Surface piercings generally suck because the piercer performing them is an idiot that doesn't care enough about their client to do the piercing correctly (not helped by the fact that every tattoo magazine and piercing website out there, desperate for attention of their own, will gladly reprint their "freaky" photos and hold them up as "artists of the month"). In the following article I will try and explain why surface piercings fail, and how they can be coaxed into properly healing. There is absolutely no excuse for surface piercings not having at least an eighty percent success rate.

TRADITIONAL SURFACE PIERCING THIS WILL REJECT!

Why do surface piercings reject?

Your body, given the choice, would rather not have piercings. It sees them as foreign matter attempting to penetrate its defenses. As such, you need to understand not just how your body heals piercings, but how it rejects them as well.

Most of the time when small objects are placed under the skin, your body pushes them out like a splinter. To simplify, this happens by "selective suicide", where the skin above the object dies, and it falls out. In the case of a piercing, this happens from the outside edges in, as seen in the animation above, and as I've marked with red in the diagrams. This happens almost automatically as the object (jewelry) disrupts the natural living processes of the cells affected.

However, by making it "difficult" by both asking the body to sacrifice "too much" tissue, by doing as little damage with the piercing as possible, and by minimizing the body's immune response, this rejection process can be frozen. It is important to note that a piercing always sits on this balance -- it never leaves. If you bump a well healed piercing even years after having it done, and cause enough damage to tip the scales, a rejection process will start. Once started, rejection processes are effectively impossible to stop.

To illustrate, I'd like to include a few piercings from BME and talk about why they failed (or will fail). My apologies to the clients and piercers involved for "outing" them, but the fact is that these are poorly done piercings:

Straight bar, vertical chest - This piercing is just a straight bar placed in the tight skin on top of the sternum. Enormous pressure is on the piercing, and it will quickly reject leaving a scar.	Tight rings, wrist - These small rings are under pressure, are exposed to constant motion, and because they cover such a small gap, will be very easy for the body to reject.	Rib bar, plastic jewelry - This jewelry puts slightly less pressure on the piercing by using flexible plastic jewelry, but the body still can't stop the rejection at the edges (rejection is inevitable).
Nylon arm bars - These arm bars will reject even more quickly than other nylon surface piercings do because they have long overhanging edges, and have been placed in a high motion, high impact area.	Long plastic rib bar - This rib bar will not only reject from the edges as other surface piercings do, but possibly also from the centre -- it is too long for the piercing to properly drain, so the centre will become flooded with dead tissue.	Tygon back bars - These have more potential to heal because they are both extremely flexible and the Tygon tube has the ability to conform more to the body's needs, but they usually still reject from the edges inward.

So let's qiuckly run-down the things that contribute to the end of a surface piercing:

• Up-pressure - The jewelry excerts leverage up on the skin above it. This stresses the tissue, and also partially clamps off blood supply to it.
• General damage - The process of doing the piercing damages the tissue and weakens it, initiating the healing/rejection process. In addition, the continual damage caused by light allergic response to the jewelry can irritate surrounding tissue enough to cause rejection.
• Motion - If a piercing is placed in a location that moves, either by twisting, stretching, or compression of the skin it's through, forces will be applied to the entire piercing, including the entrance and exit holes.
• Impact - If a piercing is placed in a location that regularly gets bumped (not just by accident, but also by things like clothing and belts), this can of course damage the piercing.
• Drainage - In the process of healing, dead tissue (both from the area, and the corpses of cells sent to help heal) is thrown away and replaced with healed tissue. The body must have a channel for disposing of this waste to effectively heal.

• Up-pressure - There are a few overlapping routes to minimizing this:
  • Placement - Some skin is tighter than others. Some looser skin, either because of its anatomical placement, or because of the age of the client, is very pierceable, even with poor technique.
  • Jewelry Material - A jewelry's ability to conform to the body's needs goes a long way to stopping rejection, but doesn't entirely eliminate the problem. Using this route to stop rejection, metals are horrible, nylon is only marginally better, and Tygon is the current champion of this method.
  • Jewelry Shape - Careful jewelry design can effectively totally eliminate up-pressure issues if the jewelry passes straight down to a "safe" distance, moves across the skin at a consistent depth, and then re-exits straight up again.
• General damage - Normally the damage shouldn't be a major issue, but realize that it's at the entrance and exit points of the piercing that any rejection will occur, so don't give it an excuse. The piercing should be cleanly done and as much as possible follow the precise path of the jewelry. As far as material, the material that causes the least response from the body should be used -- in general this means titanium, as well as some plastics.
• Motion - Draw a grid on your skin, and draw the piercing on your skin over the grid. Now, move the area as much as you can. For the piercing to be viable, this line should stay constant in shape and length, no matter what position the body is put in. Flexible jewelry will give you more freedom as far as motion, but ideally this problem should be solved with careful placement.
• Impact - If you put a piercing on your hands, your forearms, your shins, or any number of other places depending on your lifestyle, you're going to hit it on things a lot. There's nothing you can do about this outside of not putting piercings in these locations. In addition, if you know that a bra strap or belt will rub on the piercing, that alone is often enough to make it fail.
• Drainage - A piercing of a given gauge has a maximum length, with larger jewelry being able to support longer lengths. Realistically, keep surface piercings to under two inches in length.

I'd like to mention now a few of the techniques people have used to try and make surface piercings heal:

• "Traditional" technique - Ignoring the morons that pierced (and still pierce) surface piercings like they would an ear, traditionally surface piercings were done with either curved barbells or nylon bars. While these do heal in a small percentage of people, they are almost all unsuccessful in the long term. This method is unacceptable, and any piercer performing it should be avoided.
• Scalpelled technique - This technique (shown on the right) is probably the only serious method that attempts to allow people to perform surface piercings using traditional metal jewelry. The theory is to create a low-pressure "flap" that the jewelry will sit under and have minimal interaction with. Unfortunately, the body tends to "pull down" the tissue quite quickly on most people, simply slowing down rejection rather than eliminating it. In any case, this is an experimental technique that is not available to the general public.
• Scar-and-brace techniques - Some people experimented with piercing underneath a brace, either toughened tissue or a small implant. Unfortunately this tended to lead to other complications, and this techncique is rarely pursued except as a novelty.
• Surgical techniques - Transscrotal piercings and bipedical flaps are good examples of this method (which isn't really piercing anyway). The aim is for a single procedure to leave the client with a well developed fistula ("skin tube") by surgically constructing it. This technique is well out of the reach of all but a handful of piercers and should not be generally even considered.
• Flexible jewelry (Tygon) technique - Tygon is a flexible inert plastic tube that has become quite popular in surface piercing. It is far more flexible than nylon, and thus greatly reduces the pressures that the piercing puts on the skin. If you are going to use any technique other than surface bars, or want to do a surface piercing in a location not suited to surface bars, this is in my opinion the only acceptable method.
• Surface bars - Surface bars, which I will discuss at length in the next section, are in my opinion the single best -- and perhaps only -- acceptable solution for most surface piercings. They attempt to solve the problems in surface piercing by intelligent jewelry design.

Surface Bars

While surface piercing is a diverse art, and different piercings do need different solutions, if a generalization is to be made, I feel confident in saying surface bars are the best available solution to the surface piercing problem.

I'd like to define what a surface bar is, since I see a lot of people and companies making poor imitations and selling them as the real thing. First, a surface bar is made of a rigid material, generally titanium or stainless steel. Second, a surface bar is never larger in gauge that required, nor is it longer than required -- it leaves a minimal footprint.

Finally, it's shape must be matched to the anatomy (which means that you probably will need a consultation first, and then an appointment for the piercing a week or two later). First, the bars should only extend enough above the skin to accomodate any swelling -- excess length will greatly decrease the chances of good healing. The bar must go straight into the skin at a ninety degree angle (perpendicular). It then must change direction as tightly as possible (a loose curve isn't going to cut it). It must then travel across (under) the skin, staying at a constant depth. It must then exist again at ninety degrees. In flat areas, this means a staple shaped bar (as you see above right and in the middle piercing below), but for curved areas, other shapes must be used. For example:

I think it's important to credit the inventor of the surface bar, Tom Brazda of Stainless Studios in Toronto (although I'd like to think I played a role in its development as well). I have seen many other pseudo-surface bars from the same time period, and most were poorly designed and did not work as well as they could.

I'd also like to mention what may turn out to be a future evolution of surface bars -- I'm not sure what the name is (maybe "surface wire"), but it's a surface bar made of flat wire stock instead of round stock, thereby bringing its volume to an utter minimum, while maintaining surface area. Both my own experiments, as well as Tom Brazda's research on the subject have shown that this technique, at least in certain applications, offers dramatically improved performance over surface bars. Unfortunately these bars are also dramatically more difficult to manufacture.

To conclude, I'd like to show some pictures of what I consider "well done" surface piercings that are either well healed, or I believe will heal well if kept. All of the following piercings are good examples of surface bar technique:

Final Questions

What do you think of people using other techniques for surface piercing?

If a piercer wants to experiment on themselves or their close friends, fine. But when it comes to the public, surface bars must be used for most surface piercings, and those few that aren't suited to surface bars must be done using a Tygon-style technique. It is my strong opinion that as of the date of this writing, those are the only acceptable techniques.

Sorry, but I'm just one guy, and I probably don't live in your area. In Toronto, your choices are basically either going to Tom Brazda at Stainless Studios (just east of Queen and Bathurst), or to Blair at Passage (just south of Church and Wellesley). If you don't live in Toronto, call your local studios and ask, "do you use surface bars for surface piercing?" If the answer is "yes", go in and check out their portfolio. If they don't have one, or you're not happy with what you see, find another studio. There's no point in getting a piercing if it's just going to reject.

Again, I am not familiar with all the manufacturers on the market, so any list I were to make would leave out many people. I can say that 80% of the surface bars I've seen companies selling do not meet the basic design criteria. In addition, you must choose a company that will make the bars exactly as you ask. Under no circumstances should surface bars be considered a "one size fits all" solution -- although by keeping a variety of bar sizes in stock a studio could certainly always have nape and forehead bars in stock. On that subject, the most common mistakes manufacturers make are either not using a sharp 90 degree angle, or in using "legs" that extend too far above the skin.

Anyway, I don't have a list for you -- ask your regular suppliers. However, you can always contact Stainless Studios at (416) 504-1433. I know that if it was me I'd want to buy bars from the place with the most hands-on experience using them. (Note: BME has no commercial relationship with Stainless Studios, and I don't get a cent from any of their sales, nor do they even contribute photos to BME.)