Proper skin prep is an important part of the body modification process. It eliminates any bacteria, viruses and other microorganismsOpens a new window clinging to a client's skin so that they aren't pushed beneath the dermis and given easy access to a person's bloodstream, where they could wreak havoc on your client's immune system. By properly cleaning a person's skin before piercing, tattooing, branding, or performing scarification on them, you're preserving your client's health and protecting yourself from the potential legal recourse you may be hit with if you performed improper surgical skin prep or none at all. Ideally, all surgical skin prep should involve a pre-cleaning with an anti-microbial detergent/skin cleanser followed by a surgical antiseptic that's approved by the CDC (Center for Disease Control). Opens a new windowIf a client wants you to use a topical anestheticOpens a new window, you should apply it 15-30 minutes before beginning the skin prep process, at which point the topical anesthetic that hasn't been absorbed into the skin will be washed away. That's why you need to give your client's skin time to absorb the topical anesthetic before prepping their skin and modifying them. The type of surgical skin prep productsOpens a new window you use may vary slightly depending on what type of body modification you're performing and how sensitive each client's skin is. Some people are allergic to skin prep options like iodineOpens a new window, and others may be sensitive to certain soaps. You may also encounter clients who want you to explicitly use organic, vegan-friendly skin cleansers. It's important to talk to your clients before modifying them to find out what allergies, sensitivities and preferences they have and to alter your normal skin prep procedure accordingly. You can also spot test a client's skin before cleaning a large area to see if they have an immediate reaction to the surgical skin prep products you plan to use on them.

Factors That May Increase Risk of Skin Infection

There are certain risk factors that may increase a client's chances of developing a skin infection after getting a body modification. When a client suffers from malnutrition, diabetes, or severe obesity, smokes, or has an existing infection, illness or immune system deficiency, they may be at higher risk for developing an infection in or around a new piercing, tattoo or other body modification. Opens a new windowInterview each client before agreeing to modify them to see what risk factors, if any, may come into play. If any of the risk factors listed above are present, make sure your client understands that proceeding with the modification they want could potentially result in a skin infection. In particular, if the client has an existing infection or illness, it's best to reschedule their modification for a later date, once they're fully recovered and their body can focus its full attention on healing their new body mod. Opens a new windowIf the person has other risk factors besides illness or infection and still wants to proceed with getting a new modification, have them sign a body piercing release formOpens a new window or tattoo release waiverOpens a new window acknowledging and accepting the risks involved. You should also stress the importance of proper piercing aftercareOpens a new window or new tattoo careOpens a new window, including frequency of cleanings, using the right tattoo aftercareOpens a new window or piercing aftercareOpens a new window products, eating nutritiously, getting quality sleep, quitting smoking or at least substituting e-cigarettesOpens a new window or nicotine patches/gum for regular cigarettes during the healing process, avoiding alcohol, excessive caffeine and illicit drugs, and so on. Performing proper post-body modification care will help combat other skin infection risk factors. If you'd like to learn more about how each of the risk factors listed above can contribute to skin infections, read the section titled "E. Risk and Prevention" in the PDF Guideline for Prevention of Surgical Site Infection, 1999 Opens a new windowprepared by the CDC, the U.S. Department of Health and Human Services and other related agencies.

Preparing Yourself & Your Workspace

Before you prep a client's skin for a body modification, you have to make sure your workspace and tools are clean and sterile. You can read our Maintaining a Sterile Work EnvironmentOpens a new window article for suggestions. Just before performing the modification, you'll also need to wash your hands properly, put on glovesOpens a new window and other protective gearOpens a new window as needed, and setup a sterile fieldOpens a new window containing all the tools and other modification instruments you'll be using. Visit our Shop SafetyOpens a new window section to find a range of articles that will help you ensure that your workspace is properly maintained and that you're operating with sterile instruments in a safe and sterile environment. The Guideline for Prevention of Surgical Site Infection, 1999Opens a new window PDF includes several specific tips that body modification professionals should follow immediately before prepping clients' skin for tattoos, piercings, scarification designs, and brands:

• Make sure your nails are cut short, with no jagged edges. Use nail clippers and a file as needed, and avoid fake nails.
• Remove any hand or arm jewelry you're wearing.
• Wash your hands for 2-5 minutes immediately before applying surgical skin prep to a client, using the methods in our Guidelines for Hand HygieneOpens a new window article. Do not turn off the water with your bare hands immediately after you finish washing them.Opens a new window
• After washing your hands, keep your hands up and away from your body with your elbows flexed so that water runs down from the tips of your fingers to your elbows. Dry your hands with a sterile towel (which you can also use to turn off the water), and immediately put on a new pair of latex or nitrile glovesOpens a new window.
• If you are unwell or will be in close proximity to your client's face, you should absolutely put on a face maskOpens a new window in addition to any other protective gear you may want to use, like a disposable apronOpens a new window.

Piercing Skin Prep

The body part a client wants pierced will determine how you prep their skin before piercing them. Oral piercings require use of an antiseptic mouthwash prior to piercing, whereas external piercings call for an anti-microbial skin cleanser followed by an antiseptic product. For facial piercings with an oral side, you need to use a topical skin cleanser, an external antiseptic product, and an antiseptic mouthwash.

Opens a new windowOpens a new windowOral Piercing Surgical Skin Prep

When performing oral piercings like tongue piercings and oral web piercings (e.g. smiley piercings, frowney piercings, or tongue frenulum piercings), you'll need to have your client swish their mouth for at least 30 seconds with either hydrogen peroxide that's been diluted per the bottle's instructions for use as a mouthwash or a product like Tattoo Goo's X-Pressions Extra Strength Piercing Aftercare oral rinse and topical sprayOpens a new window, which contains the antiseptic CPC (Cetylpyridinium Chloride) and other antiseptic ingredients. The friction caused by swishing the antiseptic mouthwash around combined with the antiseptic ingredients will properly prep your client's mouth for an oral piercing.

Skin Prep for Facial Piercings With an Oral Side

Facial piercings that exit into the oral cavity require a two-pronged approach to surgical skin prep. Both the inside of a client's mouth and the external facial area you're piercing need to be properly cleaned and sterilized prior to performing the piercing. This applies to all lip piercings and cheek piercings, with the exception of dermal facial piercings that don't penetrate the oral cavity. Have your client swish diluted hydrogen peroxide or a product like X-Pressions Extra Strength Piercing Aftercare around their mouth for at least 30 seconds immediately before you pierce them, as instructed in the Oral Piercing PrepOpens a new window section above. Next, wash the external facial area you'll be piercing with an anti-microbial skin cleanser like Microsan Rx Surgical ScrubOpens a new window or PurKlenz Topical Antiseptic Skin CleanserOpens a new window, which contains the antiseptic agent Chloroxylenol (PCMX). Once the skin cleanser has been thoroughy washed off and you've blotted the skin dry with sterile gauzeOpens a new window, Opens a new windowfinish the skin prep process by wiping the facial area you'll be piercing with an alcohol prep padOpens a new window, a providone iodine prep padOpens a new window (only if your client has confirmed that they are not allergic to iodine), or a Prevantics swab,Opens a new window which contains 70% isopropyl alcohol and 3.15% Chlorhexidine gluconate. You should apply the antiseptic agent in concentric circles, starting at the intended piercing site and working your way outward at least an inch beyond where the piercing will be placed. Once you've done that, you'll be ready to perform your client's facial piercing.

Opens a new windowExternal Piercing Skin Prep

When performing external piercings like earlobe piercings, cartilage piercings, nose piercings, nipple piercings, belly button piercings, surface piercings, dermal piercings, and genital piercings, you should first thoroughly wash the area to be pierced with an anti-microbial skin cleanser like Microsan Rx Surgical SoapOpens a new window or PurKlenz Topical Antiseptic Skin CleanserOpens a new window. Opens a new windowIf a client asks you to use a vegetarian/vegan-friendly product containing organic ingredients, you could use a detergent like Dr. Bronner's SoapOpens a new window. Dr. Bronner's soaps are made from Certified Fair Trade organic ingredients, they're free of synthetic and petrochemical agents, and they're great for people with sensitive skin. However, they are not anti-microbial skin cleansers. If you use a skin cleanser like Dr. Bronner's Soap prior to piercing someone, you'll need to scrub thoroughly, blot the area dry with sterile gauzeOpens a new window, and follow up with an extra antiseptic wipe instead of just making a single pass over the skin with an alcohol prep padOpens a new window, providone iodine wipeOpens a new window or Prevantics swabOpens a new window. Apply the antiseptic in concentric circles, starting at the point where you intend to pierce the person and working your way outward at least an inch or two beyond the intended piercing site.

Tattoo Skin Prep

When tattooing men in particular, and sometimes women, tattoo artists will often shave the area to be tattooed as part of the tattoo skin prep process. However, the Guideline for Prevention of Surgical Site Infection, 1999 Opens a new windowPDFOpens a new window actually advises against shaving the skin whenever possible to minimize risk of skin infection.Opens a new window If the area to be tattooed is exceptionally hairy and the hair will interfere with the design application and tattooing process, shave your client immediately before tattooing them, and preferably with electric clippers rather than a straight razorOpens a new window. Hair removal creams could also be used, but they're more likely to irritate the skin.

Tattoo Skin Cleansers

Like piercers, tattoo artists may also use anti-microbial skin cleansers like Microsan Rx Surgical ScrubOpens a new window to wash clients' skin before tattooing them. Opens a new windowHowever, most tattoo artists tend to favor Green SoapOpens a new window. Green soap is a blend of liquid soap and ethyl alcohol, which is what makes it an anti-microbial skin cleanser. (Review the Green Soap MSDS here.Opens a new window) It comes in gallon bottles, 16 oz. bottles, and 8 oz. bottles that you can dilute per the bottle's instructions, as well as convenient wipe form. Green soap is by far the most preferred skin cleanser among tattoo artists today, but it isn't the only superb option available to tattoo artists. Intenze now offers a pre-tattooing skin cleanser called Intenze CleanzeOpens a new window, which cleans and cools the skin while also reducing redness. Like Green Soap, Intenze Cleanze contains ethyl alcohol as an anti-microbial agent, so the two products are comparable. However, Intenze Cleanze's additional benefits of cooling the skin and reducing redness combined with the way a 12 oz. bottle becomes a gallon of skin cleanser once diluted may make it a more enticing option for tattoo artists to use as a pre-tattooing skin cleanser.Opens a new window Whichever type of skin cleanser you choose to use on your tattoo clients, you'll likely need to dilute it or at least have a way to apply it to the skin easily. Our Precision tattoo washer bottles, available in 8 oz.Opens a new window and 16 oz.Opens a new window sizes, are the perfect solution for applying any tattoo skin cleanserOpens a new window. Once you've rinsed away the skin cleanser, blot the area dry with sterile gauzeOpens a new window before applying an antiseptic agent.

Tattoo Antiseptic Options

Once you've thoroughly washed a client's skin with an anti-microbial skin cleanser, you'll need to make a pass with an antiseptic agent. Most tattoo artists prefer to use alcohol prep padsOpens a new window, but you could also use an antiseptic swab like PrevanticsOpens a new window, which contains Chlorhexidine gluconate and isopropyl alcohol. Products like Prevantics that combine another antiseptic agent with alcohol are an ideal choice over pure alcohol, because alcohol can facilitate the transfer of tattoo ink sediment into the bloodstream and organs. Those tattoo enthusiasts who are extensively tattooed are at higher risk for accumulating larger deposits of sediment in their organs, so use alcohol as sparingly as possible when working on heavily-tattooed clients. Absolutely do not use alcohol to thin your tattoo ink in such cases; sterile waterOpens a new window is a much safer alternative. Opens a new windowWhen applying an antiseptic agent to the skin, you should start at the center of the area to be tattooed and work your way out in concentric circles, finishing up at least a couple inches beyond where the tattoo is to be applied. After applying the antiseptic and letting the skin dry, you can apply your tattoo stencilOpens a new window or draw a design on using sterile surgical skin markersOpens a new window.

Branding & Scarification Skin Prep

When preparing to apply a brand or scarification design to a client's skin, make sure you have a sufficient amount of sterile scalpel blades and handlesOpens a new window or electrocautery pen tipsOpens a new window on hand to perform the job. Opens a new windowYou may also want to stock up on DermaBond liquid skin adhesiveOpens a new window to fill scarification designs and hold them open after they're applied. If the area where your client wants their scarification design or brand applied is exceptionally hairy, you'll need to remove the hair. Preferably, you should use electric clippers to minimize the risk of a skin infection developing after the modification process. If you only have straight razorsOpens a new window at your disposal, make sure the razor you use is sterile and shave the area immediately before washing the skin. Opens a new windowAs for the actual branding and scarification skin prep process, it's very much the same as external piercing surgical skin prepOpens a new window. You'll want to thoroughly wash your client's skin where the scarification design or brand will be applied, using an anti-microbial skin cleanser like Microsan Rx SoapOpens a new window. You can use a washer bottle Opens a new windowfor easier application of the solution. After thoroughly rinsing the soap off and blotting the skin dry with sterile gauze padsOpens a new window, apply a topical antiseptic agent like alcohol padsOpens a new window or Prevantics swabsOpens a new window. Start in the center of the area where you'll be applying the brand or scarification design, and work your way out in concentric circles, finishing at least a couple inches beyond the perimeter of the area where the design will appear. Once the area to be modified is dry, you can apply your scarification design or branding pattern using sterile surgical markersOpens a new window and proceed with the modification. When you're done, perform proper post-modification clean-up proceduresOpens a new window to ensure you'll be prepared for your next client.Opens a new window

References

Guideline for Prevention of Surgical Site Infection, 1999 PDFOpens a new window Tattooing Safely: A Guide for Tattoo Artists Article on PainfulPleasures.comOpens a new window Skin Antiseptics for Piercing Preparation Article on Brnskll.comOpens a new window