Body ModificationThe What, How, and Pitfalls

Andrea Perry, RN, MSN, CEN, CNL

Objectives

• Discuss the potential medical pitfalls of body modification

• Understand the importance of extracting a full history from a patient in relation to injuries and foreign bodies

Healing Times for Piercing

• 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

• Ears: 35% had complications

• Lip/tongue piercings: 87.8% had complications

• Survey of 225 adolescents at urban hospital:

• Piercing infection-74%• Bleeding-30%• Allergic rxn-26%• Keloids-19%

Complications• Dependent on the site!

• Infection

• Nerve Damage

• Excessive bleeding

• Scar Tissue

• Airway issues

• Allergic rxn

• Ludwig’s Angina

• Cartilage piercings→ poor healing and more serious infection.

• Auricular perichondritis– inflammation of skin and tissue surrounding ear cartilage

• Can progress to chondritis, which requires the diseased cartilage to be removed

• Tx:Cipro

Oral Piercings- Uvula

• High failure rate due to strength of gag reflex

• Risks of aspiration, airway edema, airway obstruction, snoring

Oral Piercings- Tongue

• Chipped/ fractured teeth

• Gingival recession

• Bone dehiscence

• Hepatitis

• Blood loss

• Trigeminal neuralgia

• Aspiration

Male Genitalia Piercings

• Paraphimosis:

• Delayed tx →tissue ischemia → gangrene→ autoamputation of the distal penis.

• Uretheral injuries

• Infections

• Prolonged priapism

• Recurrent condyloma acuminata (HPV)

• Endocarditis

Life Threatening Piercing Complications

Life Threatening Piercing Complications

• Abscesses

Dermal Implants• Also called “single point piercings”

• Anchors are implanted under the skin using either a dermal punch or piercing needle.

• Jewelry is then screwed on and is interchangeable once healed (8-12 weeks later)

Dermal Implant Complications• Same as other piercings,

but includes:• Damage to nerves/vessels in

the dermis

• Embedding or migration

• Rejection (like with any implant!)

• Ocular: blindness, bleeding beneath the conjunctiva, perforation of the eye, conjunctivitis

Body Suspension

Body Suspension

• Has been practiced in multiple cultures for thousands of years

• Gaining popularity in Western culture

• Why?• Rite of passage

• Adrenaline rush

• Performance art

Body Suspension

• 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?

• No national regulation.

• California law delegates supervision to the county.

• Most artists are unlicensed & have learned via informal apprenticeship.

• No formal training in anatomy, infection control, or universal precautions.

Tattoo Ink

• 50+ pigments and shades employed• None are FDA approved for skin injection

• Some are industrial grade printers ink or automobile paint

• 2014: batch of contaminated ink and needles identified by FDA; research is ongoing.

• No laws for ink sterility

• Infections with M. Chelonae caused by contaminated ink have been reported around the world

Operator Health Concerns

• Unhygenic practices

• Cross Contamination• Artist/client

• Client/client

• Equipment/client

• “Sterile” equipment

Tattoo Complications• Blood Borne Diseases

• Hep B, C• HIV• Syphilis• Tetanus

• Skin Infections• HSV• Mycobacterium• Staph aureus• MRSA

• Other Severe Risks• Nerve Damage• Hemorrhage (hemophilia or extreme body modification)• Allergic rxn (ink/injections, jewelry, latex)

Infection

• 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. • 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

Infection

Other Complications

• Granulomas

• Keloids

• MRI complications

• Swelling/burns

Removal techniques

• Laser

• Dermabrasion

• Salabrasion

• Scarification

• Surgical removal

• camouflaging

Branding

Branding

• Branding is scarification usually done through the application of a heated material (usually metal) making 3rd degree burn that eventually becomes a scar.

• “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

• Strike Branding

• Electrocautery

• Electrosurgery (laser) branding

• Cautery pen

• “Freeze branding” (with liquid nitrogen!)

Branding Complications

• Infection (septic shock, splenic abscesses)

• Blood borne pathogens

• Allergic rxn

• Sequelae arising from 3rd degree burns

• Also assoc. with substance abuse and high risk behaviors

• Cavernous Sinus thrombosis (caused by staph infection; blood clot in the CS, cavity at the base of the brain

Scarification

Scarification

• “Typically the goal of scarification is to get raised scarring, preferably keloid scarring.”• Cutting- 3 mm in depth

• Chemical

• Dremel

• Tattoo Gun

• Skin removal

• Ash rubbing

Scarification Complications

• Infection

• Bleeding• What if the cuts are too deep?

• Functional impairment depending on scarring

• “[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

• Pain, swelling and infection

• Increased salivary flow

• Gingival injury/recession

• Interference with speech/mastication

• Prolonged bleeding

• Airway obstruction from edema• Ludwig’s Angina

“Bagel Head”

References• Available on request!