Surface Anchors, Punches, and Legislation Issues


(Editor’s note: These articles were first published in The Point, the publication of the Association of Professional Piercers. Since part of BME’s mandate is to create as comprehensive and well rounded an archive of body modification as possible, we feel these are important additions.

Jim Weber and David Vidra, the article’s authors, have given BME permission to publish this article for the continued education of professionals and body art enthusiasts. Enjoy.)

After Luis Garcia’s article, titled Surface Anchor Legislation Issues, was published in the last issue of The Point (#48), many questions have been raised about the information presented, specifically regarding statements about the legality of using punches to install jewelry.

As an organization, the Association of Professional Piercers has historically declined to address the use of punches by piercers. Their use has always been considered outside of the scope of body piercing—much the same way the organization has viewed branding, scarification, and tattooing. But recent legal regulations, interpretations, and determinations about the use of punches with surface anchors have made continuing this position untenable.

From the APP’s position as an educational organization, it has become obvious that many piercers in our industry are in need of education on this subject. This is not to imply there is currently a willful ignorance among piercers, but simply that there is not an educated dialogue taking place in our industry on this topic. Recently, several states have prohibited the installation of surface anchors by body art practitioners. These legal prohibitions are, in many ways, a reaction by local medical and health boards to a procedure without a convincing record of safety. But several of these determinations are a direct result of what many medical and health boards consider the indiscriminate use of punches by our industry.

In his article, Luis stated punches are “illegal to use if the practitioner is not a licensed medical professional.” While this is true, this issue is much more complicated than this short statement explains.

Currently, dermal punches are classified, but not regulated by the FDA. They are class 1 devices, for use by medical professionals only. State medical boards determine who can use each classification of products, and what level of certification, education and/or competency testing each user must have. Unless your local health department or medical board specifically allows the use of class 1 devices by body art practitioners, the use of punches by body art practitioners is prohibited.

So what does this mean for those of us who are using punches to install surface anchors and other types of body jewelry? The answer, again, is not so simple.

State medical boards have the authority to decide who can use certain devices based on FDA classification. As of this writing, state medical boards have determined—based on their classification and intended use—to specifically prohibit the use of punches by our industry in Nevada, New Jersey, and Florida. When speaking with several health inspectors and medical board members about the issue, the reason many gave for the prohibition was the concern over the indiscriminate use of dermal punches in installing jewelry—as evidenced by videos of piercers they had seen on YouTube. Currently, the biggest problem with the increased popularization of the use of punches is not their legal status, but that in several states their wanton—and very public—use has contributed to the prohibition of surface anchors and other body art procedures.

In Nevada, not only is dermal punching and performing single-point piercings specifically prohibited, but also suspension, branding, scarification, and implants. In Florida, a determination by the Florida Board of Medicine stated dermal punching constituted the practice of medicine. Suspension is similarly categorized, as is branding, tongue splitting, implantation, and labia reduction. In New Jersey, the same medical board determination that specifically prohibited the use of punches by our industry—and classified surface anchors as implants—also prohibits branding and scarification if performed by a body art practitioner.

Other states that do not currently address their use by our industry will almost undoubtedly be doing so after prohibitions are in place in other states. Anyone who is familiar with legislation knows that, quite often, states adopt other state regulations—often word-for-word—after the first state has done the work writing them. As a piercer and body modification artist, the debate on whether to use punches to install jewelry is not as simple as what will be better for healing. There are legal implications, and these extend far past the relationship between you and your client; all piercers should be fully aware or the ramifications and possible repercussions of their decision to use punches.

In response to this, there are many among us who loudly proclaim, “It’s my right to use punches!” There is not an argument—at least from us—against it being our ethical right. But unfortunately, in most states, it is clearly not our legal right to use them. There is a big difference.

There are also those who argue for the punch as being an “industry standard.” Unfortunately, this argument doesn’t carry much weight, as needles have been the industry standard for the insertion of jewelry since the beginning of modern piercing. Admittedly, there is a history of punches being used, but not as the predominant instrument of choice. (And to many legislators, our industry simply didn’t exist before about twelve years ago—around 1997—which is when the first regulations on body art went into effect in Ohio and Oregon.)

Lastly, few responsible piercers will offer their services to clients without first securing liability insurance to protect themselves and their studio, both legally and financially. While both Professional Program Insurance Brokerage (PPIB) and National Insurance Professionals Corporation (NIPC) offer liability insurance that covers surface piercings and surface anchors, their coverage does not extend to procedures where the jewelry is installed with punches. (Western States Insurance does not specifically exclude coverage of anchors inserted with punches, but the company representative I spoke to stated the coverage is not valid if the instrument used for the procedure—or the procedure itself—is prohibited by local or federal law.) If no other argument affects a practitioner’s personal decision on whether to use punches, this one should.

In closing, we urge all body art practitioners to carefully consider every side of this debate when choosing what tools to use when installing surface anchors on their clients. All of us should be aware of the legal ramifications, for not only yourself and your clients, but for the rest of the industry.

And if you choose to use punches, please—for all our sakes—don’t post the videos on YouTube.

[This article is intended to start a discussion on the use of punches and the implication their use has on legislation. It is not to be considered the definitive argument for or against their use, but simply an effort to educate all industry professionals on some of the possible legal repercussions this use may bring to our industry. A lot of help went into researching this article. We would like to thank Jonny Needles and Luis Garcia for their help with New Jersey legislation, Maria Pinto from Industrial Strength Needles for her help with FDA questions, and the various members of health and medical boards who were able to clarify their state’s position on punches and surface anchors.

Anyone who has comments or corrections about information contained in this article, or has information about similar legislation issues in other states, is invited to e-mail us.]

Legislation Links


On 10-5-2002, a determination by the Florida Board of Medicine stated dermal punching constituted the practice of medicine. The practice of suspension is similarly categorized, as is branding, tongue splitting, implantation, and labia reduction. While the Medical Board has prohibited the use of punches by body artists, the authority to enforce this prohibition has not been granted to the Florida Health Board. As the Health Board oversees inspection and licensing (not the medical board) this leaves the enforcement of this determination in question.


Dermal punching and single-point piercings are specifically prohibited, as is suspension, branding, scarification, and the implantation of jewelry under the skin.” The Nevada Board of Medical Examiners determined surface anchors are to be categorized as implants, therefore prohibiting their being performed by body art practitioners. The Nevada Health Board then enforces this prohibition.

[I was fortunate to speak to Jamie Hulbert, an Environmental Health Specialist for the Southern Nevada Health District, at the annual American Public Health Association conference in Philadelphia in early November. She stated the concern of the Health Board was about the risk of anaerobic bacteria with surface anchors, and listed this as one of the reasons for classifying them with implants. She said there was currently no discussion about repealing the ban.]

New Jersey:

Earlier this year, the Director of the Health Department approached the New Jersey Health Board with questions regarding surface anchors. The Health Board then contacted the Medical Board, and was advised that surface anchors are to be considered implants, and are therefore prohibited under New Jersey Administrative Code 8:27-2.6. As stated in the preceding article, this same determination prohibited the use of punches by body art practitioners, in addition to implants, branding and scarification.

[Jonny Needles, of Dynasty Tattoo and Body Piercing in Newfield NJ, has been in conversation with Tim Smith, New Jersey Public Health Sanitation and Safety Program Manger and Head of the NJ Body Art Department in Trenton. Together with Luis Garcia (former APP Board member), they have been working to repeal the prohibition on surface anchors. According to Jonny, Mr. Smith has stated the intention of the NJ Health Board was to start a pilot program. This program, starting before the year’s end, would give an as-yet-undetermined number of piercers the authority to perform surface anchor piercings. Jewelry quality will be specified, client numbers are to be monitored, and clients will be provided a number to directly contact the Health Board to report complications. If this program is considered a success at its completion, other piercers can apply for the authority to perform this piercing. This program is to be open to all piercers who have 3 or more years of experience.

Both Jonny Needles and Luis Garcia are optimistic that the two groups can come to an agreement on the best way to allow this procedure while still looking out for the public interest.]

Author Bios:

David A. Vidra started in the piercing community in the 1980s. He opened northern Ohio’s first piercing studio, Body Work Productions, in 1993, and it remained in operation for more than 15 years. David founded Health Educators, the first industry-specific health education company for the body modification industry, with its focus on OSHA guidelines and all health and safety issues related to body modification. He has been honored by many organizations including the APP, the Society for Permanent Cosmetic Professionals (SPCP), and BME for his efforts in the educational arena and in legislation. He has worked as a nurse for more than 20 years, has recently completed his certification in wound care, and is celebrating his 15th year teaching Bloodborne Pathogens.

Started in California in 1994, the Association of Professional Piercers is an international non-profit organization that is committed to the dissemination of vital health and safety information about body piercing to the piercing community, health care professionals, legislators, and the general public. The APP holds its annual Conference each year in Vas Vegas, Nevada in the first week in May. More information, including free PDFs of The Point, can be found at

This entry was posted in APP and tagged , , by James Weber. Bookmark the permalink.

About James Weber

James Weber is a professional body piercer. He started piercing professionally in 1993 and has been actively involved at an industry-wide level in body piercing education, legislation, and public relations projects for almost two decades. He is the founder and owner Infinite Body Piercing, Inc. Started in 1994, it is now one of the oldest—and busiest—piercing studios in the United States. James served two terms on the Board of Directors of the Association of Professional Piercers: his first as Medical Liaison, from 2005 until 2008; his second as President, from 2008 until 2011. He has overseen The Point: The Journal of the Professional Piercers as editor for seven years and twenty-seven issues.

17 thoughts on “Surface Anchors, Punches, and Legislation Issues

  1. Thanks for the article.

    I live in the lovely Australia, and was just wondering if anyone knew the laws here? ie for “punches, branding, scarfication and suspension” I have been interested to konw what we can do and not allowed to do.
    Also if anyone know of a good Insurance Broker for the industry??


  2. Dion -The three companies listed in the article all offer insurance covering body piercing procedures: Professional Program Insurance Brokerage (PPIB) have been offering these services the longest, followed by National Insurance Professionals Corporation (NIPC), then Western States Insurance.

    But I don’t know if any of them offer coverage in Australia.

  3. Thank you for you reply :)

    I shall look into them and see if they do.
    The insurance company i’m using at the moment is ripping me off a bit. For what we do.


  4. good info, someone needs to make a “piercing tool” that happens to look and function exactly like a dermal punch.

  5. Hey everyone. I wanted to comment on this posting. This is a clip from my site

    New Update! Jan. 5th 2010.
    I received a call from Tim Smith who heads the body art department for New Jersey. Tim has been consulting me from the beginning on the whole micro dermal ban as you will read below. Today Tim has told me in a few weeks he will be officially making micro dermal anchors legal again in the state of New Jersey! Letters to your local health inspector will be sent in a few weeks so technically they are still illegal until your local health inspector receives the official letter from Tim Smith. There will not be a pilot program at this point or at least its on the back burner. Tim stated to me that he will be classifying micro dermal anchors as a surface piercing. There will still be some requirements if you want to perform micro dermal anchors in the state of New Jersey. One requirement is that you show proof of insurance specific to the micro dermal anchor procedure.

  6. Also, for insurance I use Western State Insurance or WSI. They insure me for micro dermal and it is included in my normal body piercing policy. I do not get charged any extra for the micro dermal insurance add on. Here is the info

    Please tell Casey Gooley that Jonny Needles referred you. This may help you in some way. Who knows but its worth a shot. I get no kick backs or benefits for your referral.
    Casey Gooley
    Western States Insurance Agency – Missoula
    800.998.0196 toll free
    406.721.9230 fax

  7. I recieved the official word from my health dept. inspector that dermal anchors are NOW LEGAL in the great old state of New Jersey. However, you will STILL NEED to hear it from your health inspector as you must be approved to do this procedure. How do you get approved? Get yourself some darn Dermal Anchor Insurance (read above) and dont use the dermal punch or if you do behind closed doors. Also, only use titanium Grade 23 anchors. That should be it! Yah me!
    Thank you to all who supported me through NJs legislation, long meetings with state officials and book work.

    Jonny Needles

  8. Absolutly heartbreaking… I hate to hear of this fiasco, as I love giving microdermals. The “trenching method” (single point) is a more painful, and rather barbaric looking way to install the dermals. The punch is simple, precise, clean, and very quick to heal from what I have seen through my clients. Virtually painless as well from the three I have preformed on myself. I work in Texas, and so far I haven’t seen any laws here prohibiting the use of punches, and I hope this law is corrected before it gets this far.

  9. I resolve this issue by using a 10g needle to install all of my dermal anchors. Sure, a punch makes installing a skin diver easy, but who wants one anyway? I can install a proper anchor in the same spot a diver might be used. I have great depth control, and can position the feet to sort of flow with the natural shape of the body – rather than just punching a hole in the skin and dropping it in. My dermals generally stay damn near skin flat as a result too.

  10. just wondering if you know what the laws are in the u.k? i have looked into it and as far as i can work out you need an aesthetic license to practise this and your insurance has to cover you as though you are a medical practitioner!! i find this very frustrating to work out what i would need if i choose to do this. i have great liability and treatment insurance but when i got a quote for doing dermals the price increased 400%

  11. Unlike many of my peers i am a fan of MORE regulation in the industry. it seems to me that there should be separate regulation and licensing for procedures that fall outside of typical body piercing…ie dermals, implants, cutting, etc. It seems that too many piercers have taken it upon themselves to preform these procedures on clients without doing the proper research. Im sick to death of having to CUT OUT dermals and implants that were preformed by people that assumed that since they knew how to pierce that these procedures would be simple. Normal body piercings are finicky enough but there are untrained people out there that are doing what amounts to minor surgery. i got into the body mod industry to help people feel comfortable in their skin and create beauty with my clients bodies…. it makes me SICK to see trusting people be mutilated by people who dont care….. and there is my rant for the week :)

  12. Perhaps I should not be replying here as I am a Pierce not a piercer and as yet do not have any anchors but they are on my list. (By the way, I am 65 ). My question deals with self regulating. I know many Piercers seem to lack quality training in piercings. I would guess they are required to pass test regarding blood borne pathogens, but setting up and certifying industry standards might go a long way to reduce the williness of the medical industry to control the body modification industry, and not just in the US.
    Perhaps not all piercings or body mods would require such licensing, I don’t know. I am just throwing a thought out there.
    By the way, future body mods I want include penile beading, a transscrotal piercing, some scarification, and at some point a suspension.

  13. This is an issue i most recently had to research myself. It wasn’t until Jan 1st of 2011 that the state of Minesota put any type of legislation in affect for body modification. Prior to that it was left soley upto the regulations of counites. While the counties in the state may add additional restrictions that are greater than the established laws they are still mandated to follow all state requiremnets. What this meant for me, was that the method of using a punch in which i was most familiar, and believe to best option for clients had to be researched when i transitioned to a new county. While waiting for clarification, i was forced to seek out alternate ways to safely implicate this type of piercing for my client with in the confines of the law. During this time i cam across a product called chamfer, or cirlcular needles. They are made in the same gauges (or MM) as needles, and are essentially a punch with out the handle. This minor obversion to the handle allows them to be classified as a needle rather than a punch and there for usuable even when, and where the use of medical implments are not. I soon found that i could legaly use punches in my county/state, yet have no desire to do so, seeing as these new type of needles are readily available, cheaper, and non-classified by the FDA or any other governing body.

  14. corrina- The practice of subdermal implants, anchors etc is not prohibited in the UK. You just have to register with your Local Authority environmental health Department and be able to demonstrate hygienic practices.

  15. I work in Texas and while it is easier to use dermal punches it is also a felony carrying 5-99 yrs. For practicing medicine without a liscense as the punch removes tissue the shop I currently am employed by does not allow us to apply microdermals or dermal anchors due to the current lack of standardization in the jewelry the legal questions currently surrounding the procedure and the insurance necessary to perform the procedure wether single point or punch. I sts of peple who’s jewelry has healed into the body due to the loss if the tops and the inability to find new ones that will fit. I hope the situation is clarified and the jewelry standardized so that I can perform them in the future so I don’t have to see customers going to shops that pierce indiscriminantly anything on anyone with no training or concern about the customers safety. Thanks for this article.

  16. Forgive me, but I am really feeling like the backlash to this is going o lead to people getting dermals in ACTUAL unsanitary conditions, such as private homes, or other venue that has not been properly sterilized to avoid potential infection. None of us, are exactly known for confirming to rules that we perceive to be biased or unfair, and I think it is extremely irresponsible for state governments to provoke such behavior by stopping the places that have sterile environments in which to conduct these sorts of piercings in from doing them safely. Furthermore, I do not believe ANY government should have the right to tell any consenting adults what they can and can’t do with their own body, they think they do, but I find that sort of arrogance abhorrent, and that is being kind about it. The bottom line, is that by our very nature we are free spirited, we have never been conformists, and to be honest, the modern savage in us will do exactly what it wants to, regardless of rules, regulation, or a “spanking” from big brother, and if that means going to the guy down the street that has the equipment, I know that there are many who will do just that, regardless of the added risk.

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