Now that Barbie has a tattoo ? a butterfly flitting across her abdomen ? can a navel ring be far behind?
The tastefully inked doll, who's celebrating her 40th birthday this year, is proof positive that body art no longer is a sneering badge of youthful rebellion ? it has seeped from counterculture to mainstream America.
Countless Americans (literally countless; no one keeps reliable figures) will decorate themselves this year by permanently altering their bodies' largest organ: the skin. While most of them won't suffer any serious medical problems, body piercing and tattooing do have health implications ? enough that mainstream medical organizations have begun to issue statements on the practices. And enough that consumers should do their health homework before choosing a form of body art, and an artist.
A Piercing Question
For example, if Tattoo Barbie decides to add implanted jewelry on any body part other than her ear lobes, chances are the rings and barbells won't be anywhere near her ageless smile ? not if Dentist Barbie is watching.
The American Dental Association doesn't sugarcoat its opposition to oral piercing, which it deems a public health hazard. In fact, oral piercing would be obsolete if the decision rested solely in the hands of the ADA, according to Dr. Gary C. Armitage, a dentist and chairman of the ADA's Council on Scientific Affairs.
That the topic had a place on the agenda of the group's 139th annual session, held recently in pierce-happy San Francisco, says a mouthful about the widespread popularity of the practice, even among folks who floss every day. Oral piercing, which involves inserting adornments in the tongue, lips or cheeks, has been implicated in a number of adverse oral and systemic conditions, according to the ADA.
?Common symptoms after piercing include pain, swelling, infection, increased salivary flow and gum injury,? says Dr. Sheila Price of the West Virginia University School of Dentistry. In addition to the risk of infection, which is especially high due to the vast amounts of bacteria in the mouth, other problems include airway obstruction after swallowing jewelry, prolonged bleeding, chipped or cracked teeth after biting jewelry, scar tissue, speech impediment and interference with X-rays, Dr. Price reported in the Journal of the American Dental Association.
The ADA joins other venerable medical institutions and organizations that have seen fit to address a wide range of concerns about puncturing body parts, including ? but by no means limited to ? ears, eyes, mouths and noses, as well as necks, nipples, navels and sundry genitalia.
Only the Ear Lobe
The American Academy of Dermatology has taken a position against all forms of body piercing with one exception: the ear lobe. The skin specialists cited nickel allergies, cyst formations, chronic local infections and granulation tissue (fleshy bumps that form during the healing process of some wounds) as reasons not to pierce.
The ear lobe has been singled out because it's made of fibro-fatty tissue and has a good blood supply, which is crucial in case infection sets in, says Dr. Ronald Wheeland, a Santa Fe dermatologist. The piercing sites deemed especially problematic by the academy involve cartilage which, once infected, can whither and shrink because of a paltry blood supply, and complex tissue structures such as the nipples, which are more than simple skin and fatty layers.
The uncomplicated navel, although it has no ducts like the nipple or cartilage like the nose, has not yet received the same tacit approval from the academy as the ear lobe. However, individual doctors seem not to be as concerned about piercing the umbilicus as they are about other body parts.
"I know there are more complications than what we're seeing in the (scientific) literature," says Myrna L. Armstrong, a registered nurse who researches body arts and teaches health sciences at Texas Tech University. "We don't have adequate methods to collect data on complications of body art."
There's no central depository, she adds, where she could refer a health-care professional who recently wanted to report a case of endocarditis, an infection of the lining of the heart, that resulted from a body piercing.
As a precaution against the transmission of blood-borne diseases, the U.S. and Canadian Red Cross won't accept blood donations from anyone who has had a body piercing or tattoo within a year. The Centers for Disease Control and Prevention have deemed non-sterile piercing a serious health risk.
Although HIV transmission is a theoretical possibility ? the virus that causes AIDS dies at room temperature ? hepatitis is the real worry. Hepatitis B and C can be transmitted in as little as 0.00004 milliliter of blood and can survive on blood-contaminated surfaces, such as instruments and doorknobs. Transmission of spore-forming bacteria, such as tetanus, is another concern.
Still, piercing proponents point out, millions of people get body piercings each year, and millions of them do it safely.
Dr. Kenneth Arndt, a professor of dermatology at Harvard Medical School and the editor of Archives of Dermatology, recently visited a piercing studio on the Lower East Side of New York. "It was a fascinating place," says Dr. Arndt, who is impressed by the lack of any anesthesia, except for ice cubes, used during piercing procedures.
"With the amount of piercing that's going on, we have very few, if any, people coming in with side effects," he adds. "We haven't seen much infection."
Although people aren't coming to him for treatment, they do come to ask for referrals to physicians who pierce. They're in luck if they want their ears or navels done, but Dr. Arndt draws the line when it comes to piercing the mouth, nose or genitals.
Portrait of the Artist
On the same street as the Centers for Disease Control, just a mile away, is the Piercing Experience, a shiny store-front that since 1995 has attracted no small portion of its clientele from the surrounding medical community, says owner Brian Skellie.
On this day, people seem to be arriving in pairs, requesting tongue and nose piercings. One physician has taken a break from DNA research on aging to have Skellie insert a ring into his navel.
Skellie, a trustee and research advisor at the Association of Professional Piercers, as well as the editor of its official publication, The Point, is an outspoken proponent of body piercing that is safe, simple and gentle. There is such a thing, he insists, although admittedly it's the exception and not the rule.
Skellie says he apprenticed under a "master piercer" with 45 years of experience. But otherwise, he's self-trained ? body piercing is mostly self-taught and self-regulating. Skellie wears a particulate filtration mask and sterile gloves during all piercing procedures. The instruments he uses, as well as the jewelry he'll insert, are in a bag, having just been sterilized through a combination of steam, heat and pressure in one of three autoclaves in an adjacent room.
His clients recline either on a physician's exam table or a mechanized dental chair while he massages the tissue and cleans the skin prior to puncturing it. He doesn't believe in metal clamps, likening his work more to that of a seamstress than a surgeon. His needles are for one-time use, of course, and he immediately disposes of them in special medical containers for needles, in accordance with accepted medical standards.
Making the Incision
The ideal piercing needle works like a taper-cut suture needle, he says. It makes an incision about one-quarter the size of the opening that's going to be established, and it stretches the skin instead of tearing or cutting the entire area.
He never, ever ? not even on ears ? uses a piercing gun, which he says is "like trying to balance the head of a nail on a dirty hammer and pound it into someone's body."
On the antiseptic green walls are certificates of staff participation in courses on blood-borne pathogens, the germs that cause disease. Next to them hang four Best-of-Atlanta awards for piercing places. There's a document to indicate what type of sterilization process is in use and another to indicate use of a biological monitoring service for spore testing.
Reassuring as all that paperwork is, it?s not proof of anything ? certainly not safe or gentle service ? Skellie warns. Perhaps no one knows better than he that the piercing industry is overpopulated with fly-by-night operations and unscrupulous sorts who, as they experiment on impulsive adolescents in parking lots at rock concerts, aggravate the public backlash against piercing.
Certainly, his own organization may harbor a handful of less-than-credible members. The APP requires no standardized training, no licensing, no inspections. Its mission is to disseminate health and safety information to people in the practice of piercing and to the public at large.
The 100-member APP is fighting an uphill battle, Skellie admits. The piercing community is by and large an independent bunch that seems to shun collegiality as well as abhor the idea of legislation replacing self-regulation.
"Most reputable practitioners probably have an autoclave on hand and use sterile instruments," says Skellie. "To be state-of-the-art, they need to go just a bit further: to wear sterile gloves and a mask. Maintaining asepsis is ridiculously uncomplicated. Simply, it's not putting bugs into people."
Wound Care and You
If no bugs get in, care after piercing is a cinch, Skellie says. His shop has weaned itself and its customers off of the "magic" lotions and potions that purport to clean new piercings. But there may be no other area in piercing that is more subjective and varied than what people tell others about how to care for a new piercing.
Dr. John J. Ward, an orthopedic surgeon in Shreveport, La., is medical adviser to the APP and does piercings himself. He recommends to his clients ? most of whom are professionals in their 30s and 40s ? that they wash the wound with a gentle antibacterial soap such as Provon or Softsoap, taking care to stay away from scented soaps.
It's important, he says, to allow water to irrigate the area, ideally with a saline solution made of ¼ teaspoon sea salt mixed with 8 ounces of water.
Skellie lists three main causes of problems after a piercing:
Dirty fingers and sweat. Fluids wick into the piercing and pull with them viruses and bacteria.
Chemical reactions from "magic" soaps and lotions that people douse or smear on wounds in order to sterilize the skin or promote its growth.
People bumping the piercing, ripping it, sleeping on it or picking at it.
Put these behaviors together, he says, and your common navel piercing will hurt and ooze for weeks. "Ninety-nine percent of people are told to put some sort of chemical on it and move it around," Skellie laments.
His aftercare instructions couldn't be easier ? or more controversial. "Leave it alone!" he pleads. "All a clean cut really needs is your immune system." For more advice, he recommends that his clients check out an organization called The Wound Care Institute.
Skellie doesn't discount horror stories about piercing. "It can and does hurt when it's not done properly," he says. "I consider it malpractice. There are plenty of piercers who operate on an ethical level, but it's far from a majority."
In other words, Barbie beware.