Most people who need minor surgery aren't going to flip through the phone book and call the first specialist's name that pops up.

Choosing a surgeon takes time. Questions on both sides of the scalpel need to be addressed. And in most cases, a prospective patient will seek a second opinion.And surgeons are going to consult with their patients about the pros and cons of the procedure.

Body piercing is a surgery. It carries potential risks of infection by bacteria and viruses, including HIV, which causes AIDS. But unlike other medical specialists, piercers - at least in Utah - don't need a license to practice. Only piercing studios located in tattoo salons are inspected by the health department.

Piercings are nothing new to the world. They have been used in primitive rituals among the Mayans, Incas, Pacific Islanders and other cultures.

Ancient Egyptian royalty used piercings to show their status, and male members of the Victorian court used piercings to highlight their sexuality.

These days the piercings mean something different for each person.

"Ages vary," said John Pratt of the Koi Piercing Studio, 1301 S. 1100 East, "You would be surprised at some of the clientel we get. Everything from older business types to teens."

Pratt said areas most often pierced include the tongue, the navel, the nose, all parts of the ear, the nipples and genitals. Pratt said people get pierced for all kinds of reasons, from an interest in unusual decoration to rebellion to sexual prowess and belonging.

And so far, state lawmakers have put no restrictions on who can do it or where.

"The only real legislation concerning body piercing is the fact that a person has to be 18 years old to get it done without parental consent," said Pratt.

"Other than that, there's nothing. I would love to have a law passed that states every piercer must take classes and serve an apprenticeship before they can call themselves piercers.

"And even now, since the Koi is solely a piercing studio, we don't get inspected. There's something wrong with that.

"The infections and diseases we're concerned with are not new," said Pratt. "They're the same ones you get when you have problems with other puncture wounds."

They include diplococci or pneumonia, blood poisoning, staph infections, diphtheria, tuberculosis, tetanus, syphilis and any strain of hepatitis and HIV.

Dermatologist E. Barry Topham, of the Holladay Dermatology Clinic, said that in addition to the infections, some people develop excessive scar tissue known as keloids.

"Keloids are a result of puncture wounds," Topham said. "Some are as big as marbles, but I've seen others as big as ping-pong balls."

He added that the most common place to find keloids is in the earlobes, because that's the most popular place to be pierced.

"Treatment is simple," he said. "We inject cortisone, which dissolves the tissue, into the smaller keloids. The ones that are larger need to be cut out and injected. In the past, radiation has also been used as treatment.

"Aside from the keloids, other complications are the infections, especially the bacterial infections." Infections can be treated with antibiotics, Topham said, depending on the severity. "The methods used to distribute the medication are topical, oral and even through the IV.

"The viral infections such as hepatitis and HIV are more major concerns. The best way to avoid contracting those diseases is to seek out an ethical establishment that makes sure the instruments are sterile and the piercing needles are used once and thrown away."

"A lot of people stress over contracting HIV through piercing," Pratt said. "But they shouldn't if they go to a clean and meticulous piercer."

The biggest worry is hepatitis.

"That disease has a long shelf life," Pratt said. "It can live outside the body for up to two weeks. You can contract it by rubbing your eye."

Dianne Sano, a nurse manager at the Alta View Hospital emergency room, confirmed that there aren't any new wacky infections from piercings.

"New holes can get infected," she said. "But they're the same infections you see with any other puncture wound.

"I've seen pretty bad infections in the ears, but no total disasters," she said. "And we don't have any special training to treat piercings. We just treat them like any other infection."

One real problem the staff has come across is having the piercings interfere with X-rays and other metal-sensitive scans, said Sano. Another problem is the fact that piercees are very sensitive about removing their gems and charms.

"In many cases, we undress someone to check out a broken bone and find the person has all this jewelry hanging off his or her body," she said. "We ask them to take the jewelry out and they get defensive."

That's because most of the piercings, including the nostrils and navels, will close quickly, leaving only a small dotlike scar.

Some pierced areas are a bit extreme, but if piercees follow the after-care directions, they shouldn't have problems during the healing process, said piercer Russ Lightel.

"We distribute detailed pamphlets about how to clean a new piercing," he said. "And if the piercee is responsible, everything will be fine."

"We are very careful about who we work on," Pratt said. "Everyone fills out forms, and we require state- or government-issued picture IDs for each job. We require a minor's parent or proven legal guardian to be present during those operations. Both parties need to have verification of ID."

A questionnaire needs to be filled out before anything, Pratt said.

The questions range from types of allergies to types of medication last used and if the piercee has eaten in the past four hours.

"Piercings are up to the individual who gets pierced," Pratt said. "As a piercer, the main concern is to make sure the experience is a positive one.

"A piercer should take the time to talk with them, calm them down, explain what's going to happen and answer any questions."

But piercees also need to ask questions. After all, it's their body.

"I love it when people come in and all we do is talk," Lightel said. "I like it when they ask difficult questions and quiz me. In many cases, a piercee will see me two or three times before they actually get pierced."

"It's easy to get caught up in the fad of the times," Pratt said. "And it's OK to an extent. But if piercers get so caught up that they become stagnant and they don't progress with the concerns or developments in the business, it could become a problem. For example, we're in the process of revamping our questionnaires to include the issue of Fen-Phen because it messes with the heart and blood."

"It all comes down to being responsible, honest and clean," Lightel said. "You can't go wrong if those bases are covered."

Pratt began piercing four years ago in a shop that also offered tattooing.

"The piercer they had didn't know what he was doing," Pratt said. "I was asked if I wanted to do it. I said yes and took a weeklong seminar about how to pierce safely and began working."

The seminar was offered by Gauntlet Inc., considered by Pratt to be one of the most respected and trusted piercing companies in the world, founded in 1976.

Pratt, like a majority of the seminar-trained piercers, hates the use of the piercing gun.

In fact, all the Gauntlet-trained piercers post a sign in their shops that lists the dangers of using a piercing gun, Pratt said.

"The gun is basically a version of the tagging gun used to tag animals," Pratt said. "But it's not ideal for anything else other than the ear lobe."

Lightel, another Gauntlet trainee who until a week ago pierced for the Blue Boutique, spoke in more specific terms.

"A gun is designed to punch a blunt stud into the body," he said. "Needles, like the ones I use, are extremely sharp and less traumatic on the body."

Both piercers said that when a gun is used, microscopic drops of blood, tissue and skin cells explode and literally cover the plastic and metal tool.

"That makes it difficult to sterilize," Lightel said. "They wipe it with rubbing alcohol or Windex, but that doesn't thoroughly kill diseases on the gun. "

The Koi uses an autoclave oven to sterilize certain piercing tools other than needles, which are used once and then thrown away in a biohazard package.

The oven is heated to 280 degrees at 32 psi (pounds per square inch) and the tools are baked for 35 minutes.


Additional Information

A piercee's bill of rights

To be pierced in a scrupulously hygienic, open environment by a clean, conscientious piercer wearing a fresh pair of disposable latex gloves.

- To a sober, friendly, calm and knowledgeable piercer who will guide the client through the piercing experience with confidence and assurance.

- To the peace of mind that comes from knowing that the piercer knows and practices the very highest standards of sterilization and hygiene.

- To be pierced with a brand new, completely sterilized needle that is immediately disposed of in a medical-sharps container after use on the piercee alone.

- To be fitted only with jewelry that is appropriately sized, safe in material, design and construction and which best best promotes healing: gold plated, gold filled and Sterling silver are never appropriate for any new or unhealed piercings.

- To be touched only with freshly sterilized, appropriate implements, properly used and disposed of or resterilized in an autoclave (oven) prior to use on anyone else.

- To know that ear-piercing guns are NEVER appropriate, and are often dangerous, when used on anything other than ear lobes.

- To be fully informed about proper care and to have continuing access to the piercer for consultation and assistance with all piercing-related questions.

Piercing the tongue

An organ with its own unique anatomy, special care must be taken when piercing the tongue to avoid permanent damage.

A piercer must accurately locate the thin membrane between the two muscles that make up the tongue.