Piercing Images

It used to be a big deal for a 16-year-old girl to get her parents' permission to pierce her earlobes (one each please). But ever since Janet Jackson's little "wardrobe malfunction" during the Superbowl half-time show, even the elderly Norwegian bachelors in North Dakota know ear piercing is old school. Nipplegate may have been a publicity stunt to pump up Janet's exposure just before the release of her new album– but what it really exposed was how mainstream body piercing has become.

American researcher Anne Velliquette, PhD observed, "[t]oday's social climate welcomes body art to an extent that no other period in modern history can rival." Her thought is that it provides meaning to persons bewildered by the fragmentation and chaos of postmodern society: your body is the one thing you have ultimate control over.

What Janet Jackson was exercising control over with was a nipple shield, a decorative piece of jewelry held in place by a 'normal' piercing rod or barbell placed through the areola. Her 1997 album Velvet Rope featured close-ups of her nipple piercing as part of the album artwork. She no longer wears jewelry in either her septum or tongue piercings, but her ears, navel, and genitalia are still adorned. (It is thought to be a clitoral piercing.)

She has competition from Christina Aguilera. Aguilera has five piercings in her ears and one piercing each in her nose, her lower lip, and right nipple, plus 3 more. She has said these are in a place known only to her doctor and her boyfriends: it's diamond-studded, "really beautiful and expensive" and "in a place that most people wouldn't have the guts to do it."

Like the nipple placement, genital piercings reportedly enhance sexual sensitivity. Piercing sites in men include the penile glans and urethra, foreskin, and scrotum; sites in women include the clitoral prepuce or body, labia minora, labia majora, and perineum.

Britney Spears gained some media attention as she organized a "nipple piercing party" for her staff on Valentine's Day 2004 (her own left nipple is pierced). Singer Pink (Alecia Moore) recently got all dressed up and had her nipple pierced in front of her mom– on videotape. Don't we all? The boys go in for it too, particularly the musicians: Tommy Lee, Axl Rose, Lars Ulrich, and scads of others.

As a matter of fact, the really flamboyant multiple piercings seem to be the domain of male celebrities, but only amongst those that don't make their money on the silver screen: Dennis Rodman, Benji Madden, Dave Draiman are standouts.

Christy Turlington is said to have started the female naval ring fad when she strutted her belly jewel on the modeling runway. After multiple ear piercings, navel rings are by far the most common choice amongst female celebrities and the American women who imitate them. Alyssa Milano, Beyonce, Britney Spears, Gwen Stefani, Jessica Alba, Lindsay Lohan, Madonna, Keira Knightley, Naomi Campbell, Nicole Richie, Paris Hilton, Teri Hatcher all chose this placement.

When Scarlett Johansson gifted herself a bull-style nose ring in 2005, though, you could hear the howls reverberate in cyberspace. On occasion she pops it in when strolling about and it's rediscovered anew by legions of disapproving fans. The actress is currently the face of L'Oreal, and adamant that the nose ring is attractive: "[i]t's all about my creative side and I personally look lovely. So what exactly is the problem with it?" Less controversial was her piercing of the nasal alar rim (the fleshy curve of the nostril). That placement evokes images of dark, exotic Eastern women, while the other conjures up a large, wet nose attached to 500kg of un-neutered beef.

Nose piercings were first recorded about 4000 years ago in the Middle East. Even Genesis 24:22 mentions it: when Abraham requested a wife for his son, Isaac, one of the gifts presented to Rebekah was a golden nose ring. The practice of nose piercing moved on to India during the 16th & 17th centuries with the type of jewel indicating social status. Indian women traditionally pierce the left nostril, thought to be connected with the female reproductive organs, to make childbirth easier and lessen menstrual pain. Nostril piercing came to the West in the late 1960s along spiritual enlightenment from India. Punk rockers and their followers adopted the practice in the 1970s, and it was revived again in the 1990s. Now the likes of Lisa Bonet sport them.

Is there a downside to this? Well, Nicole Richie did set off an alarm at the Reno Airport as she passed through a metal detector with her nipple piercing in situ.

In general, the medical specialty societies frown on it. The American Medical Association (AMA) goes as far as considering some forms of body piercing to be illegal surgery. The major things to keep in mind before you pierce your tongue, eyebrow, belly button, lip, nipple, genitals or navel are long healing, infection, dental damage, and scarring.

Nose piercings like Johansson's are usually are performed in the inferior fleshy part of the septum and not through cartilaginous tissue. Noses, like many cartilage piercings, can be notoriously long in healing because that type of tissue is not well vascularized. The wound heals from the surface, growing a tunnel of new skin inside the hole to form a permanent piercing.

The infection rate for tongue piercings is relatively low, but the tongue & lip studs and rings can lead to chipped and cracked teeth. And then there's the excessive drooling and speech impediment problem, but that's minor.

Even good old-fashioned ear piercing isn't exempt: up to a third of persons with pierced ears had one or more complications (e.g., minor infection, allergic reaction). The most disturbing are keloid formation (exuberant scar formation in dark skinned individuals) and traumatic tearing (bifurcated earlobes aren't stylish). 'High' piercing through the cartilage of the pinna (like Fergie's) is particularly associated with poor healing and more serious infection because of the avascular nature of auricular cartilage.

And then there's the 'stretching' or 'gauging' craze. It's the deliberate expansion of a healed fistula (hole in the skin) for the purpose of wearing big jewelry. It's been around for a while: even Otzi the 5000 year old Iceman mummy found in the Valentina Trujillon glacier had an oversize ear piercing. In Ireland gold artifacts from Bronze Age were identified as ear spools and boxes needing perforations 7+cm diameter.

Most piercings can be stretched far beyond their initial size. 'Blowouts' from over-stretching, especially ones caused by 'dead stretching,' can create scar tissue, which can lead to keloiding or hypertrophic scarring. And stretching too quickly can lead to a buildup of unsightly scar tissue, often described as the 'cat-butt' effect.

Now there's a lovely thought.


Want this look?
Part of the popularity of body piercing is the entry level pricing: it's cheap. Most piercings start at under $100, even the really interesting ones. Make sure you inquire about sterile technique and be prepared to involve your physician is goes wrong.

Women & Tatts

It all comes down to Cher. Back in 1972 when she was 27 years old and newly separated from Sonny, she got her first tattoo:

"I thought it would be something different, a statement of freedom. Good girls didn't have tattoos then, no one was doing it...It was really the first step of an experiment to state making decisions on my own....I had made so few real decisions that I was bound to be bad at it. I was right."

Now all the A-list (and A-wannabe) celebrities are inking their bodies. The tattoo has become a female fashion accessory, rather than the rite of passage. It's no longer taboo, but still a little risque– different but accepted. It's almost difficult to name an actress who hasn't got a tatt. Everybody's doing it, from girl-next-door Jennifer Aniston to Bay-babe Pamela Anderson.

The subject matter of body art has undergone a revolution of sorts. The old stereotype of sailors and marines – and who doesn't know an aging WWII veteran with a blurry rendering on his bicep – are of a generation who never dreamed of finding their own name tattooed across the flesh of their stateside sweetheart. Today that's all changed. Women are elbowing out young men to get in the door of the tattoo parlor. In a recent survey, 22% of the UMass undergraduate women sports a tatt, twice the rate of the male students.

While "Mom" and the names of sexual partners still rank high in frequency and gang symbols are widespread amongst the prison-bound populace, the upsurge is in young women. Estimates are as high as 36% of all American women ages 21-32 now sport a tattoo. They seem to be indulging in tattooing as more of a journal of sorts. And the celebrity women are no exception. According to Angelina Jolie:

"Usually all my tattoos came at good times. A tattoo is something permanent when you've made a self-discovery, or something you've come to a conclusion about."

Okay, not counting the blue-tongued dragon she got when she was drunk and dropped trou in Australia a few years back (now covered by the black cross/dagger handle). Perhaps the most prominently tattooed actress today, Jolie has 13 tatts at last count and several older ones that were converted or removed. She has stated she’s just a “punk kid with tattoos” at heart, but dressed and strutting the red carpet, she is radiating more of a regal tribal look these days.

Some stars go so far as wearing it, literally, on their wrist. Not satisfied with a cement star in the sidewalk, Eva Longoria and Ashlee Simpson both sport small black outlined stars on their left wrists. Victoria Beckham has five stars on her lower back. Perhaps it’s part of the Michelin rating system?

And then there are those who want to commemorate their childhood. Nicole Richie sports a pair of ballerina slippers, as if her father’s composing Ballerina Girl for her wasn’t enough. But the little pair of angel wings on her back? You decide. Christina Ricci decided on having Aslan, the lion god of Narnia tattooed onto her left scapula to symbolize her emancipation from a hellish childhood – and seven more to go with it.

And then there are those fans that just go in for having the star himself as the tattoo: elaborate celebrity images are getting more and more popular. Reminds one a bit of those edible photographic sheet cakes.

This young female demographic is characterized by a certain exuberance of spirit that settles down as it approaches strapless wedding gowns and steady jobs. And tattoo removal. In the good old days, you died with your tattoos. Or you traded them in for horrific scars. Before the advent of lasers, a variety of treatments were tried: dermabrasion or skin sanding, X-ray treatments, chemical peel, liquid nitrogen, dry ice or CO2 'snow,' flesh-colored over-tattooing. The most common method? Surgical excision and skin grafting of the hole left behind. It wasn’t pretty.

The advent of medical laser technology has changed all that. Tattoos are created by placing drops of ink under the skin via a needle (hopefully). A Q-switched Nd: YAG laser is the one most often used to remove tattoos and other pigmented or discolored skin. The high-intensity light beam penetrates the dermis and is absorbed by the ink, vaporizing the pigment colors. It feels like rubber bands snapping against the skin. Hard. Over and over. The lymphatic system (the body’s natural filtering system) clears the dissolved particles of ink pigment. A tattoo that cost a few hundred dollars could require several thousand dollars and many laser sessions to remove.

Bright green, yellow and red inks are most difficult to remove. A new tattoo technology is available starting this fall called Freedom-2, a type of ink encapsulated in beads and designed to break up after one treatment with a special laser. It will be interesting to see if this 'removable' tattoo changes what and how often people adorn their bodies with images.

Tattoo removal clinic chains are making their mark or erasing it, so to speak: Dr. Tattoff, Tat2BeGone and Tattoo MD sprung into being on the West coast. Many states don't regulate tattooists or tattoo parlors, but do regulate medical lasers. These tattoo removal clinic chains are most often staffed by nurses. In other locales laser removal is supervised by physicians: plastic surgeons, dermatologists, or practically any physician with a laser payment to make.

Angelina Jolie has spent time in the doctor's procedure room: ex-husband Billy Bob's moniker has been lasered and the real estate tattooed over with the longitude and latitude of each of her four children. And Cher? At 61, she now thinks tattoos are "just plain stupid" and is in the process of getting them all removed.

In the final analysis, young women getting tattooed may be all about empowerment.

And power is really sexy.

What do you think? Click on the envelope icon and send us your thoughts.


(Okay, this last tattoo is made up.)


Want This Look? A professional tattoo can be had for under $100, and one that costs a few hundred dollars could require several thousand dollars and many laser sessions to remove. Dr. Tattoff charges $39 per square inch of tattoo for each treatment. Full removal takes an average of eight treatments, spaced at least a month apart, using different Q-switched lasers for different-colored inks.

Too Rich, Too Thin

Women think about their weight the way many men think about sex: all the time. So when is thin, TOO thin?

Just these last few weeks too thin has been selling Hollywood gossip rags. In Touch magazine apparently photoshopped out Angelina Jolie's (32) protruding arm veins for its May cover. The normal body fat that gives a smooth contour to the flesh is missing. Her emaciated arms reflect a significant weight drop while grieving her mother's death this past January. And Keira Knightley (22) is in and out of the tabloids. She has long denied eating-disorder rumors and in January of last year she sued a British tabloid for implying she lied about not having anorexia after losing weight during the grueling Pirates shoot. She probably is telling the truth. Neither woman appears to have a pathological relationship to food.

Last February former supermodel Tyra Banks was on the cover of People after having made a huge internet splash in an unflattering bathing suit. The very same month she was featured inside Vanity Fair channeling Audrey Hepburn. At 5’10” and 161 lbs. Banks's BMI is 23.1 and well within the range of normal health. It should surprise no one that the same woman can look fat in a paparazzi shot and stunning in a photo shoot. We all can.

Body Mass Index (BMI) is sophisticated way to calibrate height & weight (BMI=kg/m2) and do away with the "big boned" excuses. Here are the standards used in medicine:

Less than 18.5 = underweight
18.5-24.9 = normal
25-29.9 = overweight
30-39.9 = obese
40 or more = morbidly obese

We are a fat country and getting fatter. Approximately 33% of adult Americans are obese and an additional 32% are overweight. Yet we also have an peculiar national body dysmorphia, where female celebrities are ruthlessly pilloried for appearing at a normal weight. So from where does this national body distortion arise?

One finger points to the fashion industry. Unlike cigarettes and liquor, American is not protecting it's young from the influence of underweight image marketing. For example, Tyra Banks (33) began modeling on the catwalk at age 18 with a BMI of 16.2; by age 20 as she finished puberty she was curvy enough that her agency pressured her to lose 10 lbs. Instead, she switched to underwear/swim suit modeling in 1995. By 1997 she was the first black woman to be featured on a Sports Illustrated cover, then going on to Victoria’s Secret stardom – all with a BMI 18.8! That's just within the range of normal.

Drugs, diet pills, fasting, laxatives are rife in the image industry – very, very few of these women are that underweight by nature. After a spate of anorexic models died or fell ill last year, Madrid Fashion Week city council organizers enacted ground-breaking legislation: mannequins with a BMI of less than 18 (5'9" 123 lbs.) would be banned from the catwalk. About a third of the models who appeared the previous year won't qualify under the new guidelines, top models such as Brazil's Fabiana, Spain's Esther Canadas, Britain's Kate Moss and Estonian Carmen Kass. But Madrid is alone in treating this as a public health issue. The really big fashion venues – Milan, Paris, New York, London – aren't buying in.

"We worked hard to restrict advertising for alcohol and tobacco because of the potential dangers to our young people, and fashion is now the only major industry without health guidelines." –Lynn Grefe, CEO, National Eating Disorders Association

One study found 47% of school girls 5th-12th grade want to lose weight because of magazine pictures – pictures which are photoshopped out of reality (there are whole websites devoted to exposing this.) The print and film media are actively engaged in a manipulation of public perception. The female image school girls buy into is a simulacrum, an unsatisfactory imitation of, a substitute for real womanhood."Even I don't look like Cindy Crawford when I wake up in the morning," admits the famous supermodel.

How serious is it? It’s a mental illness that progressively damages the body, fatal to 15-20% of sufferers. It precipitates more deaths among females aged 15 to 24 than all other causes combined. (It caused Terri Shiavo's heart failure and brain death.) And eating disorders have doubled since 1960s. An estimated 10 million girls and women, as well as 1 million males suffer from anorexia nervosa (starves, obsessive, body dysmorphia, compulsive exercise) or bulimia nervosa (normal weight, binge/purging cycles). There is some evidence of altered brain chemistry that makes it hard to stop. For more information check ANRED.

Of course there are some famous dead Hollywood anorexics, like Karen Carpenter (32) and Margaux Hemingway (41), along with the aforementioned Audrey Hepburn (61). Several stars lived through it and talked afterwards: actress Jane Fonda (69) suffered from bulimia from age 13 to 37.

The current crop of Hollywood sufferers includes many. Nicole Richie (25) repeated bouts of fainting underscore her eating disorder/drug problem. In November, Richie told Us Weekly: "I'm not in rehab, and I don't have an eating disorder. I'm getting the help I need and taking care of my health." Denial ain't just a river in Egypt. Mary-Kate Olsen (21), Kate Bosworth (24), Victoria Beckham (33) all share the disease.

There are a few stars in Hollywood speaking out against the pervasive thin image. Cameron Diaz (34) has said:

“We get ideals from images that we see and there certainly should be more responsibility put on those people who are putting those images out into the world. Let’s be a little bit more responsible to what’s realistic.”

Kate Winslet (31), nicknamed 'Blubber' in school, has unapologetically appeared nude in six films. She describes the trend as "unbelievably disturbing." After being Photoshopped into an approximation of supermodel perfection for the cover of a GQ magazine Winslet veraciously complained: “the retouching is excessive. I do not look like that and more importantly I don’t desire to look like that.” Listen to what the GQ editor said in response and take it to heart – and tell your children:

"These days you only get two kinds of pictures of celebrities - paparazzi pictures or pictures like these which have been highly styled, buffed, trimmed and altered to make the subject look as good as is humanly possible. We do that for everyone, whether they are a size six or a size 12. It hasn't a lot to do with body size. Practically every photo you see in a magazine will have been digitally altered in this way."

Want this look? It can't be had surgically, but recovery in a facility can be expensive and ongoing.

Body Lift

Jennifer Hudson (26) gained weight to play her breakout role in Dreamgirls. Hollywood had to find an unknown to play the heavy, young singer biographically based on Florence Ballard of the Supremes.

"I had to maintain my weight to keep up, because we had a lot of dancing and performing to do and [my character's] not supposed to be a little girl....so you're all just going to have to get used to my jelly," she laughs, "Hey, somebody has to represent the big girls. Why not me?."

Just who are the "big girls" out there? In America, over half of all adults are overweight. Sixty-four percent to be exact. And in the last 20 years it's tripled amongst the 6-19 year-old group, rising to 16% of the population. It's not getting better, it's getting worse in the US.

So it makes sense that bariatric surgery is the new big thing. It's use is restricted to those with a BMI of 35+ or about 100 lbs. overweight. Over 177,000 surgeries were performed in 2006 (6 years ago it was 37,700). The average cost is $30,000 but insurance coverage is available for BMI of 40 or greater (the definition of morbid obesity). Even Medicare pays. Calculate your own Body Mass Index here.

There are two main procedures: gastric bypass and gastric banding. Gastric bypass surgery, involves fashioning a egg-size pouch (90% reduction) out of the top of the stomach and reconnecting it to half of the small intestine. Two feet of intestine go in the bucket. It’s permanent. Patients experience nutritional deficiencies or malabsorption of micro nutrients. Calcium supplements and Vitamin B12 injections are routinely required following gastric bypass. Gastric dumping syndrome also can occur.

Gastric banding is an adjustable restriction using an inflatable band to temporarily create a small pouch at the top of the stomach. Different from the traditional malabsorptive weight loss surgery, eg, Roux-en-Y gastric bypass surgery (RNY), Biliopancreatic Diversion (BPD) and Duodenal Switch (DS), banding does not cut or remove any part of the digestive system.

The tiny capacity it leaves takes away the choice about eating. You vomit. Another lovely way to phrase it is PB’ing (Productive Burping): regurgitation of non-acidic swallowed food from the upper pouch.

Who’s had it done? Singers Carnie Wilson & Ann Wilson, Star Jones (on Larry King Live 150lbs), American Idol’s Randy Jackson, Al Roker (NBC weatherman), Sharon Osbourne, Anne Rice, Roseanne Barr, (on Rosanne’s advice Etta James went to the doctor in a wheelchair & lost 200 lbs.). Nicole Richie HASN’T nor has Kirstie Alley.

It is not without serious risk: a 50% complication rate and bowel obstruction are two biggies.

After weight loss the hardest part of the adjustment may be emotional.

"I really still think of myself as a very big woman," she said. "My mind hasn't had the opportunity to catch up with the progress my body has made in a short amount of time." Debra Voight, opera singer (44)

There is another major adjustment, as well. One looks like a human sharpei. It's like having a size 26 skin hanging on a size 8 body.

Choosing the type of body sculpture is a balance of compromises, the scar for the excision vs. the benefit of the lift. The body is three dimensional. Body lift surgery addresses the loose drooping tissues circumferentially. It usually involves several stages: lower body lift, breast lift, arm lift, upper body lift. The lower body lift extends the tummy tuck incision completely around the lower torso, allowing re-suspension of the lateral and anterior thighs along with the traditional tummy tuck improvements. A medial thigh lift is also possible. An upper body procedure removes loose skin from the arms (bracioplasty), breasts (mastopexy) and upper torso. Patients wear a support or compression garment for two to six weeks.

Such surgery can run from $20,000 to $50,000 for an entire body and it usually leaves long, visible scars on the arms, chest, stomach and legs.

As to just who in Hollywood has had these post-bariatric surgeries? Star Jones has had public complications during one of her staged procedures. Rumor of Britney Spears staging a "come-back" via a body lift is just that: a rumor and a ridiculous one at that.


Hear Anne live on the Kevyn Burger show NEW TIME: 10:00 to 11:00am every Thursday featuring Knifestyles of the Rich & Famous.

Early Intervention (Authentically Aging)

Today's topic deals with those first steps– no, not the toddler ones, the surgical ones. Is it ever too soon, too early? Or, the earlier, the better? Read on...

The statistics vary, but the percentage of 20-something patients seeking out anti-aging therapies is on the up-tick. And it's not just lotions & potions that they are after. It's also the non-surgical procedures like laser treatments and dermal fillers and botox.

Premature aging is really the venue of pack-a-day smokers and girls who own tanning goggles, yet full-blown age-orexics are popping up everywhere. Hollywood has it's share– just read the tabloids to see what Lindsay Lohan, Jessica Simpson, Nicole Richie, Britney Spears, etc. are having done– but the antiaging obsession is affecting younger and younger women all across the country.

A young woman may pursue a series of light glycolic peels and microdermabrasion over several months to encourage skin cell turnover; Intense Pulsed Light therapy (IPL) laser treatments to eliminate broken blood vessels and sun spots; lipodissolve for cellulite; a little bit of Botox to forestall furrow lines between the brows or crowsfeet; and finally, Restylane or Juvederm to soften any smile creases should she be so reckless as to grin a lot (see above). And of course religious application of a topical retinol (vitamin A) preparation at night and sunblock, moisturizer and topical vitamin C everyday.

(You could also institutionalize yourself transfixed, motionless, and out of the sun ala Oliver Sacks's patients in Awakenings. All of the above will keep the face looking younger, longer.)

These would-be patients are completely preoccupied with the quest for sexy, ageless skin. Physiologically they don't want to leave their 20s. Middle-age has become no-woman's-land. Where does this antiaging fanaticism originate?

In the last decade cosmetic procedures have moved out of the exclusive domain of the surgeon's office into day spas, salons, you name it. It's now ubiquitous amongst the beauty industry. More and more surgeons have responded to the competition with...well, injections, laser, etc. for those who request it– whether or not it's medically indicated.

It's been described by one provider as akin to giving a kid who's underaged a sip of beer: "Okay, take a little taste of this. Better you try it here than at some party." No one involved in this is going to put the kibosh on it.

And today's young woman is raised in a media-driven culture. There was a time when Vogue's top fashion models were actual society beauties well into their 30s and beyond, who could afford the dresses they were wearing. Now haute couture is sold on the backs of emaciated 16-year-old giants. Hollywood has only character parts for the 'aging actress' while the surgically rejuvenated ones try desperately to fit into roles written for cellulite-free 25-year-olds. Television shows most of all exemplify the media's ever increasing tendency to marginalize the middle-aged female.

When people think of facelifts, images of aging Hollywood stars with their faces pulled as tight as their red carpet gowns might come to mind. But some of these 'ageless beauties' hung on with the help of subtle early intervention; threadlifts were said to have long ago helped the facial contours of Catherine Deneuve (63) (she's since had a lot more). And Nicollette Sheridan (43) clearly had work done when she turned 40. Sharon Stone (49) had her first facelift in her mid-30s immediately after wrapping Basic Instinct.

What constitutes subtle? Endoscopic browlifts have replaced the old-fashioned hairline deforming coronal forehead lift (Elizabeth Taylor) and nearly scarless lifts allow plausible deniability. Top-flight aesthetic surgeons have refined the techniques used for early surgery to a fine art. The best are now able to combine several minimally invasive procedures to give a final result which surpasses that of traditional facelift surgery IF the patient starts early– in her late-30s to mid-40s and her skin is in great shape.

Key here is the integrity of younger, intact skin. Pampered epidermis is elastic and resilent before hormone shifts kick during a woman's 40s. So these 20-somethings do have some validity to their concerns: rejuvenation really is all about the skin.

Can you age-proof the body? Not really. You can turn back the clock, like daylight savings time, but the clock is always running. It is a youthful conceit to believe that medicine has conjured up a surgical Dorian Gray.

So what's a girl to do? The most effective anti-aging interventions are well within the pocket book of every 20-something. Wear sunscreen liberally, year round. Indulge your inner movie star with polarized sunglasses when you venture out. Exfoliate daily and avoid smoke like the deadly wrinkle-producer it is. Save some of your money for another decade or two when gravity really kicks in.


Hear Anne live on the Kevyn Burger show Thursdays featuring Knifestyles of the Rich & Famous.