by Merry Sue Baum Reclining in a plush, purple leather chair, 16-year-old Heather squeezes her girlfriend's hand. She's nervous. The procedure about to be performed - a navel piercing - may be somewhat painful. But it won't take long and the end result, she knows, will be "absolutely awesome." As he dons a pair of latex gloves, "Wild Bill, owner/ operator of Pleasurable Piercings in Hawthorne, reassures Heather that it will barely hurt - no more than a pinch. He carefully cleans the area with betadine solution and alcohol, and using a marker puts a tiny dot on the spot to be pierced.

Next he clamps the skin with Pennington forceps - an instrument that looks like a pair of narrow hot dog tongs - and before you can say "body modification," he's pushed a sterile needle through the rim of her belly button. A split second later he slips a small, gold ring through the hole and announces that it's over. As Heather admires her jeweled navel in the mirror, Bill disinfects the chair and instrument table and begins setting up for his next customer.

Howard, Heather's 15-year-old brother, takes the seat she has just vacated and in almost no time, his upper ear is pierced. He's followed by 19-year-old Joe who decided only an hour earlier to begin sporting a gold barbell through his tongue. A legal assistant, Lynn, who is thirty-something, spends her lunch hour at Pleasurable Piercings, having her navel pierced, and on and on it goes. In any given day, "Wild Bill," known as the "Grand Piercer," and his staff, "the Piercing Posse," perform between 20 and 40 procedures. That's some 7,000 a year. Prices start at $15 and go up to $40 (for anything below the waist), not including the jewelry.

Several decades ago, piercing in America went no further than the earlobes of young girls. Anyone even giving body piercing a thought back then, probably surmised that people with rings dangling from their noses, lips and genitals existed only in far-off lands or in anthropology books. But times have changed. Teens, Yuppies and even those over 40, from every income level, are frequenting parlors like Pleasurable Piercings to have eyebrows, noses, lips, tongues, nipples, navels and genitals pierced and adorned. It's done for a wide range of reasons - from acting on a dare to believing it will enhance sexual pleasure. Whatever the motivation, the question many are asking, especially parents, is: How safe is it?

Pointers on Piercing Never pierce yourself or let an inexperienced person pierce your body. Go to a reputable piercing parlor. Don't have piercing done if you are pregnant or nursing. Before you go, consult with a physician or other knowledgeable health care professional to learn the anatomy of the region you want pierced. Know the risks. Question the piercer. A reputable piercer will be more than willing to cooperate. Does the person know anatomy? What kind of training and experience does he or she have? Ask your physician about vaccination against hepatitis B before getting pierced. Find out if equipment being used is sterilized in an autoclave, a table-top piece of equipment that kills infectious micro-organisms with steam, heat and pressure. Ask to see a certificate verifying that the autoclave has been recently inspected. Boiling water won't do the job, so if the piercer doesn't use an autoclave, head for the door. Talk to others who have had piercings. Ask what kind of experiences they've had. Wear only jewelry made of 14k yellow or white gold, niobium, or surgical-grade stainless steel. They contain fewer alloys than other metals, and therefore are less likely to cause an allergic reaction. Be sure to follow after-care directions to the letter. Consult a physician immediately if you suspect an infection or other medical problem. Think long and hard before having your body pierced. Are you sure you want to have it done? Are you sure you're sure. After you decide, think again.

New Jersey has no state laws regulating body piercing. Tony Monaco, a coordinator of health projects with the state department of health, says legislation has been pending since 1994, but has yet to be passed. Piercers learn on their own or from others in the industry; no actual schools exist and there are no required exams or licensure.

Nevertheless, there are responsible piercers. "Wild Bill," for example, has nearly seven years experience, won't pierce anyone under 18 without parental permission, gives precise, written after-care instructions and uses sterile techniques.

"Wild Bill" Krebs, 29, owner/operator of Pleasurable Piercings in Hawthorne, says he loves "making people beautiful" with piercings.

Bill learned to pierce, he says, first by reading every book he could get his hands on. Since he couldn't find anyone on the East Coast who was doing piercing at that time, he consulted with experienced piercers in California who helped him learn the trade. And he continues to learn. He says he and his entire staff, even those who don't pierce, have taken courses in CPR and blood-borne pathogens. He keeps in contact with the state board of health to learn of new programs or procedures that might apply to his trade, and a dermatologist-friend keeps him informed of the latest medical news that might affect his field.

As for the other piercers in his shop, most have learned from Bill. "That way I know they're learning the right way to do things," he says.

Not all piercing establishments, however, hold themselves to such standards, and physicians at UMDNJ say piercing the body is fraught with hazards, especially for do-it-yourselfers. That's why those being swept by "piercing-mania" should proceed cautiously.

The most immediate concern after a piercing is infection, says Roger Brodkin, MD, clinical professor of medicine at UMDNJ-New Jersey Medical School. "Any time you puncture the skin, you become vulnerable." The navel is especially susceptible to infection, Brodkin notes, since it is an area of the body that he terms very unhygienic. Another problem, he says, is the formation of keloids, lumpy overgrowths of scar tissue.

"They're unsightly and they can be painful and itchy," he adds. It's impossible to predict who will get a keloid, and their removal can be painful. It's done either by injection of cortisone or surgery, and there's no guarantee another keloid won't form. Added to that is the risk of having an allergic reaction to the metal in the jewelry.

Brodkin says he has repaired numerous tears in the skin after jewelry, especially earrings, inserted in a piercing got caught and pulled by clothing. And he recalls one case where it was necessary to surgically remove a cyst that had formed in the oil gland that is located in the eyebrow, after it was pierced.

Because piercing involves the use of needles, Brodkin warns the medical risks include contracting diseases, such as hepatitis, AIDS, cutaneous TB and tetanus. If a sterile technique is used, however, and the area is kept clean during healing, he says, the risk is markedly reduced.

Among the most popular sites to be pierced is the tongue. Unfortunately, it is also one of the most dangerous. Because the oral cavity has a greater bacterial density than any other environment in the body, the risk of infection is high, even in a healthy mouth, says David Sirois, DMD, PhD, director of the division of oral medicine at UMDNJ-New Jersey Dental School. "If the person being pierced has an undiagnosed infection that the piercer doesn't recognize - anything from yeast to infected gums - 'seeding' might occur. When deeper layers of tissue become infected, treatment is difficult and permanent scars can form."

But more than that, Sirois says, piercing the tongue could result in excessive bleeding: "The tongue has a very rich blood supply. Someone putting a hole in the wrong place could hit a blood vessel." He adds that even a professional piercer would not be equipped to stop the bleeding. "The minimum you'd need would be electrocautery to seal the vessel, and conceivably even sutures."

Eric Nyenhuis, a 29-year-old tattooist, wore a barbell in his tongue for nearly a year, but removed it. "It chipped the enamel off three of my teeth," he confesses. "When you chew you don't recognize the barbell as something other than food and you bite down on it." Nyenhuis says immediately after having the piercing, his tongue swelled "like a baseball." For two weeks after the piercing, he was instructed to rinse with Listerine® every time he ate or drank, and talking became a real challenge. "You really have to get used to it," he says. It took about six weeks for his tongue to heal completely. Now that the barbell is gone, Nyenhuis says he has "a big knot" in the center of his tongue.

Not surprising, says Sirois. The mouth, including the tongue, is lined with epithelial cells. "Normally they migrate across a wound and healing begins," he explains. "However, the barbell creates a barrier so the epithelial cells form a tunnel through the tongue. The likelihood of having scar tissue or a chronic fistula is very high." The only way to correct it, he notes, is to surgically recreate the wound and let it heal with the aid of a few sutures.

Having a lip pierced is somewhat safer, since the blood supply is not as great. However, Sirois says there are still reasons for concern. Piercing the junction of the lip and skin might result in a permanent scar that may have to be corrected surgically. He adds that if one of the many tiny salivary glands located in the lip is injured, a cyst may form, plaguing the person with salivary blisters.

The safest places to be pierced, Sirois says, are the side of the nose and the earlobes. "There is a very low blood supply to those areas and there's not much that can get damaged."

Jeffrey Schiller, MD, cringes at the possible ill effects of piercing the eyelids and eyebrows. A 1979 alumnus of New Jersey Medical School and a clinical associate professor of ophthalmology there, he says the most obvious risk is that the piercer might slip and cause permanent injury to the eye. It is also possible that an infection could develop.

"We often see infections of the eye that developed without an injury," he says. Wearing even a small piece of jewelry through the eyelid, he adds, may cause abrasion of the cornea. It could also result in the lid drooping permanently - a condition that would have to be rectified surgically.

Schiller says a large nerve bundle exits the skull behind the eyebrow. While a piercer would have to go fairly deeply to injure it, there is a slight possibility of loss of sensation and/or movement of a small area of the forehead, should that occur.

Paulette Stanford, MD, associate director of adolescent medicine at the medical school, says piercing the nipples can be risky business. A reaction to any foreign body that may enter the wound could result in the formation of a cyst or an abscess behind the nipple that would require surgical removal. A young girl who doesn't seek treatment may find it difficult or even impossible to later nurse a baby, due to scar tissue.

Piercings done below the waist, as it's delicately put, are subject to the same risks as other areas. Stanford says women who get an infection or keloids could end up with urinary obstruction or loss of sensation in the clitoris. Painful tears are a possibility, too.

People get piercings for a variety of reasons - from acting on a dare to wanting to identify with a group.

For males, there are even greater risks. Eli Lizza, MD, clinical assistant professor of surgery and director of the division of male reproductive medicine at New Jersey Medical School, says piercings behind the scrotum, close to the rectum, are particularly prone to infection. An artery, known as the frenula, runs along the underside of the penis. If it is accidentally pierced, profuse bleeding can occur. A piercing done through the head of the penis could result in damage to the urethra, which is part of the urinary system, or cause impotence.

Despite the risks, piercing is probably here to stay, at least for a little while. In light of that, all the physicians concur: Follow a few guidelines, and don't hesitate to seek medical treatment if something goes wrong. "A person need not be embarrassed," says Sirois. "As doctors, we have an obligation and a desire to help patients, no matter what the nature of the injury."

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