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     London is always fun, because there is the chance to see the latest fashion experiments being tried before making their way to the USA. Piercing has been around a long time, and it's not that piercing of body parts is a new idea and experimental, it's just that being in a large city I was exposed to a lot more of it than I see in the greater New Orleans area. In fact, my wife, son, and I had the experience of sitting in a restaurant next to a pretty young girl who had fourteen separate piercings and accessories in her face alone. (It made me think of John Travolta's reaction in the movie, Pulp Fiction.)  Her eyebrows, bottom lip, all over her ears, and her nose sported rings and poles of all kinds.
     I had the ravioli.
     Now don't get me wrong. Back at Jesuit High School in the late 60s, greasing down my hair on school days so that I could hide its true length, I vowed never to fall into that generation gap-trap of dissing (Is it OK for someone like me to say that?) any trend du jour just because it might be different. And looking at it another way, are holes anywhere else in the body any more philosophically distasteful than wearing earrings? Let's be fair, shall we?
     But as a doctor, I have some medical feelings on the subject. One of the things I noticed in London was that a lot of these piercings had tell-tale sites of inflammation around them. London is a dirty city, and it's almost impossible to keep yourself from sailing through all of the air-borne pollutants that saturate the air there. Add to that type of environment putting in a hole where it doesn't belong, and the prolonged superficial infection from the dirt may delay the healing process such that scarring may be part of the cosmetic effect. Next, there is a difference between piercing the ears, eyebrows, navel, and even the nipples from piercing the nose and lips. This is because the former and the latter differ by the types of tissue they are. Ears, eyebrows, and the like are mainly skin and subcutaneous tissue. These are tissues that don't have large openings--they don't need them because of the nature of their function. But the nose and mouth have big openings because the have to. They secrete.
     Mucus and saliva are manufactured and collected, then drained by the nostrils, pharynx, esophagus, and mouth--openings designed to do just that. But when you puch a hole through the skin that establishes communication between these mucus membranes and the outside world, you've established another drain sight that was never meant to be. In medicine, there's a name for it because it's considered pathology: fistula.
     A fistula is a diagnosis, and we do surgery to remove it. Now true the holes we're talking about in fashion are small and shouldn't cause much of a problem, but they could. The nose and mouth are loaded with bacteria, and these are going to migrate through the opening where there just happens to be, in addition, a foreign body (jewelry). It may never heal completely. Let me make journalistic history by proudly declaring that we've been blessed with all of the right holes in our bodies. But if you think a few extra ones won't matter, choose them wisely, because you are altering anatomy to make a fashion statement. And choose a clean place to live, because while your germs are trying to get out of your new holes, the outside world is trying to get in. Life is complicated enough.

Copyright 1998 Gerard M. DiLeo, M.D.

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