Ask Angel

Piercing Consequences: Bleeding, Swelling & Bruising

Ms. Angel,
OMG, I just did a nostril piercing that GUSHED blood and would not stop! I have never seen a piercing bleed like that and wasn’t sure whether to take out the jewelry or leave it in? Last week I pierced a nipple and it swelled up so huge I had to swap for bigger jewelry right then. And before that, I did a Christina that bruised dark purple all around it and looked just awful. What am I doing wrong? Help!

Dear I.,

Bleeding, bruising, swelling, or any combination of these consequences is perfectly normal following a break in the skin—including piercing. As part of my routine, I always explain this prior to piercing. I also inform clients that vascular areas (those with good blood circulation) tend to heal better (i) because the body can more effectively deliver nutrients and remove waste products. Then, when a piercing has one or more of these outcomes, instead of being concerned or frightened, the piercee feels confident that they will heal well. Don’t panic, be reassuring, and take appropriate action (details below).

If you pierce enough people, eventually some are going to experience excessive blood flow, massive swelling, and/or florid bruising. This doesn’t necessarily mean you did anything wrong. Even when everything is handled according to standard practice, some piercees will have a more extreme aftermath.

Sometimes a reason can be discovered. Discuss any client history of atypical swelling/bleeding or relevant medical conditions, and recent usage of alcohol, caffeine, and drugs. Over-the-counter medications such as Advil/ibuprofen, Aleve/naproxen, or aspirin could be to blame. Many herbs and supplements can thin blood and contribute to such effects, too.

Everyone knows that you should avoid poking a needle into a visible vein—unless you’re a phlebotomist. But careful piercers still puncture blood vessels all the time. Naturally, the larger you pierce, the greater the risks of hemorrhage and other serious ramifications, which is one of the reasons a 10-gauge needle is the largest I use. Damage that does occur is more apt to heal quickly and completely if you aren’t wielding a gigantic spike. If you sever a hefty vein, a hard-to-stop flow is to be expected. However, when a small one is breached, bleeding shouldn’t be as difficult to control. Pierce with anatomy-proportionate sizes to minimize risks.

Prior to piercing, always evaluate local anatomy under bright light to locate visible veins and arteries that must be avoided. I had penlight keychains printed with my studio information and logo. Placed inside a clean glove for hygiene, the device safely illuminates the area for inspection. After use, I’d give it to the piercee. Headlamps are another functional lighting option, but admittedly, they do look dorky. Note that depending on tissue density, even a thorough visual and physical examination will not always reveal all local structures. Exercise extreme caution when piercing close to a detected vessel. If you don’t have sufficient experience and control to know exactly where your needle will go, you should decline.

Right before piercing, I routinely perform tissue manipulation wherever the body is suited to it. Lifting, pinching, and rolling the skin can help to clear the zone of veins and other structures. Keep plenty of sterile gauze on hand so you’re ready when heavy bleeding does occur. Also, disposable instant cold packs are inexpensive, convenient, and effective at minimizing the aftereffects of piercings.

CSR wrap, Moore Medical

If you see excessive swelling and/or bruising, apply a cold pack immediately. A rapid response is critical because it helps to prevent the situation from worsening. Just pop the pack inside a clean glove and wrap it in a fresh dental bib or sterile CSR wrap (ii) to maintain hygiene. Apply it to the affected area for ten minutes.

On occasion, frightful discoloration will appear around a new piercing. This is simply bleeding under the skin surface. Though harmless, contusions can be distressing to the client, especially when on the face. If you see a blossoming bruise, apply a cold pack and advise the use of ice as described below. They may want to pick up some arnica montana gel or cream at a pharmacy or health food store. Topical applications of this natural herb preparation can diminish discoloration (iii), but it should not be put into the wound.

When a piercee is far from home, I might provide a second pack to apply in an hour or so. If the condition requires further attention, ice packs should be used during the first forty-eight hours. Following that, warm compresses are preferred. A safe schedule is ten minutes of cold, followed by a fifty-minute wait before reapplying. A clean zip-top plastic bag with ice, frozen peas, or blueberries will work, and a bit of water helps the contents conform to the body more comfortably. The baggie should be wrapped in a clean paper towel, and soggy towels replaced with dry ones as condensation wets them, especially if bleeding is an issue. Too much moisture can disrupt a fresh scab, resulting in prolonged bleeding.

Instruct clients not to perform any saline soaks until bleeding has been fully resolved; submersion in liquid can prevent a wound from clotting. I always suggest waiting for three days once bleeding has ceased—even if there isn’t any during the procedure.

If a piercing rhythmically spurts bright red blood, you have pierced an artery. When possible, keep the wound elevated above the heart. Abandon the piercing right away and apply constant firm, direct pressure with sterile gauze for 15-20 minutes. If blood soaks through, add more layers on top, but do not lift the gauze to check if the bleeding has subsided. If bleeding is not controlled during that time, you need to seek emergency medical assistance IMMEDIATELY. Call 911.

When there is an unusual amount of non-arterial bleeding after a procedure, firmly pinch the tissue between pieces of sterile gauze for 15-20 minutes. Apply continuous pressure as directly as you can, since there’s jewelry in the way. If the bleeding is not staunched via pressure with the jewelry in place, you’re going to have to remove it. Apply pressure for that duration once again. In most areas, you’ll be able to do this much more effectively without an ornament in the wound, so it should be easier to stop the flow. If practical depending on placement, add a cold pack on top of gauze to use in conjunction with pressure on a bleeding wound.

Should a client leave without wearing jewelry, you’ll have to issue a full refund. You may want to converse about whether re-piercing some other time is a viable option, probably with modified placement. Do not repierce the region until it is well healed.

Having some dried, crusted blood around a new piercing isn’t pretty—but it isn’t harmful, assuming they haven’t contaminated the wound. If seepage or flow starts again every time they try to clean up a piercing, that indicates it needs to be left alone for a longer period of time. Coagulated blood can be left on a piercing for 24 -36 hours or more if necessary to stop ongoing bleeding.

Some piercees will experience more extreme consequences, even when you’re doing everything safely and appropriately. In the event of excessive bleeding, bruising and/or swelling, it is important to remain calm, provide reassurance, and know the steps to take.

ii For example,