Permanent body piercings (as opposed to play piercings) are performed by creating an opening in the body using a sharp object through the area to be pierced. This can either be done by cutting an opening using a needle (usually a hollow medical needle) or scalpel or by removing tissue, either with a scalpel or a dermal punch.
Contemporary body piercing studios generally take numerous precautions to protect the health of the person being pierced and the piercer. Tools and jewelry are sterilised in autoclaves and non-autoclavable surfaces are cleaned with sterilising agents on a regular basis and between clients. Sterile, single use gloves are worn by the piercer to protect both the piercer and the client.
Most professional studios will only pierce with stainless steel or titanium jewelry. Some use one or the other exclusively. Piercers who use titanium exclusively will note that even stainless steel can sometimes contain too much nickel to be safe for a piercing. Jewelry made of pure platinum as well as 14k and 18k gold is not considered safe for piercing, but is often used for decorative jewelry when the piercing has healed. However, many piercers also claim that 14k gold contains too much copper, opting for at least 18k for any jewelry piece.
Decorative jewelry bought at retail stores is often highly discouraged by piercers, as much of it contains components that can be irritating or even toxic. Even some jewelry that is claimed to be titanium is often composed of cheaper metals such as nickel and iron. Silver in any use or form is also highly discouraged due to the threat of argyria and possible carcinogenic effects of various silver compounds.
Much like tattoos, it is often much better to avoid bargains and low prices, and instead opt for reasonably expensive jewelry and procedures.
Standard Needle Method
The standard method in the United States involves making an opening using a hollow medical needle. The needle is inserted into the body part being pierced, but not all the way through. While still in the body, the initial jewelry to be worn in the piercing is pushed through the opening, following the back of the needle. Piercing using hollow medical needles does not actually remove any flesh, the method cuts a slit and holds it open in the shape of the cross section of the needle, in this case, a circle. In this method, the needle is the same gauge or larger than the initial jewelry to be worn. Piercings that penetrate cartilage are often pierced one or two gauges larger than the jewelry, to reduce pressure on the healing piercing, allowing for a fistula to properly form.
Indwelling Cannula Method
Many European (and other) piercers use a needle containing a cannula (hollow plastic tube placed at the end of the needle, also see catheter). Procedure is identical to the standard method, only that the initial jewelry is inserted into the back of the cannula and the cannula and the jewelry are then pulled through the piercing. This method reduces the chance of the jewelry slipping during the insertion procedure, and also protects the fresh piercing from possible irritation from external threading (if used) during initial insertion.
Pierce and Taper
Similar to the standard method, this is a more advanced technique, sometimes used to pierce where large gauge initial jewelry is desired. In this method, after the needle is inserted and the opening is created, a tapered steel bar (usually one gauge larger than that of the needle at the large end) is inserted instead of initial jewelry. Then the jewelry is pushed through the opening, following the tapered bar. The success of this method is dependent on the elasticity of the skin in the area being pierced, the skill of the piercer and the type of piercing being done.
In this method, a medical scalpel is used to cut a slit, allowing for the insertion of large gauge jewelry. This method is often used in the creation of large gauge ear piercings. Scalpelling can also be used to correct an improper placement on piercings, an example of this would be cutting existing large gauge ear piercings to match symmetrically. If the jewelry is removed from a scalpelled piercing the fistula may not shrink or close over time and unwanted piercings may have to be surgically repaired. Scalpelling is most commonly used on earlobes, but can be used anywhere where large gauge piercings are desired.
In this method, a dermal punch is used to remove a circular area of tissue, into which jewelry is placed. This method is usually used to remove both skin and cartilage in upper ear piercings, where cartilage must be removed to relieve pressure on the piercing to ensure proper healing and long term viability of the piercing. Like scalpelled piercings, the healed fistulas created or enlarged using a dermal punch will usually not shrink over time.
Piercing guns are commonly used in retail settings to perform ear piercings. These gun-shaped devices are designed for piercing the ear lobe only, they are not marketed or designed for use on any part of the body other than the ear lobe, and should never be used on the upper ear. Piercing the upper ear (through cartillage) with a ear piercing gun often results in longer healing times, and possible increased discomfort.
Many professional body piercers discourage the use of these instruments. The major complaint is that ear piercing instruments perform the piercing using a great deal of force with a relatively blunt ear piercing stud. Because of this, it is more difficult to direct the piercing than with a body piercing needle, and healing is prolonged due to the additional trauma involved. Also, the autoclaving of ear piercing guns is difficult or impossible. Even though they are occasionally used for other purposes, ear piercing instruments are designed for ear piercing only.