Why the next skin prep fad will hurt body piercing

I must admit that the day the FDA issued their press release regarding Care-Tech Labs, stating that "...Care-Tech violated numerous provisions of the FDA’s current good manufacturing practice (cGMP) regulations that direct how antimicrobial drugs are made ... the FDA recommends that Care-Tech’s customers seek alternative products”[1], effectively pulling bottles of Techni-Care® off the shelves, I felt no small amount of schadenfreude. I could not say “I told you so” enough. Why?

Techni-Care® violated both the “if it ain't broke don't fix it” and the "if it is marketed specifically at body piercers, it's probably bad” rules. As an industry, we believed and perpetuated the myth of povidone-iodine allergies[2]. We completely ignored the efficacy and appropriateness of isopropyl alcohol[3]. Piercers quickly became fond of lauding Techni-Care®'s 30-second kill time (but were typically remiss in acknowledging the instruction that called for a 2-minute swab)[4]. I was frequently told how much better it was than the alternatives, but could not find any convincing studies to indicate that Chloroxylenol (PCMX) works at all, much less any better than what doctors and nurses use on an everyday basis[5][6]. In short, we bought the marketing and skipped the analysis. The lack of critical thinking could not be more evident than when piercers started paying top dollar for expired bottles of the recalled* product on eBay®. Downright Jonestownian Kool-Aid® drinking.

Eventually, some product, maybe even a newly FDA-approved Techni-Care®, will vie to be the new darling of the body piercing industry, and when that happens my suggestion is this: Think Critically. Specifically consider the following:

1) Is "Product X" widely used by doctors, surgeons, or nurses for skin prep?

Answer: It won't be. Talk to any doctor, and ask them what they use to prep skin for outpatient procedures similar to a body piercing (something like an injection, biopsy, or blood sample). It will nearly always be isopropyl alcohol or povidone-iodine, with the occasional chlorhexidine gluconate or even “injections don't really need skin prep”[3]. Think about what this means: The stakes are much higher for the medical industry. Doctors are far-better educated than nearly every body piercer, and they are the ones who research, test, and evaluate new products. Sure, that process takes time, and this is a good thing.

2) Is "Product X" in a sterile, single use pouch (like an alcohol or iodine swab)?

Answer: It (probably) won't be. If Techni-Care® is the model, it definitely won't be. The bottle out of which you dispense “Product X” can be contaminated, whereas sterile single use alcohol or iodine swabs are far less likely to be mishandled. In either case, there are examples of the manufacturer contaminating their own product, but, in the piercing shop, bottle dispensers are not as good as sterile, single-use supplies of any product we use on a client.

3) What advantage is there in using "Product X," a skin prep product that is brand new, and has not stood the test of time?

Answer: Street cred. That's all. Your ego might get the benefit of jumping on the bandwagon, but in truth you are gambling with your client's safety. Choose to follow a preponderance of evidence, particularly research-based evidence. Large, properly-conducted studies with peer reviewed papers should be the requirement before we, as an industry, even consider adopting new skin prep chemicals.


There are a few facts we need to acknowledge: We are not doctors. We are rarely scientists. Collectively, we have egg on our faces for widely endorsing Techni-Care® with nearly no data to back it up. We need to see Techni-Care® for the very big mistake it was, not the (unfulfilled) promises it made. Techni-Care® should be held up as a “Never Forget (that we aren't as smart as we think we are.)”

Where do we go from here? My suggestion: in lockstep with the medical industry. If we are going to be proven wrong (ahem, again), we should be proven wrong at the exact moment every doctor, nurse, phlebotomist, researcher, etc. is proven wrong. What does lockstep with the medical industry mean? It depends on how you choose to categorize body piercing: Surgical skin prep or injection skin prep.

I hate the meme “body piercing is a small surgical procedure.” It conceptually biases our perspective to an inaccurate extreme. However, if you believe that piercing falls nearer to “surgery” than “injection”, povidone-iodine or clorhexidine gluconate (though, keep CHG away from mucous membranes) and isopropyl alcohol is the way to go. If you prefer to consider a body piercing on par with injection or blood draw, the medical community nigh universally chooses 70% isopropyl alcohol. At present, you make this decision, but either perspective and practice is a safer bet than blindly adopting whatever new "Product X" is around the corner.


[1] http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm181654.htm

“Care-Tech Laboratories Agrees to Stop Making, Selling and Distributing Unapproved Antimicrobial Products”

[2] http://www.ncbi.nlm.nih.gov/pubmed/2302848

- "Sensitization to povidone-iodine."

[3] http://www.clinicaladvisor.com/improved-pre-injection-skin-prep/article/166068/

quote: “No controlled studies exist, but the standard of care is to use an alcohol-based solution to cleanse the skin before intramuscular, intradermal, or subcutaneous injection, as well as before venipuncture for nonsterile specimens. An iodine-based solution should be used before injecting a joint space or obtaining blood for culture.—Reuben W. Zimmerman, PA-C (137-1)”

[4] http://www.caretechlabs.com/ctl-reference.html#prep

quote: "Swab site for 2 minutes insuring coverage inside sterile field." from the article "Skin Prep".

[5]www.ast.org

quote: “Studies of parachlorometaxylenol (PCMX) have produced contradictory results and therefore, further studies are required in order to determine the efficacy of the agent with other agents (Soulsby, Barnett, & Maddox, 1986).” from “Recommended Standards of Practice for Skin Prep of the Surgical Patient” - Association of Surgical Technologists

[6] http://web.archive.org/web/20100526060618/http://www.chloraprep.com/study-27

http://www.jbjs.org/article.aspx?Volume=87&page=980

quote: “The positive culture rate associated with the hallux site in the ChloraPrep group was significantly lower than that in the DuraPrep™ group, which was significantly lower than that in the Techni-Care® group” from “Efficacy of Surgical Preparation Solutions in Foot and Ankle Surgery
Ostrander RV, Botte MJ, Brage ME. Efficacy of surgical preparation solutions in foot and ankle surgery. J Bone Joint Surg Am. 2005;87:980–985”.

*I have been corrected on referring to Techni-Care as having been "recalled". Technically, "shut down by the FDA" is more accurate, as Care-Tech never initiated a recall.

This blog post was written by Jef Saunders, owner of
Rockstar Body Piercing, Instructor at the
Fakir Intensives and Member of the
Association of Professional Piercers.


Why the next skin prep fad will hurt body piercing by Jef Saunders is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.

Surface Anchor Removal

Today I did a short demonstration and question and answer discussion with the staff of Newport Hospital on the removal of surface anchors. Below is the content of the handout I gave to them.

Special thanks to >Industrial Strength Needles, LLC for donating tools for removing anchors to the hospital!

Surface Anchor Removal

Surface Anchors are performed several different ways, and with a few differing jewelry options. They are performed all over the body and go by a variety of different names (dermal anchor and microdermal being the two most common).

Determine if the piercing is actually an anchor

To remove them, it's important to first make sure they are actually surface anchors. A traditional surface piercing is one barbell underneath the skin, and is far easier to remove. Simply unscrew one end, lubricate it, and pull the other end out through the exit hole.

Surface Anchor Jewelry Styles

There are several different anchor styles. Unfortunately, most have holes in them for tissue to grow through. This doesn't tend to help the anchor from rejecting, but it does make the anchor harder to remove.

Some anchors have very large holes to allow lots of tissue to grow through them, further complicating anchor removal.

The best anchors in my opinion have no holes for tissue to grow through. They are easier to remove and heal better than anchors with holes.

Parts of a surface anchor

Heel: The short, back part of an anchor.

Foot: The long front part of an anchor.

Post: The portion of the anchor that connects the foot and heel (also known as the base) to the disc, gem or ball outside the skin.

Removal with a disc or gem attached

1) Attempt to figure out which way the anchor is oriented. The heel is the easy portion to remove, so finding which direction the foot is facing will tell you where the heel is.

2) Attach your anchor removal tool to the disc portion of the anchor.

If the gem or disc is too big to clamp the anchor removal tool down, feel free to wrap the tool with rubber bands.

3) Apply gentle pressure to the anchor removal tool pushing TOWARD the foot and pulling up from the heal. While doing this, pull the skin behind the heel firmly. The anchor should pop out very easily.

4) If there is tissue growth through a hole in the anchor, use a sharp instrument to cut it away. As a piercer, I usually use a thick needle. You may choose to use a scalpel blade.

Removal with no gem or ball

1) If the gem has fallen off the anchor , but it is still visible through the skin, grab a threaded anchor tool.

Screw the tool into the anchor as securely as possible.

Repeat the same steps as before, putting pressure toward the foot and pulling up the heel, while pulling the skin back firmly from the heel.

Note: Occasionally skin will have completely healed over the anchor. Before cutting the jewelry out, you may try cutting a very small hole with a needle and trying the threaded anchor tool first.

We have had a lot of success using a 16 gauge piercing needle to allow us to rethread the jewelry.

Need more tools?

The surface anchor removal tools you received today were donated by Rockstar Body Piercing and Industrial Strength Needles, LLC.

Industrial Strength has lot of body jewelry tools and even has kits they have for hospitals. They can be reached at:

Industrial Strength Needle, LLC www.isneedles.com / 1-877-667-4277

If you have any questions, want further information, or need to send someone to me for help, I am available at:

Rockstar Body Piercing

Jef Saunders

crooshjef@rockstarpiercing / 401-272-0345

267 Thayer Street Providence RI 02906

Jef Saunders' Ear Piercing Stretching Guide

Kids: Get your parents permission before you permanently alter your body. And despite what you've been told, it is permanent.

Parents: We made this manual because your kids were butchering their ears anyway, please don't blame us.

Introduction

Stretching your ear lobe piercings can be a comfortable, inexpensive body modification that you can do almost entirely on your own. Following a few basic principals can result in healthy, aesthetically pleasing stretched ear lobes.

Proper Placement

Depending on how far you want to stretch your ears, the placement of your initial ear lobe piercings is essential. Slightly deeper piercings allow for far more blood flow to get to the tissue of the underside of your lobe. Blood flow is essential for healthy ear lobe tissue. If you plan on stretching your ears very large, consider repiercing your ears with a trained, professional body piercer.

Stretch Slowly, Be Patient

Assume that your ears have been pierced with a 16 gauge (1.33 mm) captive bead ring. After the piercing has completely healed and has been healthy for a few months, the next size thicker, a 14 gauge (1.63 mm) captive bead ring, should slide through with no discomfort. After 6 to 8 weeks, your ears will once again be able to tolerate a size larger (12 gauge, or 2.06mm). By proceeding very slowly and deliberately, you will allow your scar tissue to become flexible and avoid small tears in the scar tissue ring around your piercing. These tears can result in a puckered appearance to your ear lobe when jewelry is removed, or excess scar tissue, sometimes referred to as a “blow out”. Neither of these looks is aesthetically pleasing.

Tapered Jewelry and Taper Pins

Many people who stretch their ear lobes make the mistake of forcing their ears from one size to the next by using tapered jewelry or taper pins and simply pushing them through, regardless of pain or even bleeding. Forcing your ears in this way almost certainly results in torn scar tissue, which makes subsequent stretching more difficult and excess scar tissue formation almost inevitable. Tapered jewelry is good for getting from one size to the next one, and even then only after the ear lobe has been comfortably at the previous size for some time. For example, an ear lobe that has had an 8 gauge (3.26mm) plug in it for 6 to 8 weeks, a 6 gauge (4.12mm) pyrex glass spiral will slide in nicely with a little lubricant. This is especially easy after a warm shower to soften the skin.

Tape Wraps, a.k.a. The Subang Method

(wrapped ear picture courtesy Ken Coyote)

Once your ears are to a size large enough to wear a plug (solid) or an eyelet (hollow), you can attempt stretching slowly using tape wraps. The tape most successfully used is neoprene electrical tape or Teflon pipe thread tape. Silicone tape would most likely be the most body friendly, but it is incredibly difficult to find.

You can stretch your ear by wrapping a single layer of tape around your jewelry, and reinserting the jewelry in your ear. After a week, apply another layer of tape, alternating where the seam ends. It is important to wrap the plug evenly, without stretching the tape over the plug, as the tape will return to its original length exposing adhesive to your piercing. The adhesive will likely irritate your ear tremendously. By wrapping your jewelry regularly, you can stretch your piercing relatively quickly without damaging your scar tissue. This can save you a lot of money, as you will not have to buy a new piece of jewelry each size. Electrical, silicone, and Teflon tape were never intended for use in the body. Before endeavoring to use these products for the purpose of stretching your ear, you should consider the risk of potentially strong allergic reaction, and make an informed decision.

Massage

Regular cleaning of your stretched ear lobe piercings is obvious and a hygienic responsibility. What very few people do, but more should, is massage their stretched ear lobe piercings with vitamin E oil or jojoba oil. This nourishes the scar tissue, keeps it flexible, and maintains good blood flow to the ear lobe. Doing this routine just once a week can make your ears significantly more responsive to stretching.

Single Flared vs Double Flared Jewelry

Some plugs and eyelets are made with a flare on only one side, with a rubber or silicone o-ring (rubber band) on the other side to hold the jewelry in. This jewelry was made with ease of insertion in mind, and this is the jewelry you will wear if you are stretching (for example) from a 4 gauge plug to a 2 gauge plug. Double flared jewelry is made for ears that have been at a specific size for a long period of time. You cannot stretch your piercing with double flared jewelry, because the flare is larger than your ear is ready for. Stretching into a double flared 2 gauge plug from 4 gauge would be more like stretching from 4 gauge to 0 gauge, damaging your ear in the process.

A word about “gauge”

The use of the term “gauge” has been the cause of serious teeth gnashing in the body piercing scene as of late. Gauge is a reference to size, based on the Brown and Sharpe gold wire standard. It is only a reference to size. Stretched ear lobe jewelry, like plugs and eyelets, have never been referred to as “gauges” and never should be. Referring to jewelry as “gauges” makes as much sense as calling jewelry “inches” or “millimeters”. Increasing from one size to another is called stretching. It has never and should never be called “gauging”.

Techniques that Usually Don't Work

- Weights. Using weight to stretch your ears usually results in a thin spot or even a split at the bottom of your lobe. Ideally, stretching the ear is uniform, not entirely on the bottom scar tissue of the ear.

- Biopsy/tissue removal. While this technique does result in large holes from the get go, it also removes tissue that may be helpful in holding large jewelry in the future. In general, the enemy of someone stretching their ears is a lack of room in the lobe. Removing tissue, in this regard, is counterproductive.

- Ear cutting. Using a scalpel to make very, very large holes in an ear can actually result in very healthy, very large stretched ear piercings. Unfortunately they can also result in weak spots at either side of the cutting site, which results in aesthetically displeasing stretching after the fact. This is a big risk to take when patience would work better.

- Silicone Eyelets. Silicone eyelets and plugs are flexible. An ill conceived sales gimmick was put forth by the manufacturers of this type of jewelry as a way of stretching from one size to the next. Simply squeeze the jewelry into your ear, and let the silicone jewelry's natural shape force your ear into the next size. Unfortunately, the silicone is “grippy” in texture and tends to irritate as the jewelry expands. This is a strongly suggested against method for stretching ones ears.

Further information is available from your local professional body piercer, as well as us at:

Rockstar Body Piercing

401-272-0345

www.rockstarpiercing.com

Jef Saunders' Ear Piercing Stretching Guide by Jef Saunders is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
Based on a work at www.jefsaunders.com.
Permissions beyond the scope of this license may be available at www.jefsaunders.com.

Anchor Videos are back up!

The 18g surface anchor videos are back up on YouTube, but unlisted. This means I can control who sees them with them being private. So if you are a former Fakir Intensives student, or a verifiable body piercer, send me an email at crooshjef AT rockstarpiercing dawt com and I will send you a link!

I'm hoping to have a new blog post up after this week's Fakir Intensives class. Look out for it.

A letter to all would-be body piercing apprentices...

A Letter to all would-be body piercing apprentices...

I get asked for an apprenticeship nearly every day I work. Obviously, that means I need to say “no” to an awful lot of people. It’s not in my nature to be painfully honest and tell people what they don’t want to hear. That having been said, a lot of you folks out there that are looking for jobs in the piercing industry are just not the right fit. So I have written the following not to be insulting, self righteous, or egotistical. I’ve written it to be as honest and helpful to you as I can possibly be.


There are a lot of things that can make you a good candidate for an apprenticeship, and a lot more that can kill your chances. I want to be very clear about the criteria and qualities necessary to be a piercing apprentice at my shop:

1) I need to have a place for you to work.

Why? Well, let’s say I train you and you become a competent piercer. Won’t you be frustrated that you aren’t actually piercing for a living? I know it would bother me that I could pierce well and wasn’t actually making money doing it. If you find yourself working one shift a week, or just substituting for the other piercers, you are going to go stir crazy. Eventually, I’m going to lose you to another shop, and now I have trained someone who will be my competitor. Keep in mind, taking on an apprentice is extra work for me, and now I’ve worked for months (or years) on someone who will be a competent competitor. That’s bad business.

2) I need to know that you are really motivated to be a great body piercer.

Being really motivated seems easy enough, right? I mean, you are already really motivated! Well, at least you think you are. To work at my shop, you must attend the Fakir Musafar Basic Piercing Intensive. When you say, “I’m really passionate about body piercing, but I can’t afford the school or the flight right now”, try to put yourself in my shoes. Essentially, you will need to save about $2500 to take the Fakir Basic Piercing class and stay in San Francisco. If you can’t save that amount of money it means to me you are either too irresponsible to save money or you want instant gratification. Neither of those qualities is especially compelling to make me take you on as an apprentice.

3) Getting an apprenticeship is a popularity contest.

My shop doesn’t need the brooding, quiet, introverted type. We need the body piercing equivalent of a cheerleader. We need happy, friendly, positive folks that can light up a room with their smile. Body piercers need to be clean, smart, creative and passionate, but they also need to be likable, approachable, and able to command the center of attention for the length of time it takes to perform a piercing. If you hate people, hate public speaking, and hate awkward social situations, why on Earth would you want to be a body piercer? Make no bones about it: body piercing is a job for people who like people.

4) My shop is not the stepping stone to a tattoo career.

Piercing is not the way to get into tattooing. That’s sort of like becoming a dentist so you can eventually be a gynecologist. Don’t waste either of our time. Start drawing.

5) When your apprenticeship is over, do you want to open your own shop?

That’s good! You’re an entrepreneur and I can relate to that! You will need to pay for your apprenticeship, though. No one wants to train another piercer out of the goodness of their own heart. We, the established piercers, need to see a profit in the future, whether that is from
your work as our employee or from actually being paid for the apprenticeship. I think you will save us both a lot of drama by being up front about this. By being forthcoming and being prepared to pay for your apprenticeship, you also nearly guarantee that you’ll actually get taken on for training. This also goes back to #2, and if you pony up a large chunk of money for an apprenticeship, I know you are serious about becoming a good piercer.

Here are some final tips for making yourself into an attractive piercing
apprenticeship candidate not only to me, but to most good body piercers:

• Wear good body jewelry. Better yet, wear body jewelry from my shop.

• Have retail sales experience.

• Take a bloodborne pathogens class from an OSHA approved instructor. (Health Educators, Inc for example) www.hlthedu.com

• Learn CPR/First Aid at the American Red Cross.

• Take anatomy and physiology classes at your local community college.

• Volunteer to promote my shop.

• Read a lot about piercing. Learn its history.

• Work on your people skills.

• Go to Sky Renfro’s apprenticeship primer class from Professional Piercing Information Systems. More info is available at www.Propiercing.com

• Go to the Fakir Intensives Basic Piercing class. More info is available at www.Fakir.org


An Open letter to all would be body piercing apprentices by Jef Saunders is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 United States License.

The Baloney Detection kit. This was done by the Richard dawkins foundation based on a Carl Sagan principle. This is useful in so many areas of ones life, but especially useful to a body piercer for evaluating new products and ideas.

1) How reliable is the source of the claim?
2) Does the source often make similar claims?
3) Have the claims been verified by somebody else?
4) Does this fit with the way the world works?
5) Has anyone tried to disprove the claim?
6) Where does the preponderance of evidence point?
7) Is the claimant playing by the rules of science?
8) Is the claimant providing positive evidence?
9) Does the new theory account for as many phenomena as the old theory?
10) Are personal beliefs driving the claim?

Surface Anchor and Stat IM technique

I've been meaning to do some demos for the Fakir School so folks could compare what they are doing to techniques we normally don't teach in class. Videos have always seemed more effective at this, so today I finally did a video of some very cool and very new surface anchors.

Many thanks to Anatometal for supplying the INGENIOUS 18g surface anchor design. Also, thanks to Stat-IM (www.piercing.org/statim) and Brian Skellie for the Stat-IM cassettes used in the video.

I intend to leave the video up for about 2 weeks, and then I will make it private. The video is intended for experienced piercing professionals only, but I'm not quite sure how to make it both public AND private so this is the way I am doing it. If you would like access after I have made the video private, please email me.

(UPDATE 6/15/09) Videos got up to 84 views, so I have made it private. Leave a comment on this blog or email me and I can give you access to the youtube videos)