Tragus Piercing Beaten to Death

In this addition to my Blog series Beating Each Piercing to Death, I will be focusing on the Tragus piercing. Which is often one of the most mispronounced or misnamed of the piercing that are located on the ear.  Though Webster's has the pronunciation as Tra-gi, I was taught from the begriming to pronounce it Tray-Gus. So, I think it is safe to say that I have been mis-prouncing 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 normally not a very painful piercing 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 insure 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 then the piercing itself or the jewelry insertion and closure. 

History and Background:

The Tragus piecing is a modern invention with no known ties to ancient cultures and no one claims it invention but I'm guessing that like most piercing it's roots are in 1980s. I know that it first appeared in PIFQ in 1995 but when I went through my apprenticeship in 1993 and 1994 it was already a common piercing. My guess is that it came about around the same time as the invention of other advance ear piercings like the Rook and the Daith.

The name comes from the medical term of the area it is pierced through which is the flap of tissue the 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 important 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 how large the tragus is but also depending on the jewelry there needs to be room for the jewelry to hang naturally from the piercing and not add additional stress on the piercing 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 is at a slight angle that will allow the jewelry to hang outside of the entrance of the ear canal.

Placement should be dead center or slightly above the mid way 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 a number of piercings on the tragus are extremely rare. However can be done. Also industrial and orbit 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 orbit or industrial piercing in combination with a tragus piercing, they will need to be planned out in advance. Since the angle and placement needed for combination maybe greatly different from that of a normal tragus piercing it is often ill advised to try to add them to an existing piercing. Even though in some cases the jewelry can be bent to fit into existing piercings, it is always best to plan out ahead of time. The same with a grouping of piercing, since adjustments to the placement will be needed to make room of the additional piercings and jewelry.

Jewelry Types:

With the tragus there is a wide range of jewelry that has been used over the years from the basic Captive Bead Ring to L-bends. It is my experience that for the piercing and healing, rings or circular shaped jewelry is best. Rings allow additional room for swelling, are lighter than barbells style jewelry and do not block the discharge that takes place during the healing. 

The jewelry should be 18g to 14g, though I most commonly suggest 16g. The advantage of 16g is that it is lighter and takes up less room than 14g but is less likely to tear or migrate than 18g. The other advantage is that is a great deal more thread jewelry and variety at 16g than 18g. The jewelry in either case should be at least an 1/8th of an inch wider than the tragus which will average from 5/16th of an inch to 7/16th of an inch. Though the most common is 3/8th of an inch. Once again it really depends on the anatomy of the piercee.

• 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 the best option. It is not only lighter than Threaded jewelry but it will not have to be longer than the piercing to allow for swelling. Once the piercing begins to heal the jewelry will tend to lay flat to the face.
• Labret Stud - A straight post with threaded end on one side and a flat disc on the other. Another option is the threadless or pressure ends.
• Circular Barbells - A circular shaped horseshoe with two threaded ends. Can be used during healing and after the piercing is healed with one main concern, weight. Since the ends add additional weight to the jewelry it can increase the risks 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 confortable and easier to change than labret 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 this 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 insure the angle of the piercing is correct. This is a huge factor with tragus piercings because the tissue will need to be bent to allow for a correct angle and can be helpful in clearing the needle from causing damage to the ear or face.  In fact because the forceps flatten out the tissue giving the needle a shorter distance to travel, the piercing is faster and less painful. The forceps should be tight but not painfully tight and should be supported during the whole procedure. 

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

• Back to front method - After set up, prep and marking, the forceps are clamped to the tissue, making sure that the angle matches the natural angle of the tragus. The forceps are then bent forward toward the face to allow access to the side of the tissue that is toward the ear canal. Next the needle is placed against the back side and the piercing is done making sure that the needle is angled square with the forceps. With the forceps still on, the needle is carefully slide through the piercing with a cork on the tip to insure that it doesn't scratch the face. This will often mean that pressure will need to be applied to the helix area of the ear to guide the needle through. Once the back end of the needle has cleared the structure of the ear, the forceps are removed and the jewelry is inserted. 
• Front to back - After set up, prep and marking, the tissue is clamped with forceps but unlike the other method the tissue is not bent or adjusted out of it's natural angle. A cotton tip applicator is placed against the piercing exit and the needle is inserted to the point where only the tip is exposed. The forceps are removed and a needle receiving tube is placed against the exit side of the piercing and the needle is pushed through the needle receiving tube. Once the needle is cleared the ear, the jewelry is inserted into the piercing. With Labret studs an additional step must be taken because the jewelry will need to be inserted from the back. So the needle will be pushed out of the piercing with a taper pin and then taper pin will be inserted into the labret stud. The jewelry is then inserted into the piercing.

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 worst than it is. In most cases these after effects 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 will involve hot soaks or compresses with warm water and sea salt twice a day and cleaning the piercing in the shower twice daily. Also you will need to take steps to reduce the likelihood 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, ear plugs, ear bugs and stethoscopes should be avoided until the piercing is healed.

It is important 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 piercing can cause migration and other problems. If you must sleep on that side elevate the piercing off the bed using a donut shaped pillow, rolled up nest shaped towel or a neck pillow.  Also avoid clothing and sport safety equipment like helmets and masks that are tight in the piercing area. If you are required to wearing 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 hair cut or a new style make them aware of the piercing and ask them to try and 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 is just 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 line scar. This can be avoided by removing the jewelry at the first signs that the piercing is rejected. A healed piercing will increase the size of the tragus. In most cases it is so minor that most people wouldn't notice it but the area will not reduce in size if the piercing is abandoned.

Some rare but still risks to be considered is an infection leading to Bells Palsy or ear collapse caused by an infection destroying the structure of the cartilage, 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 really consider a different piercing or using one ear until the piercing is healed completely.