How Transdermal Implants Work

Kala Kaiwi, a body mod artist from Hawaii, poses at the 2015 Venezuela Expo Tattoo. Among other mods, Kaiwi sports transdermal and subdermal implants, a split tongue, various piercings and tattoos and oh yeah, he's the world record holder for the largest non-surgically made stretch earlobes.
© Jorge Silva/Reuters/Corbis

When a guy walked out of house in Phoenix in 1996 with metal spikes protruding from his head, it was the start of something big. Not tattoos-and-tongue-rings big -- as far as "body modifications" go, those are downright mainstream. But big as in a giant leap for extreme body modification: That "metal mohawk" was, as far as we know, the first transdermal implant, and it laid the groundwork for all other implant designs that followed [sources: BMEzine Encyclopedia, Philips].

Almost anything we add to or change about our bodies for appearance' sake is a body modification, technically speaking [source: Bradley University]. Most are about getting closer to a cultural ideal of beauty, like nose jobs, breast implants or foot binding. Others are simple adornments, like pierced ears. They're often pretty by cultural norms. We hardly notice them.


Extreme body mods are something different, partly because they're about straying from widespread appeal, not moving toward it. They may have some element of ritual associated with them [source: Bradley University]. In Western cultures, modifications like transdermal implants, genital piercing, branding and ear stretching are all considered extreme. They're relatively rare, and they may provoke negative reactions among the general public [source: Sprague].

Yet many of these extreme modifications have long histories outside the West. Ear stretching, or the gradual enlargement of an ear-lobe piercing around progressively larger discs, dates back millennia to Egypt, China and Mayan and African cultures [source: DeMello]. Branding has its roots in the ancient rituals of tribes like the Australian Aborigines and the Karos of Ethiopia [source: Guynup]. Penis piercing is described in the Kama Sutra, ancient Hindu's guide to sensuality [source: Siderius].

And then there are transdermal implants, which appear to date all the way back to 1996, when Phoenix-based "body artist" Steve Haworth attached metal spikes to Joe Aylward's head [source: BMEzine Encyclopedia].

A transdermal implant is an object inserted under the skin and made to cross the dermal barrier. Transdermals can be problematic, to say the least: The healing rate is abysmal, and the procedure required to get them in is at least somewhat illegal [source: Stokes]. It's primarily an underground practice, and detailed information from traditional sources is somewhat sparse [source: AP]. But information offered in body-mod wikis and forums paint a picture of a practice that's controversial even among the extreme.


Implant Art: Sub, Trans and Micro

The trio of transdermals on that gentleman's forehead look as though they might be a bit irritated. Transdermals are notoriously bad at healing.
© Camilo Delgado Castilla / Demoti/Demotix/Demotix/Corbis

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].


Transdermal Procedure: In, Under, Through

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]:


  1. If local anesthetic is being (illegally) used, it's administered [source: Orden, Stokes].
  2. The artist marks the intended implant location on the skin, as well as another location about an inch (2.5 centimeters) away for the incision.
  3. With a scalpel, she makes a 1-2 inch (2.5-5 centimeter) incision and inserts a dermal elevator* either among or beneath the layers of skin (proper placement is controversial) [source: Larratt]. She pushes the dermal elevator through until it sits just beneath the marked implant point. The result is a "pocket" running from the incision to the marked implant point.
  4. Using the scalpel or a dermal punch (an instrument with a sharp, hollow circle at the tip), she cuts a hole in the skin down to the dermal elevator, which remains in place to protect underlying tissue while the hole is made.
  5. She inserts the transdermal anchor into the incision, moving it through the pocket until it arrives at the hole. The post is worked through the hole so it emerges outside the skin.
  6. She sutures the incision.

*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?

The transdermal implant procedure
© 2015 HowStuffWorks


The Wide Range of Risks for Transdermal Implants

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.


Lots More Information

Author's Note: How Transdermal Implants Work

It's rare that I come across a topic with so little in-depth coverage by traditional media. Extreme body mods in general have gotten a lot of press, though details of procedures are often vague, perhaps because of legality issues, though I have to wonder if "let's not encourage people to do this" plays a part as well. I personally had several questions about the procedure that went unanswered -- I contacted several artists, but none responded. My detailing of the procedure, then, is not comprehensive and, even if it were comprehensive, should not be viewed as instructions. Serious complications occur even when a highly experienced, skilled artist with medical knowledge performs the procedure, so imagine how bad things can get when a novice has a go at it. In other words, PLEASE DO NOT TRY THIS AT HOME. You could hurt someone.

Related Articles

More Great Links

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