LETTER TO THE EDITOR
Surface piercing—a new trend in cosmetic piercing, potential
complications, and impact on our practice
Received: 29 June 2013 /Accepted: 31 July 2013 /Published online: 8 September 2013
Springer-Verlag Berlin Heidelberg 2013
Ear and nose piercings are probably the oldest forms of
piercing with their earliest documentations dating back to
1500 BC. Apart from them, lip and tongue piercings were
found in African and American cultures, while nipple and
genital piercings have probably originated from ancient Indian
cultures. Since WWII, various forms of body piercing have
gained increasing popularity in the Western culture.
In recent years, there has been an increase in the demand
and supply of what is known as “surface piercing” which is
not limited to any site of the body.
We have carried out a field investigation by visiting a
number of piercing studios and tattoo parlors in order to get
some insights about this new trend in cosmetic piercing. We
investigate the impact these piercings might have on our
practice and also highlight the complications of these implants
and the responsibility for removing them when things go
There are two basic types of surface piercings, and both are
usually made from stainless steel material. The first type is
known as dermal diver (also “microdermal anchor” or simply
The second type is more complex and known as the dermal
anchor. It is more difficult to insert and remove as it has two
portions (Fig. 2). The bottom footplate is fenestrated, and it
anchors itself as the dermis grows through it. There is a slight
resemblance to the Brånemark technique for the insertion of
prosthesis but only at the dermal level .
Consent Although most piercing studios agree that this is a
form of implant, only very limited information is provided to
the customer—that, too, is only upon request—and there is no
formal consenting procedure. Customers are required to fill
out and sign a health waiver, releasing the studio from any
responsibility from any complications that may arise from
having the implant.
Insertion There is no local anesthetic involved. The tattoo
artist uses a punch biopsy needle to take out a disk fragment
of skin that is then discarded.
Then, depending on the type of piercing used, they may
need to create a dermal pocket which is done by pinching the
skin on either side of the hole and dilating a small pocket with
a round dilator.
Aftercare Customers are advised to keep the piercing clean
with salt water wash. No further information is provided at
Removal According to the staff we interviewed, they are able
to remove most of the piercings upon request. More complex
or difficult ones are sent to A&E.
A 23-year-old lady presented 6 months after a dermal
implant with one baseplate completely extruded and two
others in the process of extrusion (Fig. 3). The resulting skin
changes are evident in the photograph.
Body piercing is an increasingly common practice in the
UK as shown by various surveys. This involves piercing the
skin which carries a potential risk of skin infections, allergic
reaction, and transmission of blood-borne viruses, in addition
to keloid and hypertrophic scars. In contrast to the traditional
methods of piercing, the new style of surface piercing is an
invasive procedure which involves dissection of a dermal
pocket for placement of the footplate so it becomes integrated
into local tissue. This has resulted in a shift of location of
piercings into anatomical areas that are known for keloid
formation [2, 5].
S. Ramman (*)
Department of Plastic Surgery,
The Royal Preston Hospital, Preston, UK
Eur J Plast Surg (2014) 37:119–120