Tragus Piercing Beaten to Death

In this edition of my Blog series, Beating Each Piercing to Death, I will be focusing on the Tragus piercing. It is often one of the most mispronounced or misnamed piercings that are located on the ear.  Though Webster's has the pronunciation as Tra-gi, I was taught from the beginning to pronounce it Tray-Gus. So, I think it is safe to say that I have been mispronouncing it and incorrectly correcting clients on the pronunciation for close to 20 years now, and will continue to do so. Tay-Gus just rolls off the tongue; it sounds attractive and pretty. Tra-Gi sounds ugly and alien. Like something out of a Sci Fi B-Movie, "The Tragi are invading the Earth and they come for our brains." 

The piercing is usually not very painful at all. Often said to be less painful than a standard upper ear cartilage piercing. However, as I like to explain, it can be more uncomfortable than painful. The reason is that to do the piercing, the tragus will have to be bent and have additional stress to ensure that the needle doesn't puncture or scratch other areas of the ear or face. Clearing the needle safely may be more uncomfortable and take longer than the piercing itself, or the insertion and closure of the jewelry. 

History and Background:

The Tragus piercing is a modern invention with no known ties to ancient cultures. Although it is not claimed as an invention, I suspect that, like most piercings, its roots date back to the 1980s. I know that it first appeared in PIFQ in 1995, but during my apprenticeship in 1993 and 1994, it was already a standard piercing. I suppose it emerged around the same time as the invention of other advanced ear piercings, such as the Rook and the Daith.

The name comes from the medical term for the area it is pierced through, which is the flap of tissue that protrudes in front of the ear canal toward the face.   

Migration, Anatomy, and Placement:

The tragus and anatomy of the ear can be vastly different from person to person and even vastly different from the left to right ear on the same individual. It is why it was used in the 19th century as a form of identification.  When evaluating whether a piercing can be done, the key structures I'm looking for are:

1. Is the tragus large enough to be pierced? It is essential to make sure that the piercing will be through the cartilage and not just through the soft tissue on the very edge of the tragus. If it is not through the cartilage, the piercing will more than likely reject or migrate.
2. Is there going to be room for the jewelry? This, in part, comes down to the size of the tragus, but also, depending on the jewelry, there needs to be room for the jewelry to hang naturally from the piercing without adding additional stress, which could distort the tissue or cause the piercing to migrate.
3. Does the tragus protrude far enough away from the face? The tragus ideally sits at a slight angle that allows the jewelry to hang outside the entrance of the ear canal.

Placement should be dead center or slightly above the midway point of the tissue. I prefer to place the piercing so that if a ring is worn, it will fit comfortably into the notch below the tragus called the intertragus. The piercing itself should not be at an angle through the tissue but as straight as possible, so that it transects the tissue. Often, this may require that the piercing is done front to back with a needle receiving tube.

Industrial, orbits, and Groupings:

Due to the small size of the area, groupings of several piercings on the tragus are extremely rare. However, it can be done. Also, industrial and orbital combinations can be done with other ear piercings, including Tragus to Conch Industrial and Tragus to Anti-Tragus Orbits. These are highly dependent on anatomy and your piercer's ability. 

If you are considering multiple tragus piercings, or an orbital or industrial piercing in combination with a tragus piercing, they will need to be planned out in advance. Since the angle and placement required for a combination may be considerably different from that of a typical tragus piercing, it is often ill-advised to try to add them to an existing piercing. Although in some cases the jewelry can be bent to fit into existing piercings, it is always best to plan. The same with a grouping of piercings, since adjustments to the placement will be needed to make room for the additional piercings and jewelry.

Jewelry Types:

With the tragus, a wide range of jewelry has been used over the years, from the basic Captive Bead Ring to L-bends. In my experience, the best option for piercings is labret studs. This is due to the lower profile and reduced movement. Making the piercing easier to isolate. The other advantage of a labret is that, since the inside is a flat disc, after healing, it doesn't significantly affect the use of sound devices in your ears. The post will need to be longer to allow for swelling and will need to be downsized during the healing process. 

The jewelry should be 18g to 14g, though I most commonly suggest 18g. The advantage of 18g is that it is lighter and occupies less space than 14g. The jewelry in either case should be at least a 1/8th of an inch wider than the tragus, which will average from 5/16th of an inch to 7/16th of an inch.

• Labret Stud - A straight post with a threaded or threadless end on one side and a flat disc on the other. Another option is the threadless or pressure ends.
• Captive Bead or Beaded Ring - A circular ring with a fixed bead or ball, or a bead or ball that is held captive by the tension of the ring. For piercing and healing, I have found that a ring is not the best option.
• Circular Barbells - A circular-shaped horseshoe with two threaded ends. It can be used after the piercing is healed, with one primary concern: weight. Since the ends add additional weight to the jewelry, it can increase the risk of migration.
• L-bends and Nostril Screws - This is a post with a ball or setting on one end and then a long wire with no end. The wire can then be bent or shaped to reduce the likelihood of the jewelry falling out. Some find them more comfortable and easier to change than labrets, but still give the "stud" look they like. However, the bent or U-shaped wire will often sit inside the ear canal and be uncomfortable, and they are not as secure as a barbell or labret stud would be.

Procedure:

I always do the piercing with forceps. Do not be sold on the idea that a freehand piercing is going to be less painful. The reality is that the forceps are needed to pull the tissue away from the body, support the tissue, and ensure the angle of the piercing is correct. Most importantly, forceps are required to reduce the likelihood of the tissue rolling and making an incorrect angle. 

There are two methods for tragus piercings, but I find piercing from front to back to be faster and less painful. However, with some anatomies, the piercing will need to be done front to back to get the angle correct. This is especially true if the tragus is angled more flat to the face, where the piercing will need to be done into the ear canal.

• Front to back - After setup, preparation, and marking, the tissue is clamped with forceps; however, unlike the other method, the tissue is not bent or adjusted out of its natural angle. A Needle Receiving Tube is placed against the exit point, and the needle is inserted into the tube. The forceps are removed, and the needle is then pushed out with a backward guide pin. The jewelry is then attached to the guide pin on the back side of the piercing, inserted, and closed.

Hassles and Aftercare:

Tragus piercings are prone to bleeding, redness, and swelling. In most cases, this will fade after a few days and usually looks much worse than it is. In most cases, these aftereffects will be slight and completely unnoticeable. The piercing will, however, be tender to the touch and can throb off and on right after the piercing is done.

Basic aftercare involves removing discharge with a sterile saline spray, such as Neilmed's Piercing Aftercare, twice a day, and rinsing the piercing at the end of your shower. Additionally, you will need to take steps to minimize the risk of cross-contamination. For more details, go to Basic Aftercare Instructions. Due to the location of the piercing, you need to take precautions to avoid the piercing coming in contact with cosmetic and hair products. Since sweat tends to collect in the area, it is a good idea to clean the piercing after strenuous activity, especially if you use hair products. With all ear piercings, contact with telephones should be avoided, especially those used by other people. Also, because of the location, earplugs, earbuds, and stethoscopes should be avoided until the piercing is healed.

It is essential to avoid stress and abuse to the piercing during healing and after. Which side you naturally sleep on should be considered before getting the piercing. Sleeping on the piercing, especially during the healing process, can cause migration and other complications. If you must sleep on that side, elevate the piercing off the bed using a donut-shaped pillow, a rolled-up nest-shaped towel, or a neck pillow.  Also, avoid clothing and sports safety equipment, such as helmets and masks, that are tight in the piercing area. If you are required to wear safety equipment for a job or sport that is tight-fitting in the area, you may want to consider a different piercing.

When getting a haircut or a new style, make them aware of the piercing and ask them to try to avoid the area. Also, if they are using spray bottles, make sure they cover the piercing with a clean paper towel. You should also do the same when you apply anything from a spray bottle. There are two concerns. The first is that the chemicals and other items in hair products will get into the open wound and cause a reaction. The second is that you will introduce a foreign pathogen into the piercing. So, even if it's tap water, cover the piercing.

Risks & Concerns:

Since the piercing is on the face, there is a concern about permanently changing the tissue of the ear. If the piercing is healed correctly, there will be two small indented scars, but if the piercing migrates or rejects, you will be left with a linear scar. This can be avoided by removing the jewelry as soon as the first signs appear that the piercing is rejected. A healed piercing will increase the size of the tragus. In most cases, the change is so minor that most people wouldn't notice it, but the area will not shrink in size if the piercing is abandoned.

Some rare but still significant risks to be considered are an infection leading to Bell's Palsy or ear collapse caused by an infection destroying the cartilage's structure. Both are rare and caused by not treating an infection quickly.

If you work in the medical profession and are required to use stethoscopes, you may find the pressure on the piercing uncomfortable and painful. You should consider a different piercing or wait until the current one is completely healed before using it in the other ear.