Implantable Body Jewelry and Methods for Their Removal

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Permanent body art, including tattooing, traditional piercing, and atypical piercing such as the placement of dermal anchors and implants, is increasing in popularity. Fourteen percent of people aged 18 to 50 years old report having a body piercing, with a higher prevalence seen in women,1 although there is a scarcity of literature regarding this subject. As piercings of the ear lobule, helix, tragus, nasal ala, and navel have become routine, individuals are trying more extreme forms of self-expression. The most common jewelry devices used in atypical body modification are skin divers, microdermal implants, and subdermal implants. These types of implantable jewelry allow the skin to appear pierced on any surface of the body, as opposed to traditional body piercings, which can only be placed across 2 epithelial surfaces (Figure 1). The implantation of these devices is unregulated and their embedding is most often performed by street artists without a medical background. The authors will review these different devices, methods of implantation, common complications, and recommendations for removal by the dermatologic surgeon.
“Skin divers” are the most simple of jewelry implants. These are single-piece items with an ornamental head and a cone-shaped insertion base that are pushed into a wound that is first created with a biopsy punch. These devices almost always reject from the skin within months of insertion, as there is little anchoring them into place.
Conversely, “microdermal” or “transdermal” implants consist of 2 pieces (Figure 2). The first piece is an interchangeable ornament with a male-threaded leg. The second piece is a base or “dermal anchor” that is inserted into the dermis or subcutis that has a 1/8″ or 5/32″ female-threaded neck protruding from the skin surface into which the first piece screws.2 These anchors are made of either plastic or metal, with titanium and stainless steel most commonly used. Similar to skin divers, microdermal implants are also inserted into a wound created by a biopsy punch or large gage needle, but have a larger anchor underneath the skin, shaped like a foot, which helps keep them in place for longer.2 Sometimes a pocket must be burrowed to allow the anchor to be inserted. Often the base is sutured in place underneath the skin to prevent expulsion, or the base has fenestrations in the anchor in an attempt to allow tissue to granulate around the metal to keep it in place.
“Subdermal” implants, commonly made of silicone, are a separate type of implant placed fully underneath the skin after an incision is made and an insertion pocket is created. Subdermal implants are designed to show figures and patterns as contour changes in the skin, but do not have ornaments that protrude through the skin.3 The implant site is often distant from the incision so that the visible scar created by incision does not interfere with the aesthetics of the implant.
Immediate risks associated with these types of deep piercings are bleeding, arterial puncture and hematoma formation, infection, and pain (although injectable anesthetics are sometimes used illegally); permanent risks include scarring and nerve damage.3 The creation of large incision pockets is the most risky and potentially destructive, especially when performed without sterile technique and without knowledge of the regional anatomy. The most common pathogens that infect piercings are Staphylococcus aureus and Group A Streptococcus. Implants are also at risk of spontaneous rejection. It is suggested that anatomic placement of the jewelry is crucial to survival as there are 2 reports of microdermal implants being rejected during gravid abdominal distention of pregnant women.4 Implants are more likely to be rejected in skin folds or convex body surfaces.
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