Body Modification
The What, How, and Pitfalls
Andrea Perry, RN, MSN, CEN, CNL
Objectives
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Discuss the potential medical pitfalls of body modification
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Understand the importance of extracting a full history from a patient
in relation to injuries and foreign bodies
Healing Times for Piercing
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Ear lobe – 6 to 8 wks
Ear Cartilage – 4 mos to 1 yr
Eyebrow – 6 to 8 wks
Nostril – 2 to 4 mos
Nasal Septum – 6 to 8 mos
Nasal bridge – 8 to 10 wks
Tongue – 4 wks
Lip – 6 – 8 weeks
Nipple – 2 – 4 months
Navel – up to 9 months
Female Genitalia – 2 weeks to 4 months
Male Genitalia- 3 – 9 months
Piercing Complication Rates
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Ears: 35% had complications
Lip/tongue piercings: 87.8%
had complications
Survey of 225 adolescents
at urban hospital:
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Piercing infection-74%
Bleeding-30%
Allergic rxn-26%
Keloids-19%
Complications
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Dependent on the site!
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Infection
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Nerve Damage
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Excessive bleeding
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Scar Tissue
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Airway issues
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Allergic rxn
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Ludwig’s Angina
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Cartilage piercings→ poor healing and
more serious infection.
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Auricular perichondritis– inflammation of
skin and tissue surrounding ear cartilage
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Can progress to chondritis, which requires
the diseased cartilage to be removed
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Tx:Cipro
Oral Piercings- Uvula
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High failure rate due to strength of gag reflex
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Risks of aspiration, airway edema, airway
obstruction, snoring
Oral Piercings- Tongue
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Chipped/ fractured teeth
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Gingival recession
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Bone dehiscence
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Hepatitis
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Blood loss
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Trigeminal neuralgia
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Aspiration
Male Genitalia Piercings
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Paraphimosis:
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Delayed tx →tissue
ischemia → gangrene→
autoamputation of the
distal penis.
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Uretheral injuries
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Infections
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Prolonged priapism
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Recurrent condyloma
acuminata (HPV)
Life Threatening Piercing
Complications
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Endocarditis
Life Threatening Piercing
Complications
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Abscesses
Dermal Implants
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Also called “single point piercings”
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Anchors are implanted under the skin using
either a dermal punch or piercing needle.
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Jewelry is then screwed on and is
interchangeable once healed (8-12 weeks
later)
Dermal Implant Complications
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Same as other piercings,
but includes:
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Damage to nerves/vessels in
the dermis
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Embedding or migration
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Rejection (like with any
implant!)
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Ocular: blindness, bleeding
beneath the conjunctiva,
perforation of the eye,
conjunctivitis
Body Suspension
Body Suspension
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Has been practiced in multiple cultures for
thousands of years
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Gaining popularity in Western culture
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Why?
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Rite of passage
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Adrenaline rush
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Performance art
Body Suspension
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Associated risks?
• Bruising
• Fainting (most commonly
vasovagal in origin from
pain, seeing the needle,
or seeing blood)
• Excessive bleeding
• Falls
• Infections/pain
• Post-suspension
depression (fairly
common)
Tattoos
Tattoo Regulation?
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No national regulation.
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California law delegates supervision to the county.
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Most artists are unlicensed & have learned via
informal apprenticeship.
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No formal training in anatomy, infection control, or
universal precautions.
Tattoo Ink
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50+ pigments and shades employed
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None are FDA approved for skin injection
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Some are industrial grade printers ink or automobile paint
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2014: batch of contaminated ink and needles identified by
FDA; research is ongoing.
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No laws for ink sterility
• Infections with M. Chelonae caused by contaminated
ink have been reported around the world
Operator Health Concerns
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Unhygenic practices
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Cross Contamination
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Artist/client
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Client/client
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Equipment/client
“Sterile” equipment
Tattoo Complications
Blood Borne Diseases
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Hep B, C
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HIV
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Syphilis
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Tetanus
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Skin Infections
HSV
Mycobacterium
Staph aureus
MRSA
Other Severe Risks
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Nerve Damage
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Hemorrhage (hemophilia or extreme body modification)
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Allergic rxn (ink/injections, jewelry, latex)
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Infection
Infection
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A study of 766 college students:
• Infection-45%
• Local skin rxn-39%
• 2 cases of Hepatitis
Commercially acquired tattoos accounted for
more than twice as many hep C infections as
injection-drug use.
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People with several tattoos or complex/large tattoos
have increased risk
Consider infective endocarditis in a febrile pt
without a source and a recent tattoo:
• MRSA, MSSA, S. epi, strep viridans,
haemophilus, and neisseria
Other Complications
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Granulomas
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Keloids
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MRI complications
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Swelling/burns
Removal techniques
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Laser
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Dermabrasion
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Salabrasion
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Scarification
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Surgical removal
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camouflaging
Branding
Branding
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Branding is scarification usually done
through the application of a heated
material (usually metal) making 3rd
degree burn that eventually becomes a
scar.
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“The tools must be hot enough to do
sufficient damage to the tissue so as to
form a permanent scar… it can be
anything from a propane torch to a lowly
candle… most experienced artists lean
toward a propane torch.”
Branding Methods
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Strike Branding
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Electrocautery
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Electrosurgery (laser) branding
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Cautery pen
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“Freeze branding” (with liquid nitrogen!)
Branding Complications
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Infection (septic shock, splenic abscesses)
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Blood borne pathogens
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Allergic rxn
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Sequelae arising from 3rd degree burns
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Also assoc. with substance abuse and high
risk behaviors
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Cavernous Sinus thrombosis (caused by
staph infection; blood clot in the CS, cavity
at the base of the brain
Scarification
Scarification
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“Typically the goal of scarification is to
get raised scarring, preferably keloid
scarring.”
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Cutting- 3 mm in depth
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Chemical
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Dremel
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Tattoo Gun
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Skin removal
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Ash rubbing
Scarification Complications
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Infection
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Bleeding
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What if the cuts are too deep?
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Functional impairment depending on
scarring
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“[California] State law does not expressly
address scarification and definitions of
other practices are too narrow to include
it.”
This “surgery” was
performed by
“body modification
specialists.”
Tongue Bifurcation
“Typically” done in a piercing shop under “sterile”
conditions… but some people do it at home.
Bifurcation Complications
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Pain, swelling and infection
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Increased salivary flow
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Gingival injury/recession
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Interference with speech/mastication
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Prolonged bleeding
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Airway obstruction from edema
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Ludwig’s Angina
“Bagel Head”
References
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Available on request!