What does it take for a client to have a healthy piercing they can expect to wear for a long time? Think of a healed and healthy piercing as being in a state of balance. At all times the health and viability of a piercing rests on a set of six factors that have to be maintained. If any of these factors (or more than one) aren’t aligned with what an individual’s body will tolerate they’ll experience a piercing in a poor state health.
We can think of each cause of a problem as being a source of imbalance. If you’ve been either a piercer or enthusiast for a long time you’ve likely seen piercings that won’t heal no matter what, and of course the opposite of that, impractical piercing ideas that sometimes seem to do well on certain people. The reality is different people have different tolerances for these individual factors that determine the success (or failure) of a piercing. As piercers we need to be observant of the conditions that help or hurt a piercing and identify the factors that are out of balance if a client is struggling with a piercing.
The required pillars for a viable piercing are:
- Suitable anatomy
- Proper jewelry size and style
- Placement
- Material quality
- Suitable aftercare
- External considerations

Anatomy
We’ll start with the first in the list, anatomy. While there are exceptions to every rule, most people will have suitable anatomy for the most common and simple piercings like ear lobes. Still, an experienced piercer will always first study the anatomy of any person wanting to be pierced. This quick examination tells them a few things. First, they confirm that they’re confident they can pierce it safely and properly. Second, they check to see if there are any anatomical features they need to consider that may prevent the piercing from healing. And third, what size and style of jewelry they should start with. All piercings have unique considerations and an experienced piercer will be able to distinguish between anatomy that is well suited for the desired piercing and anatomy that is poorly formed to support a piece of jewelry. If a person doesn’t have ideal anatomy for the piercing they want, one of the required six pillars has already been compromised or eliminated. Neither the piercer nor the client should expect an easy healing time or long term success of the piercing if performed.
Jewelry size and style
If a client does have well-formed anatomy for their new piercing we have to consider jewelry size and style. Both a size and style that fit the piercing well are necessary if we want to increase the chances of an easy healing period and successful piercing that may be worn long term. A piercer should be able to recognize when a curved shaft is more appropriate than a straight one, when a ring is not appropriate, and when thinner or thicker jewelry should be used. Jewelry that’s too tight compresses the tissue and doesn’t allow the body to move or stretch naturally and may restrict blood flow. Jewelry that’s too big may weigh more than the body can tolerate or move excessively preventing healing. If you’re trouble shooting a piercing with problems and the jewelry is not an adequate size or style you can’t expect any significant improvement until you correct this issue.
Jewelry size and style are crucial to a healing piercing because pressure and friction are known causes of many piercing problems. The modern piercer’s aftercare suggestions will always caution their clients to avoid intentionally spinning their jewelry in a new piercing. Dirty fingers are risky enough, but the additional friction will never help a healing piercing succeed. Curved barbells and rings also apply pressure to a piercing which can be made worse by jewelry that is unnecessarily thin.

Placement
Placement is similar to anatomy. If a client has poor anatomy for a particular piercing they won’t likely even receive the piercing from a professional piercer. Without well suited anatomy existing first, there’s no such thing as suitable placement. No other factors will correct or compensate for this. Once pierced, placement can’t be changed. If a piercing sits at an odd angle or depth, we can only expect a difficult time keeping it long term. The site of a piercing has natural features that tell us where to pierce, or where not to pierce. A really observant piercer can read the body well and a skilled piercer can install the jewelry exactly where it belongs.

Jewelry Material
Jewelry material is one of the most misunderstood issues in the industry. There are two basic business strategies used by jewelry manufacturers. There are those that make great jewelry, and those who make low quality jewelry. A decades long problem is that low quality jewelry is advertised as high quality, and our clients and salespeople (at non-industry stores) don’t often know the difference. Another concern is when piercers themselves don’t understand what they’re selling. They learn terms like “surgical steel” and “316LVM” without learning actual standards like ASTM F-138, and believe they have more knowledge than they actually do. The way beads fit on to rings and barbells and the metal’s polish are just two other indicators of jewelry quality that an untrained person may not recognize the significance of.
While there are many reasons why a piercing might be struggling to heal, jewelry quality is one of the most common because low quality jewelry is so abundant. Its simply attractive to some professionals and their customers because of the low cost. When a piercing has been healed, perhaps for many years, it’s not unreasonable for a client to change jewelry. If they purchase new jewelry that is a lower quality than their particular piercing can tolerate they’ll see problems. If they develop problems and there are no other obvious reasons for their problems, the likely solution is returning to better jewelry.
Aftercare
Aftercare is another factor that impacts a new piercing and sometimes an old piercing even if it’s been considered healed. A piercing is a unique kind of wound and requires aftercare different than the most common injuries people are familiar with. Like jewelry materials, even piercers can be confused about what quality aftercare guidelines look like. The body heals itself and the best aftercare supports this function without slowing it down. If a client is using products not suited for a puncture wound like a piercing, and not intended for repetitious or long term use, the result can be a constantly irritated piercing or one that never seems to heal. Products should always be used according to the manufacturers instructions and other than saline wound wash, the products found in medicine cabinets, pharmacies, and first aid kits won’t likely be appropriate for a piercing.

External Considerations
External Considerations refers to quite a lot of things and is related to aftercare. For our purposes we’re referring to elements in someone’s life not directly related to the piercing that might interfere with its long term success. A client may have great anatomy for their piercing. They may wear great quality jewelry that’s well placed and of a suitable style and size. They may also have a great aftercare routine and expect to see their piercing heal well.
With all those factors listed above being in harmony with a piercing, there are still many external considerations that can prevent a piercing from healing or cause a well healed piercing to be distressed. Clothing or accessories that bump or snag a piercing or fit too tight, sleeping on a piercing, an accident that causes trauma to the piercing, stress and illness, poor hygiene, and personal care or cosmetic chemicals getting into a piercing are all examples of external considerations that can be problematic for a piercing. A piercing long considered healed and healthy can be compromised by repetitive exposure to a source of discomfort or even a single accident.
Summary
If we’re troubleshooting a piercing that was previously healed and mysteriously became irritated we have to first determine what’s changed. A piercing doesn’t go from healthy to unhealthy for no reason. If we can rule out the previous five factors we’ve discussed above, the issue is certainly something that’s changed in the person’s life. A new exercise routine or athletic gear, the way new clothes fit, new shampoos or soaps, seatbelts in a car, and even illness and stress may be suspect. The possibilities and combinations seem endless.
No single one of these factors is truly more important than another because they’re all required to be in balance for a healthy piercing. To what degree each is required will vary from client to client because their individual tolerances won’t be the same. Some people can heal their piercings quite well with low quality jewelry, their body will simply tolerate less pure metals better than most others. Similarly, some people may successfully wear piercings at such an angle that one feature of the body is pressing up against the jewelry in a way that prevents the jewelry from sitting naturally or laying properly with gravity. Scenarios like this are rare, but they happen and are reminders that healing and wearing a piercing long term is always a set of probabilities.
A properly executed piercing means each of the necessary factors are in equal measure, but the client must remain diligent with their aftercare and aware of (and mindful of) external considerations. Piercings are not particularly easy to heal. It takes some patience and sound decision making to convince the body to grow a healthy layer of tissue around a foreign object not intended by nature to be there. The six factors discussed here can be out of balance and outside the body’s tolerances in any combination, which only complicates healing further. Fortunately, jewelry materials, size and style, and aftercare can be adjusted at nearly anytime.
However, unfortunate anatomical features cannot be ignored or changed, and once a piercing has been performed, the placement can not be adjusted. Often, jewelry can be removed and once the tissue has suitably recovered the piercing can be performed again, hopefully with improved placement.