How Transdermal Implants Work

Transdermal implants create the appearance of external objects implanted straight into the body. In reality, the implanted object is an anchor with a threaded post. The post protrudes through a hole in the skin, and "jewelry" screws onto it.

In Aylward's "metal mohawk," now removed, the jewelry was thin metal spikes up to 1.5 inches (3.8 centimeters) long [source: Webb]. Body-mod artist Samppa VonCyborg has a mohawk of stout horns [source: Larratt]. Dennis Avner, aka "the Cat Man," now deceased, screwed whiskers onto implants in his eyebrows [source: Stokes]. Some people choose more traditional jewelry, like stars or studs that sit flush to the skin. An NYU professor who got transdermals in 2010 for an "art project" screwed a camera onto three implants on the back of his head [source: Orden].

Body-mod pioneer Steve Haworth designed both the procedure and the first anchor, drawing on a background in medical-tool engineering [source: Stokes]. Those in use 20 years later look a lot like the original.

Anchors are typically forged of implant-grade titanium [source: Russ Foxx]. Often custom-made, their exact designs can vary but generally consist of a flat base, either a circle or a rounded rectangle, that has a perpendicular, threaded post at the center [source: Beyond Body Modification]. The base has multiple openings in it, allowing scar tissue to grow through and firmly embed it in surrounding tissue, placing transdermals in the "permanent mod" category [sources: BMEzine Encyclopedia, Beyond Body Modification]. Size depends on the intended jewelry, with bases ranging from 6-16 millimeters (0.2-0.6 inches) in length or diameter and posts ranging from 1.5-5 millimeters (0.06-0.2 inches) tall and 2-8 millimeters (0.08-0.3 inches) in diameter [source: Rock The Body].

A lot of the controversy surrounding the modification relates to the procedure required to implant the anchor, which can only be described as surgery.

Of course, performing surgery without a medical license is legally hazy at best, so if you're the one doing the surgery, you'll likely describe it as "art" [source: Stokes].

The transdermal-implant process is invasive. It involves an incision, tissue separation and sutures. And if there are any actual medical doctors performing it, they're not advertising. The work is done by body artists, some highly skilled, some winging it [source: Stokes].

As described in blogs and wikis serving the extreme-body-mod community (and in photos not recommended for queasy readers), implanting a transdermal anchor goes much like this [sources: BMEzine Encyclopedia, Beyond Body Modification]:

*Dermal elevators are common plastic-surgery tools used to lift and separate skin from underlying tissue. They look a little like metal spatulas. Not all cutters use a dermal elevator, but it's considered the right tool for the job -- as opposed to the butter knife, which some use instead [source: Stokes].

And all of this, um, art, is carried out by a cutter who may or may not possess any medical training, with equipment that may or may not be properly sterilized, and usually in a room in someone's house [source: Stokes].

What could possibly go wrong?

A body-mod wiki user tells of a man with a transdermal mohawk who developed an infection at an implant site. It briefly hurt but then seemed fine, and while he went about his life the infection quietly left the surface and traveled inward, eating a hole in his skull that finally left him in so much pain he went to the hospital, where he traded out his implants for a metal plate in his head [source: BMEzine Encyclopedia].

True? Who knows. The important thing is, it's entirely possible.

Transdermal implants have an estimated "success rate" of 20 percent, which might be high [source: Philips]. Even in the extreme-mod community, they're considered high-risk – more so than subdermal implants, which often heal quite nicely [source: Beyond Body Modification]. The big problem with transdermals is that the implant site is open to the environment [source: Beyond Body Modification]. Infection is pretty likely [source: CBSNews].

Infection is one of the biggest risks associated with transdermals, especially the inward-traveling kind that can eat a hole in a skull. Others include deep transdermal placement, in which the artist places the anchor too deep, potentially damaging muscle and bone and leaving the area particularly vulnerable to inward-traveling infection; rejection, in which the body pushes the implant out; migration, in which the implant changes location; and various types of scarring, bubbling, oozing and bruising [sources: BMEzine Encyclopedia,Philips].

Almost all transdermal implants eventually need to come out (typically due to complications, though a necessary MRI would mean removal, too), and getting them out is a lot harder than getting them in. Scar tissue has grown through the anchor base. Removal can mean huge incisions that leave prominent scars, and if inward traveling infection or deep transdermal placement is involved, removal can require major surgery [source: BMEzine Encyclopedia].

Transdermals' risks and poor track record have led to a general sense of ill-advisement in the extreme-mod community, especially with the development of microdermals[source: Philips]. Microdermal implants protrude through the skin but sit on anchors small enough to be implanted using piercing techniques, as opposed to surgery [source: Beyond Body Modification]. They don't support the jewelry sizes seen in some transdermals, though, like the spikes in Joe Aylward's metal mohawk.

As for that groundbreaking implant, it lasted a full decade before Aylward had it removed "for personal reasons" [source: BMEzine Encyclopedia]. All in all, not a bad run.