were
no statistical dierences in any of the data items of the
2 groups (P > 0.050; Table 2). However, a comparison
of the changes in the pre- and postintervention values
within each group revealed signicant dierences for 2
items. On the one hand, the mean state anxiety score
of the control group signicantly increased aer the
patients waited in the silent room for 15 minutes (before,
45.6±3.5; aer, 48.4±4.3; P = 0.027). On the other hand,
the VASA score of the music group signicantly decreased
as a result of listening to music (before, 2.7±2.3; aer,
1.9±2.0; P = 0.039). No other signicant dierences
within the groups were revealed. Moreover, no side
eects were reported during the study period.
DISCUSSION
Regarding the cognitive behavioral model of social
anxiety, exposure to a feared social situation activates
assumptions that have been formed by past experiences.
ese assumptions activate socially anxious individuals
to regard certain social situations as dangerous, leading
to low self-esteem.
18
According to this theory, the loss of
hair can create anxiety and aect self-esteem and self-
image. Consequently, eective treatments are sought for
patients with hair loss.
19
Several studies have reported
hair transplantation to be an eective way to potentially
reverse psychosocial problems by reducing anxiety and
improving self-condence.
19,20
However, eective strategies
Volume 75, No.1: 2023 Siriraj Medical Journal
https://he02.tci-thaijo.org/index.php/sirirajmedj/index
17
Original Article
SMJ
TABLE 2. Comparison of rst- and second-measured state anxiety scores, VASA scores, and physical parameters
of control and music groups.
Mean ± SD
Variable Control group Music group P value
(n, 14) (n, 12)
State anxiety score
1
st
measurement 45.6 ± 3.5 45.7 ± 3.6 0.946
2
nd
measurement 48.4 ± 4.3 46.3 ± 3.5 0.173
VASA (n = 19)
1
st
measurement 2.2 ± 2.4 2.7 ± 2.3 0.652
2
nd
measurement 1.6 ± 1.7 1.9 ± 2.0 0.730
Heart rate
1
st
measurement 82.6 ± 12.8 82.1 ± 12.9 0.924
2
nd
measurement 76.8 ± 15.9 80.4 ± 10.9 0.518
Respiration rate
1
st
measurement 15.9 ± 0.9 15.5 ± 1.2 0.339
2
nd
measurement 15.8 ± 1.0 16.2 ± 0.6 0.415
SBP
1
st
measurement 126.1 ± 11.2 129.4 ± 13.4 0.495
2
nd
measurement 126.5 ± 12.3 129.4 ± 10.2 0.535
DBP
1
st
measurement 79.3 ± 11.9 78.3 ± 6.2 0.788
2
nd
measurement 81.2 ± 15.5 77.4 ± 11.7 0.510
e data are presented as mean ± SD
Abbreviations: DBP, diastolic blood pressure; SBP, systolic blood pressure; SD, standard deviation; VASA, visual analog scale for anxiety
to decrease preoperative anxiety in hair transplant patients
have not been explored.
Previous studies demonstrated that listening to
music signicantly reduced anxiety in patients undergoing
dermatological procedures.
21-23
Vachiramon and associates
found signicant reductions in the anxiety of patients who
listened to self-selected music while waiting for physicians
and during the rst stage of Mohs micrographic surgery.
is was especially the case for patients undergoing
the surgery for the rst time.
21
Sorensen and others
concluded that listening to classical music during an
injection of local anesthesia signicantly decreased pain
and anxiety in non-Mohs dermatologic procedures.
22
Similarly, Deivasigamani and colleagues found that music
intervention reduced anxiety in patients undergoing
dermatosurgery under local anesthesia.
23
In contrast,
Alam and coauthors reported that relaxing music was
not associated with any signicant dierences in pain,
anxiety, blood pressure, or heart rate in patients undergoing
excisional surgery for basal and squamous cell carcinoma.
24
In the present study, listening to music was not
associated with reducing the anxiety of the patients
undergoing hair transplantation, and it did not aect their
physical parameters. ere are several possible reasons
for this. First, the state anxiety score of the patients in
this study was only slightly higher than 40, which is the
cuto score used to detect anxiety symptoms.
25
Similarly,
anxiety levels measured by VASA showed mild anxiety.
is is contrary to the work by Ahmad and Mohmand,
who reported moderate to severe anxiety in patients
undergoing hair transplantation.
10
is dierence from
our study may be because individuals are increasingly
using the Internet to access a wide range of health
information. eir internet research may cause them
to perceive that hair transplantation is a safe and minor
surgical procedure with very few complications, leading
Volume 75, No.1: 2023 Siriraj Medical Journal
https://he02.tci-thaijo.org/index.php/sirirajmedj/index
18
Wongdama et al.
them to worry less.
26
Listening to music may therefore
be unable to measurably decrease their low level of
state anxiety. On the other hand, the patients in our
study had a high mean trait anxiety score.
27
is may be
because the patients had previous personality or mental
health problems. Patients who suer severely from hair
loss experience multiple feelings and emotions due to
personal and social pressures. e hair loss may lead to
psychological stress out of proportion to the problem.
28
Accordingly, such patients are more likely to have high
expectations for their hair transplant results. erefore,
these expectations might also impact the eects of music
on their pre-intervention anxiety.
Second, the patients were instructed to listen to
classical music and were unable to select the music of
their choice. Although classical music was shown to oer
greater benets than other musical genres, some authors
reported that the greatest anxiolytic eect may be achieved
when patients select familiar music that they enjoy.
6,21
ird, the duration of music intervention in the current
investigation may have been a contributing factor. is
study administered a 15-minute music intervention.
is is shorter than the intervention period of previous
studies, in which patients listened to 30 minutes of music
in the preoperative setting.
29,30
Further studies with larger
sample sizes and longer music interventions may be
required to elucidate the eects of music on anxiety in
hair transplant patients.
Although this study did not detect significant
differences between the music and control groups,
signicant dierences within the groups were reported.
ere was a signicant increase in anxiety measured by
STAI-S in the control group. is could be attributed to
an increasing trend of preoperative anxiety over time.
31
Additionally, a reduction in anxiety using VASA was
demonstrated by the music group after listening to
music. e theoretical basis of music in terms of anxiety
reduction lies in the impact of music on the autonomic
nervous system, which enhances relaxation. e auditory
stimulation of music is believed to aect a number of
neurotransmitters and alter the experience of anxiety,
fear, and pain. Consequently, more positive perceptual
experiences, including stimulation of stress and anxiety
reduction, are achieved. Additionally, music promotes
feelings of physical and mental relaxation by refocusing
attention on pleasurable emotional states.
32
While listening
to music, patients’ awareness of time passing was distracted
because their attention was on the music, resulting in
greater relaxation.
33
is study demonstrated a trend
of reduction in anxiety through music listening. Since
music listening is a noninvasive, easy-to-administer,
eective, and safe method, its introduction should be
considered as a means of reducing the anxiety of patients
undergoing hair transplantation or similar procedures.
is study has some limitations. As it was a preliminary
study, only 26 patients were included. In addition, the
prevalence and severity of androgenetic alopecia have
been reported to be higher in males than in females.
34
Consequently, most of the hair transplant patients in this
study were men. Validation through a larger sample size
and a sex-balanced distribution is needed to conclusively
demonstrate the eects of music on preoperative anxiety
in patients undergoing hair transplantation. Moreover,
the patients in our study could not be blinded to the group
assignments. is may have aected their evaluations,
resulting in bias. In addition, the unequal waiting times
before the commencement of the procedures may have
aected the patients’ pre- and post-surgery anxiety scores.
In conclusion, music is an easy-to-administer,
eective, and safe method to reduce preoperative anxiety
in patients undergoing hair transplantation surgery.
During the preoperative period, listening to music should
be recommended to the patients. e method may also
be considered for use in similar procedures.
Conicts of Interest: All authors declare that there are no
conicts of interest related to any aspect of this research.
Funding sources: is research project was nancially aided
through a grant provided by the Faculty of Medicine Siriraj
Hospital, Mahidol University, ailand (R016231035),
and it was facilitated by the Siriraj Integrated Perioperative
Geriatric Excellence Research Center.
REFERENCES
1. Sigdel S. Perioperative anxiety: a short review. Glob Anaesth
Perioper Med 2015;1:107-8.
2. Roomruangwong C, Tangwongchai S, Chokchainon A. Preoperative
anxiety among patients who were about to receive uterine
dilatation and curettage. J Med Assoc ai 2012;95:1344-51.
3. Jiwanmall M, Jiwanmall SA, Williams A, Kamakshi S, Sugirtharaj
L, Poornima K, et al. Preoperative Anxiety in Adult Patients
Undergoing Day Care Surgery: Prevalence and Associated
Factors. Indian J Psychol Med 2020;42:87-92.
4. Gan TJ. Poorly controlled postoperative pain: prevalence,
consequences, and prevention. J Pain Res 2017;10:2287-98.
5. Donaldson M, Gizzarelli G, Chanpong B. Oral sedation: a primer
on anxiolysis for the adult patient. Anesth Prog 2007;54:118-
29.
6. Bradt J, Dileo C, Shim M. Music interventions for preoperative
anxiety. Cochrane Database Syst Rev 2013;(6):CD006908.
7. Ju W, Ren L, Chen J, Du Y. Ecacy of relaxation therapy as
an eective nursing intervention for post-operative pain relief
in patients undergoing abdominal surgery: A systematic review
and meta-analysis. Exp er Med 2019;18:2909-16.
Volume 75, No.1: 2023 Siriraj Medical Journal
https://he02.tci-thaijo.org/index.php/sirirajmedj/index
19
Original Article
SMJ
8. López-Cepero Andrada JM, Amaya Vidal A, Castro Aguilar-
Tablada T, García Reina I, Silva L, Ruiz Guinaldo A, et al.
Anxiety during the performance of colonoscopies: modication
using music therapy. Eur J Gastroenterol Hepatol 2004;16:
1381-6.
9. Varothai S, Bergfeld WF. Androgenetic alopecia: an evidence-
based treatment update. Am J Clin Dermatol 2014;15:217-30.
10. Ahmad M, Mohmand M. Anxiety and Hair Restoration Surgery.
e American Journal of Cosmetic Surgery 2021;38:71-4.
11. Matza LS, Morlock R, Sexton C, Malley K, Feltner D. Identifying
HAM-A cutos for mild, moderate, and severe generalized
anxiety disorder. Int J Methods Psychiatr Res 2010;19:223-32.
12. Julian LJ. Measures of anxiety: State-Trait Anxiety Inventory
(STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and
Depression Scale-Anxiety (HADS-A). Arthritis Care Res
(Hoboken) 2011;63:S467-72.
13. Zsido AN, Teleki SA, Csokasi K, Rozsa S, Bandi SA. Development
of the short version of the spielberger state-trait anxiety inventory.
Psychiatry Res 2020;291:113223.
14. Techakomol W. Selected factors aecting self regulated learning
of secondary school students in Bangkok Metropolis [Master’
thesis]. Bangkok. (ailand): Chulalongkorn University; 1998.
15. Wongpakaran T, Wongpakaran N, Wannarit K. Validity and
reliability of the ai version of the Experiences of Close
Relationships-Revised questionnaire. Singapore Med J 2011;52:
100-6.
16. Vitasari P, Wahab MNA, Herawan T, Othman A, Sinnadurai SK.
Re-test of State Trait Anxiety Inventory (STAI) among Engineering
Students in Malaysia: Reliability and Validity tests. Procedia
Soc Behav Sci. 2011;15:3843-8.
17. Mimouni M, Abualhasan H, Mtanes K, Mazzawi F, Barak Y.
Patients’ Experience of Anxiety and Pain during Retrobulbar
Injections prior to Vitrectomy. J Ophthalmol 2019;2019:8098765.
18. Clark DM, Wells A. A cognitive model of social phobia. In:
Heimberg RG, Liebowitz MR, Hope DA, Schneier FR, editors.
Social Phobia: Diagnosis, assessment and treatment. New
York: Guilford Press; 1995. p. 69-93.
19. Liu F, Miao Y, Li X, Qu Q, Liu Y, Li K, et al. e relationship
between self-esteem and hair transplantation satisfaction in
male androgenetic alopecia patients. J Cosmet Dermatol 2018.
doi: 10.1111/jocd.12839.
20. Mohebi P, Rassman WR. Psychology of hair transplants.
International Society of Hair Restoration Surgery 2008;18:41-7.
21. Vachiramon V, Sobanko JF, Rattanaumpawan P, Miller CJ.
Music reduces patient anxiety during Mohs surgery: an open-
label randomized controlled trial. Dermatol Surg 2013;39:
298-305.
22. Sorensen EP, Gu H, Tabacchi M, Council ML. Music reduces
pain and anxiety associated with local anesthesia for dermatologic
procedures: A randomized controlled trial. J Am Acad Dermatol
2021;85:989-91.
23. Deivasigamani D, Sreedevi A, Sundar S, Balasundaram S,
Pragasam S. Evaluation of music interventions for anxiety
during dermatosurgery under local anesthesia. Int J Res Dermatol
2020;6:376-82.
24. Alam M, Roongpisuthipong W, Kim NA, Goyal A, Swary JH,
Brindise RT, et al. Utility of recorded guided imagery and
relaxing music in reducing patient pain and anxiety, and surgeon
anxiety, during cutaneous surgical procedures: A single-blinded
randomized controlled trial. J Am Acad Dermatol 2016;75:
585-9.
25. Emons WH, Habibović M, Pedersen SS. Prevalence of anxiety in
patients with an implantable cardioverter defibrillator:
measurement equivalence of the HADS-A and the STAI-S.
Qual Life Res 2019;28:3107-16.
26. Kerure AS, Patwardhan N. Complications in Hair Transplantation.
J Cutan Aesthet Surg 2018;11:182-9.
27. Kayikcioglu O, Bilgin S, Seymenoglu G, Deveci A. State and
Trait Anxiety Scores of Patients Receiving Intravitreal Injections.
Biomed Hub 2017;2:1-5.
28. Dhami L. Psychology of Hair Loss Patients and Importance
of Counseling. Indian J Plast Surg 2021;54:411-5.
29. Uğraş GA, Yıldırım G, Yüksel S, Öztürkçü Y, Kuzdere M, Öztekin
SD. e eect of dierent types of music on patients’ preoperative
anxiety: A randomized controlled trial. Complement er
Clin Pract 2018;31:158-63.
30. Cooke M, Chaboyer W, Schluter P, Hiratos M. e eect of
music on preoperative anxiety in day surgery. J Adv Nurs 2005;
52:47-55.
31. Kumar A, Dubey PK, Ranjan A. Assessment of Anxiety in Surgical
Patients: An Observational Study. Anesth Essays Res 2019;13:
503-8.
32. aut M. Neuropsychological processes in music perception and
their relevance in music therapy. In: R U, editor. Music erapy in
the Treatment of Adults with Mental Disorders New York:
Macmillan; 1990. p. 3-32.
33. Guzzetta C. Music therapy: nursing the music of the soul.
In: D C, editor. Music Physician for Times to Come. Illinois:
Quest Books; 1991. p. 146-66.
34. Ghafoor R, Ali SM, Patil A, Goldust M. Association of androgenetic
alopecia and severity of coronavirus disease 2019. J Cosmet
Dermatol 2022;21:874-9.
