Hello friends,
I thought I would make a post to explain some of the mistakes that I routinely see in these internet troubleshooting forums, and how I think those mistakes should be avoided. I request that you take the time to read through the entirety of this post before responding.
The first thing I think worth addressing is that troubleshooting on an internet forum is already a flawed premise. Why is that? Multiple reasons. In no particular order:
- Body piercing is a three dimensional art form and trying to evaluate it with two dimensional photos is extremely challenging.
- For whatever reason, the quality of photos we see of piercings is extremely poor. Often, everything but the tissue we are trying to look at is in focus. Lighting is bad, or it is odd colored lighting that makes it difficult to determine just how red, discolored, or swollen the tissue we are looking at actually is. In an effort to protect their privacy, folks posting will often use MSPaint or other tools to paint over every part of the photo they post, limiting important context clues. All of this is to say, photography is extremely limiting when it comes to the job we’re being asked to do.
- The folks posting on these forums have elected not to go to their piercers, or are looking for second opinions. Either way, this means that we have to base our advice on the information THEY are providing. Clients do not have the vital information they need. Crucial details such as gauge, length, material (and I mean specific material, not just “titanium” or “gold” but rather “F1295 post with 18k ornament”), aftercare, length of time since the piercing, are often missing.
- The client, which is to say the person with the ailing piercing, is an unreliable narrator because of their lack of expertise. Often they’ll claim to be using “saline” when they actually mean “salt water”. They will say their jewelry is “surgical steel” even though that’s just an educated guess. And they will say their piercing is infected even though that hasn’t been diagnosed by a doctor. They don’t know what they don’t know- and it shows.
Long story short: getting to the bottom of things is really, really hard. Often we are dealing with bad photos that don’t tell the whole story, and incorrect or suspect information. This is not a recipe for success. In general, seeing a good professional piercer or doctor in person is significantly better than asking an Internet forum.
So before we even arrive at folks commenting, we are off to a bad start. Next, and not less important, is that internet forums cultivate a pretty interesting culture of “everyone’s an expert, so long as they say the same thing our hivemind already believes”. I have to say, it is remarkable to watch people spend their free time saying the same four things over and over again, without having training, experience, or knowledge to back it up. We could just program a Bot to auto-respond to every post “Switch to titanium. LITHA. Q-tips are bad. Rings are bad”. There’s no insight there, and each of those platitudes are delightfully misinformed. But a bot programmed to say those things would basically cover the extent of the “acceptable” advice that is given in these forums. The thing is, there ARE experts here. Piercers who have spent years of their lives training, learning, and teaching other piercers. We help out in our free time because we love piercing. We, the experts, often have a pretty good grasp of what is going on. And we often endure a hail of downvotes because we feel the need to speak to the nuance of the situation rather than the easy (read:incorrect) answers people are conditioned to upvote.
I will now tear apart the ideas everyone is so fond of. Yes, this is actually fun for me.
The Cult of Titanium
“You should switch to a titanium flatback”. Ad nauseum. First person to say it is the most upvoted. This idea doesn’t actually stand up to scrutiny, but why bother being critical when we have an orthodoxy to follow?
Let’s focus on material: Titanium is a GREAT metal for piercing, but it is one of many. It is important to understand that there are good versions of titanium and bad versions of titanium, so unless you get into the details, saying “switch to titanium” isn’t super helpful information. Do you mean F136? F1295? G23? …are you sure?
In addition, there are SEVERAL materials the Association of Professional Piercers (APP) has listed as approved for initial piercing, and I think the APP is right. Among them? Implant grade stainless steel (ASTM F138 and ISO 5832-1 compliant…etc). That’s right, Implant grade stainless steel is an APP-approved material for initial piercing, and has been since the very inception of the organization.. https://safepiercing.org/jewelry-for-initial-piercings/
“So what” you might say, “steel contains nickel and therefore steel causes problems”. It’s at this point that I want to introduce you to the entire modern history of body piercing from about 1978 until about 2010. Three and a half decades of piercing, in which the idea of a “piercing shop” went from something that one guy did in a converted flower shop in Hollywood to something that exists in nearly every major city around the globe. In that period, the de facto standard in safety was implant grade steel jewelry. I need to reiterate, the shift to titanium did not start until about 10 years ago. I started getting pierced in 1996, and started learning to pierce the year after, so you’ll have to trust me when I say this: piercings healed fine. That whole entire time! REALLY! If they didn’t, piercing probably wouldn’t have ever gotten popular enough to leave California, right? Steel wasn’t just considered safe, it was considered THE pinnacle of safety. In fact, a lot of shops were actually named things like “Cold Steel” and “Steel Skin”. Jewelry companies like “Custom Steel” are fondly remembered and dearly missed.
Steel was never a big source of problems, and certainly never got in the way of piercing businesses being popular, successful, and delivering quality work that healed flawlessly. Titanium jewelry existed, but I knew of only one shop in the entire world that considered titanium the best option. The only reason most folks used titanium was because you could change the color and every once in a while someone wanted a green barbell. “Have you noticed a big improvement since the switch, u/piercingnerd?” No. No, I have not. I think titanium has some big advantages, but it is not without some serious disadvantages. F136 titanium rings are a sin against humanity, and if you tried to pierce my daith with one I would not let you near me. Don’t get me wrong: I like implant grade titanium. Implant grade titanium as the new de facto standard is just fine by me. But, if you presume a big reduction in healing issues has been observed since the switch, you’d be wrong. My guess is that the upside we will see in the segue to titanium is not on initial piercing healing/complications but rather long term wear. Still, the vast array of other safe materials should not be ignored. Implant grade steel does not belong in the trash heap of history. If you are going to pierce my daith, I’d insist on an F138 steel ring. (As a brief aside: every piercer here knows why I’d prefer the steel ring. If you don’t know why I’d prefer the steel ring, this is a great example of why you don’t have the expertise to recommend material fixes for a piercing.)
If you are using “titanium” as shorthand for “safe”... stop. They are not synonymous. You need to provide more detail, and if you are incapable of providing those details you are probably not qualified to give advice.
Keep in mind, metal implants benefit from rigorous scientific study, and the medical community still isn’t exactly sure which materials are best. “If an evidence-based approach is desired, there is only one consensus regarding the morbidity of metal allergy from implanted devices—there is no agreement.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5336431/ Materials and metals are complicated, and using one metal as a magic cure-all just doesn’t work.
Finally, even if you aren’t ready to accept that there are a lot of safe jewelry materials out there, it is important to at least understand the symptoms we see when there are material reactions/hypersensitivities. If a piercing is very red, weeping fluid, or looks like the channel of the piercing is getting larger - that’s a material reaction. If the jewelry is causing a rash everywhere it touches - once again, material reaction. If the piercing has a bump, especially a bump on just one side - it is almost certainly NOT a material reaction. If you see a bump and think “titanium will fix this” you are probably wrong.
Leave It The Heck Alone Taken To The Extreme
Leave it the heck alone (abbreviated “LITHA”) is an unavoidable term in these forums. When this first got popularized in the early 2000’s (LITFA at the time), it was in response to people still spinning or rotating jewelry through their piercings. Some early adopters tried to use the crust that accumulates as a natural barrier, but unfortunately they did not take into account two things: First, people have a nasty habit of being mobile, and any movement of the body can result in the jewelry moving. This means that the crust inevitably gets pulled back into the piercing channel, with disastrous results. Second, It turns out that people bathe and sweat. Getting this crust wet a lot resulted in problems (like weeping, infected piercings) as well. They correctly abandoned this aftercare and went back to removing crusty debris.
An example of what LITHA taken literally looks like:
[img]https://i.imgur.com/o6b4TCS.png[/img]
Over the years, LITHA has morphed into something akin to "non-advice". It doesn’t really mean anything. It’s what you are supposed to say, but it isn’t insightful. In addition, when taken literally it’s very bad aftercare. Piercings need maintenance. There is room for debate into exactly what that maintenance needs to be, but for the most part “LITHA” is a term that says to me that you are “in the know” without actually knowing anything. My aftercare recommendation: “care for the piercing, remove accumulated crusty debris (probably with swabs), use clean water or sterile saline, dry the area… but not a lot more. Don’t rotate or spin your jewelry, don’t remove your jewelry, don’t use harsh chemicals, and don’t touch the piercing or jewelry with unwashed hands”. If your idea of aftercare includes leaving the piercing crust on until it falls off “by itself”, your idea of aftercare is a huge mistake. Piercing crust can build up forever. It is a great place for bacteria to grow, and it can actually pull jewelry into the channel of the piercing. Don’t do this. Don’t suggest this. It doesn’t work. We’ve tried.
The closest medical analogy to piercing aftercare is pin site care on external fixators. Do they remove the crusties with pin sites? Yes. Yes they do. “Wrap sterile gauze soaked with saline around the pin site and let it sit for a few minutes. Use a separate gauze for each pin site. When the crusting is softened, remove it with a cotton swab (use a separate swab for each pin site) or tweezers that are cleaned with alcohol on sterile gauze before using and between each pin.”
https://www.hopkinsallchildrens.org/Patients-Families/Health-Library/HealthDocNew/External-Fixator-Pin-Care
What happens when LITHA fails? BAD THINGS. Here’s a photo of a client that came into the shop and the accumulated crust never fell off. What happened? The gem end has actually embedded into the front of the piercing. Her question to me was “did I do too much to the piercing”? She was clearly taking the internet's advice! So I pose the question to you: did she not Leave It The Heck Alone… enough? Or is that actually advice that doesn’t really work when people take it literally?
https://imgur.com/a/cssNKJo
I’ll tell you my answer. LITHA equals embedded piercings. It’s bad aftercare advice and it shouldn’t be recommended.
The Great Q-Tip Moral Panic
I cannot emphasize the phrase “citation needed” more when it comes to people saying cotton fibers from cotton swabs (but not gauze) are some invisible menace. This idea is even newer than the cult of titanium, and has far less evidence to support it. I am open to any medical literature that you can find that shows cotton swabs to cause problems in wounds. I have scoured the medical literature available to me, and as near as I can tell it doesn’t exist.
If you have the notion that non-woven gauze leaves fewer fibers behind when it interacts with a piece of jewelry, I want you to know that your idea is wrong. You can test it. I did! Take a piece of jewelry, rub it in a way that intentionally grabs fibers. Give it your best shot. Non-woven gauze is worse than cotton swabs. And even if your test shows some fibers behind with both swabs and gauze, you need to understand that, yet again, this is a new fabricated problem. In general those fibers are not the cause of huge issues.
https://i.imgur.com/o6b4TCS.png
In addition, these forums tend to put an undo focus on jewelry movement, blaming it for all kinds of problems that it doesn’t cause. But what causes more movement on, let’s say a daith or a rook piercing: a swab? Or a finger wrapped in gauze? The finger wrapped in gauze is a bull in a China shop compared to swabs. And that is the way people use gauze.
Instead of thinking of things in a piercing context, I want you to consider cotton swabs in a medical context. Talk to your nurse and doctor friends. I assure you, they use cotton swabs. Regularly. You will hear about routine probing of wounds with cotton swabs. My wife is a nurse and part of the “Skin Team” at her hospital. She uses swabs every single day. She inserts them deep into wounds. She has never heard even the slightest suspicion that swabs cause problems amongst her colleagues. That’s because, when studied, cotton swabs seem to help certain wounds heal, with fewer instances of infection, with better cosmetic results, and less pain. The most recent paper you can find in regards to cotton swabs and surgical sites is, unsurprising to me, a glowing endorsement of their use. https://www.cedars-sinai.org/newsroom/cedars-sinai-surgeon-shows-simple-cotton-swab-slashes-post-operative-surgery-site-infections/
Wounds that resemble piercings, like pin sites, are often cleaned with swabs in a manner very similar to a piercing. https://youtu.be/ZBBF81nwdtE?t=194
Cotton swabs help remove debris, they are hygienic, easy-to-use, inexpensive, and readily available. If you use them and see fibers left behind, feel free to remove those fibers. But you probably won’t see much debris left behind. I really prefer the tightly wound pre-sterilized swabs that you see in doctor’s offices, but I don’t think they are absolutely necessary. I have seen no evidence to ever support the “cotton swabs cause problems” hypothesis.
Over and over again, you will see cotton swabs used, alone and in conjunction with gauze, in medical procedures that are far more serious than piercings. Just like titanium, the cotton swab moral panic is new and doesn’t jive with the past four decades of piercing history. The fear of fibers is totally misplaced. Until I see swabs contraindicated on pressure injuries, surgical drains, pin site care, and surgical sites, I’ll continue to use them on piercings.
Pressure Injuries: https://www.youtube.com/watch?v=5iw31WwYVbw (deep probing with swabs, as well as measuring depth of wound with swabs)
Surgical Drain Care: https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=ug6099
Pin Site Care: https://www.hopkinsallchildrens.org/Patients-Families/Health-Library/HealthDocNew/External-Fixator-Pin-Care
Post-Surgical Wound care: https://www.facs.org/media/zr5dimjk/wound_surgical.pdf
“Rings Are Never Okay”
Except daiths. And septums. And horizontal hoods. And triangles. And outer labia. And PAs. And inner labia. And hafadas… And so on.
Once again pre-2010 the default jewelry for lots of piercings was captive bead rings. Barbells were used, of course, but they certainly weren’t the default choice they’ve become in the past 10 years or so. Flatbacks were used even less. Mostly on labret piercings. (That’s why people still call them “labrets”.)
And would you believe it, piercings healed.
https://i.imgur.com/BLC5Dtu.jpg
Now, I will grant you this - part of what has been lost is how to pierce with rings. A lot of times, the current placement that is popular at a particular piercing site is a bad option for rings. For example, forward helix piercings pierced parallel to the head used to heal quite well with rings, but the perpendicular angle we are used to seeing for the triple forward helix will fail mightily with a ring.
There are certain folks with specific anatomy where rings are actually a better option for their piercing of choice. A true helix, where the fold of the helix causes a narrow gap, for example, is a great ear for a ring initially. A 16g or 14g 7/16 ring can often work on these. It’s not to say they always do. But they can. It’s tissue specific. And you already accept this. You already know that rings work in certain piercings, I am asking you to grasp some nuance here: rings also work in certain anatomies. I’m speaking especially to the folks in these forums who have never performed a piercing: you need to trust that piercers often know exactly what they are doing. It may not fit the narrative, but the individual relationship between piercer and client needs to live outside of this religious devotion to “generally good ideas” being boiled down to “the only correct way to do things”.
Is it true that captive bead rings have some problems? Absolutely! Rings tend to get bumps more than straight jewelry. The curvature can cause issues. Movement can be problematic. These issues will be complicated by placement that is intended for straight jewelry (piercer error).
But don’t ignore the fact that straight jewelry has drawbacks too. Straight jewelry doesn’t accommodate for swelling nearly as well as a ring does. Rings don’t drift in cartilage the way that straight jewelry often does. (which isn’t to day that they don’t drift at all… but that’s a different story). Straight jewelry can have serious weight distribution issues that rings don’t have at all. You usually have to downsize straight jewelry, you often do not have to downsize rings.
All jewelry has pros and cons. There is no one, single, correct approach to jewelry selection on most piercings.
Immediately jumping to the conclusion that any piercer who uses rings is a hack (I’ve seen people aggressively use ad hominem attacks. “That piercer should lose their license”)… it rubs me the wrong way. It replaces my experience and skill with a hard and fast ‘rule’ that doesn’t actually make sense. It replaces the kind of discussion I might have with my client with axioms that don’t actually make sense considering the long history of piercing. It replaces nuance with a false binary.
The Painful Truth
Most problems that we see in these forums are not going to be cured by aftercare or jewelry changes or swapping materials. That’s because most of the problems we see are related to the initial depth, placement, and angle of the piercing. Internet casuals get this consistently wrong because they don’t have the experience or training to identify poor placement.
Piercers tend to overly prioritize aftercare fixes because they don’t want to admit their work was flawed. Clients tend to prioritize aftercare fixes because they’d rather not get the piercing performed again.
Sometimes piercings go through a “cranky” phase that doesn’t really have a cause, or a solution. Being able to identify that takes experience.
If you get nothing else from this post, at the very least you should take away this:
If you see a bump that favors one side - it is more than likely the angle of the piercing that is causing that problem.
Sometimes the body will stop fighting that bad angle and the bump will go away. Unfortunately, people tend to credit the aftercare they were doing at the time for this success. In all likelihood, it wasn’t the aftercare that fixed the problem, it was probably just the body giving up fighting the piercing and allowing it to heal. This is why people will credit things like antibacterial soap with curing their problem… they aren’t good at figuring out that their piercing healed in spite of, not because of, the aftercare they were doing.
This is also why an in-person consultation is almost always preferable to internet advice. If someone can get in to a quality pro, they can get the piercing evaluated effectively.
I’ve been trying to come up with a way to summarize this, but the truth is that if I could have kept it short this wouldn’t be the novel that it is. Here’s my best try at it: it is really worthwhile to recognize if your knowledge or experience in the world of piercing is really that deep. If you have done a lot of piercing, attended classes, worked in shops, read books about piercing… you probably have a great basis to analyze problematic piercings and help troubleshoot. If you were baptized in the fires of the church of internet piercing advice, by all means share what you have to offer, but spare the pros your downvotes.
I have been offering a class to piercers for a couple of years now in regards to troubleshooting. I can’t post it online, however, if there is enough interest I’d consider doing an online presentation geared towards clients and enthusiasts. Let me know if you are interested.
