Piercing Healing

Initial Healing | The Fistula | Fistula Development | Effect of Jewellery | Effect of Cleaning

This guide aims to explain, in the most simplistic way possible, what makes healing a piercing hole so different from healing a scraped knee (or similar wound) and why jewellery and cleaning are so important to that process. We also discuss in detail the different stages of healing and how best to treat your piercing during them.


TL;DR –Too much information? For a shorter version try reading our quick reference guide here!


Initial Healing Process

At first your body will try to heal the piercing like any other wound you might get in your body: It begins by the damaged veins constricting, a plug being formed out of platelets and then blood clotting which stops the bleeding. Inflammation (swelling) then takes place which cleans the wound by having lots of white blood cells (called phagocytes) mop up any unwanted bacteria or dirt. Inflammation also signals to your immune system that certain healing cells are needed in the area. Swelling is, therefore, an important part of healing so, unless it will endanger you (such if your jewellery is too short), it’s usually advised not to try and treat this swelling.

Usually in small or stitched wounds the new tissue begins to form immediately after this clotting process but a piercing is a much deeper wound where the edges are not very near each other so it heals a little differently. Piercings are actually wounds that are left open as they heal (known as secondary intention wound closure) which is why they need such regular cleaning!

After the white blood cells have helped to prepare the piercing for healing, tissue known as granulation tissue begins to form instead of ‘normal’ tissue. Granulation tissue is quite delicate because it forms much faster than ordinary tissue and uses a weaker form of collagen to do so. This tissue is a kind of ‘emergency patch’ placed by your body to close the wound and protect itself from any outside influences. Normal tissue cells rely on the granulation tissue for nutrients that help them to grow properly so if the delicate granulation tissue gets damaged new tissue cannot form.

The granulation tissue helps the building of the new tissue by moving new cells from the edge of the piercing outwards (in a sort of leap-frog fashion). This allows the edges of the wound to close. The process takes a long time because the piercing needs to be filled with granulation tissue first and then slowly replaced with ‘proper’ tissue using stronger collagen. Healing in this way is particularly slow in cartilage (like the top of the ear) because cartilage does not contain blood vessels like other tissue. Instead cartilage is supplied by diffusion so healing cells and nutrients are only slowly filtered into the tissue and don’t reach the piercing as quickly.

This long healing process often produces a light yellow, white or clear discharge which many people call lymph fluid. The ‘proper’ name for this discharge is serous fluid which can contain lymph fluid. The fluid is not pus and instead contains bits of protein, platelets, dead cells and other useful things that have been helping to heal your piercing. It is simply ‘body garbage’ and is produced throughout the healing process.

In a piercing the normal tissue that does (eventually) form over the top of granulation tissue does not form as it usually would. This is because the piercing jewellery is in the way of full wound closure. Instead your body uses this ‘normal’ tissue to form a tunnel known as a fistula.

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The Fistula

A fistula is a tunnel of new tissue that connects one area to another.

Your body forms a fistula mostly as a defence mechanism, sealing off the jewellery (which is a foreign object) and the outside world so that the body cannot be harmed by it. It is almost like building a wall between a neighbor so you can have privacy and feel safe!

Fistulas normally only form in the body if something gets in the way of the passage of fluids inside the body (For example; a tumour in the bladder could cause a fistula to form as your body redirects the urine flow another way). It is unusual to get one in an area where no major fluid exchanges need to take place and so make use of your body’s natural processes in a way other things rarely do!

Fistula’s themselves take quite a while to form, and tend to have three distinct areas of development during the healing process.

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Fistula Development

First Stage: In an ideal situation (if you are pierced with good jewellery and have taken care of your piercing) a weak initial fistula will have formed at about two weeks.  This fistula is mostly made up of granulation tissue so is very weak at first.

Gradually the fistula will improve in strength and flexibility (tensile strength), supporting the shape of the piercing hole and the jewellery itself. This is partly why a piercing may feel healed before it is because the skin will be gaining strength and replacing the granulation tissue rather than patching itself up still!

Second Stage: At the recommended healing time for your piercing your fistula will be fully formed but not at full strength. So it will be ok for you to change your jewellery without damaging the fistula but you may find that very frequent jewellery changes will make the piercing upset.

It is also likely that your piercing will be able to close over quite easily if the jewellery is left out for too long. This is because the piercing hole may lose shape without the jewellery there to guide it into where to strengthen. The time you can leave jewellery depends where it is on the body. The fistula closes more quickly at body ‘gateways’ like the mouth or nose as your body constantly replaces cells here to defend itself from outside attacks. The fistula closes more slowly in places like the lobes which is just fatty tissue and doesn’t play a large role in body defense.

Third Stage: Around 6 months after your recommended healing time your fistula will be at full strength. This means you will be able to change jewellery without problems, leave jewellery out for a short time (again this really depends on placement), wear cheaper materials if you must and begin stretching or ‘gauging’ the piercing if you wish to!

It is important to note that the third stage is not irreversible. Stretching too quickly or catching the piercing may cause damage to parts of the fistula and it will need to go back through the stages again to reach full strength. The general rule is that if the piercing bleeds or forms a bump its not at the third stage anymore.

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Effects of Jewellery

To your body a piercing is more like a splinter than anything else; it’s a foreign object stuck underneath the skin which needs to be removed. Your body’s natural response to this is to try to push the jewellery out by using swelling to flush the area with the white blood cells that help remove debris, foreign material and bacteria in a wound.

Eventually, with proper care, your body will accept the jewellery is not a threat and will begin to heal around the bar instead of trying to remove it. Good quality, well fitted, jewellery is essential to this process and without it several problems can occur:

Jewellery which contains irritating materials (such as acrylic or surgical steel) endanger the healing process because it causes constant aggravation to the healing wound, making the piercing seem an unending threat to your body. This means the body will continue in its attempts to push out the bar and even form a histamine (allergic) response to help it do so. You may never heal the piercing successfully because of this.

Jewellery that moves around too much inside the wound, such as a ring or jewellery that is too large, causes healing problems due to irritation (as above) but with the added problem of dragging dead skin and other debris into the wound, causing damage to the delicate healing tissue and increasing the chance of infection.

Jewellery that does not sit correctly or rests awkwardly is also a problem for the same reason (irritation). It puts a lot of pressure on the piercing holes and cause other problems such as, migration, ear collapse or gum damage.

Jewellery that is too small can endanger your health as well as the health of your piercing. Without enough room for the natural swelling process to take place a large amount of pressure will be placed on the tissue. As well as causing irritation problems this causes a viscous cycle of swelling to start as the pressure creates more swelling. If the problem isn’t dealt with the jewellery will embed into the tissue and can even be healed over entirely, potentially causing infection if the jewellery is not clean (like butterfly backs on gun earrings which cannot easily be cleaned). In addition to this the constant presence of the swelling stops the rest of the healing process from taking place.

Incessant irritation from poor jewellery also causes problems such as hypertrophic scarring.

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Effects of Cleaning

In the same way poor jewellery can damage your healing process a cleaning routine containing harsh chemicals (for example ethanol / alcohol and peroxide), or antiseptic agents can be just as detrimental because it encourages your body to see the piercing as a threat and not something it wants to heal around.

While keeping your piercing free of bacteria sounds like a good idea in theory your body actually needs a certain level of bacteria to heal properly with and by removing that bacteria you set back your body’s natural healing process and make it work twice as hard. Martin C. Robson, Professor Emeritus of Surgery (University of South Florida, USA), explains it like this:

‘Health is not a germ-free state. Rather it is an equilibrium between the factors of host defense and a myriad of bacterial organisms. Each of the cellular processes of the wound healing scheme as well as the humoral mediators or messengers have been shown to be affected by bacteria.’

It is also worth being aware that some bacteria are quite resistant to antiseptics and studies (Blunt, 2001) have shown that in order to be fully effective at cleansing a wound an antiseptic must be in constant contact with the wound for around 20mins. This is something you are unlikely to get from a spray or gel as they are easily absorbed into the surrounding skin and don’t necessarily stay in place as you move around.

Certain chemicals, as well as striping away healthy bacteria, can also damage the delicate healing tissue, undermining your body’s efforts to close the wound. As well as not encouraging your body to heal around the jewellery, regular destruction of this tissue causes thicker, harder scar tissue to form because the piercing will try to resist the damaging effects of the cleaning. This scar tissue can hinder people who wish to stretch their piercings and even create, permanent, unsightly topical scarring.

Another common practice, of simply using soaked cotton buds to clean the piercing have also been shown, through medical studies (Bale and Jones, 1997), to be an ineffective way to clean a secondary intention wound as debris and bacteria are redistributed around the wound, rather than being washed away like they are with irrigation. In the case of a piercing, with the jewellery in the way, actually reaching the contaminates inside the piercing hole becomes an issue and even getting full irrigation from a spray is unlikely.

These issues are all part of the reason why saline soaks are highly recommended. We have a collection of aftercare cleaning guides for each type of piercing that  can be found here.

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Sources:

1. Martin C. Robson Quote from: CHRONIC WOUND HEALING MICROBIOLOGY: AN OVERVIEW via Christopher Rosch on: http://en.allexperts.com/q/Biology-664/Bacteria-aids-wound-healing.htm
2. Robson MC, Mannari RJ, Smith PD, Payne WG. Maintenance of wound bacteria balance. American Journal of Surgery. 1999. Nov;178(5). 399-402.
3. LEVY, STUART B. MD. Antibiotic and antiseptic resistance: impact on public health. October 2000. Pediatric Infectious Disease Journal.  Volume 19 – Issue 10 – pp 120-122.
4. Blunt, J. 2001. Wound cleansing: ritualistic or research based practice? 2001.Nursing Standard 16, 1. 33-36.
5. Bale, S, Jones, V. Wound Care Healing. 1997. Journal of Clinical Nursing. Volume 8. Issue 1. P114.