“There is nothing permanent except change,” said Greek philosopher Heraclitus.
That may be true, but not when it comes to body modifications. Body art, such as permanent tattoos, piercings (in locations other than the earlobe), stretching or scarification which involves scratching, etching, burning, branding (yes, like cattle) or superficially cutting designs into the skin, can stay with you forever.

Scarification tattoo before and after
Photo Credit – Rebel Circus.com
Not long ago, the wearing of tattoos was relegated to those in the military and a few rock stars and celebrities. Tattoos and multiple piercings were generally associated with criminal activity, gangs, drug usage and other “high-risk” behaviors.
These days, body modification is more socially accepted than ever; it’s becoming, well, mainstream.
To those who wear them proudly, tattoos, piercings, and scarifications have always been a form of self-expression, empowerment, and autonomy–which sometimes flew in the face of social norms.
In California, tattoos are illegal for those under the age of 18. Body piercing on persons under the age of 18 can be performed legally in California in the presence of the person’s parent or guardian, or with a notarized letter from them. Ear piercing is exempt.
The American medical community has recognized this cultural shift and has recommended that pediatricians and health care providers talk to their patients about it.
“Adolescent and Young Adult Tattooing, Piercing, and Scarification,” the first clinical report from the American Academy of Pediatrics‘ Committee on Adolescence appears in the October 2017 issue of the journal Pediatrics. Directed to pediatricians, the study describes the types and methods used to perform body modifications, the potential medical complications, and how physicians can talk about these topics with patients and families. The report also offers guidance to pediatricians about how to distinguish typical body modification from more dramatic or intense efforts to inflict self-harm, called non-suicidal self-injury syndrome.
The report also encourages pediatricians and other health care providers to initiate a conversation with young patients about body modification. Doctors should advise patients to discuss their decision to have one of these procedures with their parents or another adult first. Most importantly, they recommend that patients research and examine their desire for wanting body modification, consider where it will be placed, weigh the possible health risks, and lastly, think about the potential repercussions visible body art may have on their future educational and professional lives.

Ear stretching and nose piercing
Photo Credit: Tom Wallace – Star Tribune
The American Academy of Pediatrics reports that infections are the most serious complication from any form of body modification. The organization stresses that infection control tools being used for tattoo or piercing should mirror that of a doctor’s office: the environment should be clean and the tools should be sterile. Also, any person considering tattoos should make sure their immunizations are up-to-date and that they are not taking any medication that may compromise their immunity.
Here are some things to consider before having body art done:
- Ink tattoos are permanent and removal is difficult, expensive, and only partially effective.
- People who have a history of keloid formation should avoid body modifications that puncture the skin such as tattoos, piercings, and scarification.
- Lesions that appear to grow or change within an ink tattoo require evaluation for new, abnormal growths.
- Red henna temporary tattoos can destroy red blood cells in those with positive glucose-6-dehydrogenase deficiency .
- The dye used in mehndi, or black henna temporary tattoos can cause chemical burns and lead to allergic reactions.
- Tongue piercing jewelry often chips teeth.
It’s also important to research the body art facility before making an appointment. Also, if you play contact sports, remember to remove all jewelry to avoid endangering yourself and others. And, if there are any signs of infection, seek medical help immediately.
Before scheduling an appointment with a pediatrician, remember to always check the status of the license first by going to the California Department of Consumer Affairs‘ License Search page.