Proper skin prep is an important part of the body modification process. It eliminates any bacteria, viruses and other microorganisms 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). If a client wants you to use a topical anesthetic, 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 products 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 iodine, 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.
Interview 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. If 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 form or tattoo release waiver acknowledging and accepting the risks involved. You should also stress the importance of proper piercing aftercare or new tattoo care, including frequency of cleanings, using the right tattoo aftercare or piercing aftercare products, eating nutritiously, getting quality sleep, quitting smoking or at least substituting e-cigarettes 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 prepared 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 Environment article for suggestions. Just before performing the modification, you'll also need to wash your hands properly, put on gloves and other protective gear as needed, and setup a sterile field containing all the tools and other modification instruments you'll be using. Visit our Shop Safety 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, 1999 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 Hygiene article. Do not turn off the water with your bare hands immediately after you finish washing them.
- 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 gloves.
- If you are unwell or will be in close proximity to your client's face, you should absolutely put on a face mask in addition to any other protective gear you may want to use, like a disposable apron.
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.
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 spray, 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 Prep section above. Next, wash the external facial area you'll be piercing with an anti-microbial skin cleanser like Microsan Rx Surgical Scrub or PurKlenz Topical Antiseptic Skin Cleanser, 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 gauze, finish the skin prep process by wiping the facial area you'll be piercing with an alcohol prep pad, a providone iodine prep pad (only if your client has confirmed that they are not allergic to iodine), or a Prevantics swab, 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.
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 Soap or PurKlenz Topical Antiseptic Skin Cleanser. If a client asks you to use a vegetarian/vegan-friendly product containing organic ingredients, you could use a detergent like Dr. Bronner's Soap. 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 gauze, and follow up with an extra antiseptic wipe instead of just making a single pass over the skin with an alcohol prep pad, providone iodine wipe or Prevantics swab. 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 PDF actually advises against shaving the skin whenever possible to minimize risk of skin infection. 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 razor. 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 Scrub to wash clients' skin before tattooing them. However, most tattoo artists tend to favor Green Soap. 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.) 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 Cleanze, 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.
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. and 16 oz. sizes, are the perfect solution for applying any tattoo skin cleanser. Once you've rinsed away the skin cleanser, blot the area dry with sterile gauze 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 pads, but you could also use an antiseptic swab like Prevantics, 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 water is a much safer alternative.
When 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 stencil or draw a design on using sterile surgical skin markers.
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 handles or electrocautery pen tips on hand to perform the job. You may also want to stock up on DermaBond liquid skin adhesive 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 razors at your disposal, make sure the razor you use is sterile and shave the area immediately before washing the skin.
As for the actual branding and scarification skin prep process, it's very much the same as external piercing surgical skin prep. 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 Soap. You can use a washer bottle for easier application of the solution. After thoroughly rinsing the soap off and blotting the skin dry with sterile gauze pads, apply a topical antiseptic agent like alcohol pads or Prevantics swabs. 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 markers and proceed with the modification. When you're done, perform proper post-modification clean-up procedures to ensure you'll be prepared for your next client.