Many years ago, when I was first beginning my blog, I wrote what would become one of the first iterations of my 101 series- cheeks 101, a brief overview. This was one of the first three 101 series pieces I ever produced, and if I’m being honest it was written quite selfishly. My whole blog was, actually. I was working as a studio manager and social media lead at the time, alongside being a junior piercer in the late stages of my apprenticeship. I spent my days answering messages and questions online, many of them the same things over and over. I got tired of typing out the same long explanations about why we didn’t offer horizontal tongue piercings and why you shouldn’t put peroxide on your piercing. So I had the brilliant idea to start writing these things in a blog. I could just send clients the link, rather then typing up the same explanation over and over. And it worked! I also found a love for writing, and sharing education.
But back then the purpose of my blog posts was to expand on information I found myself needing to give to clients often, it was designed to answer questions, not give in-depth education. Looking back, the blog post I did on cheek piercings was woefully brief. I wrote it because I wore cheek piercings, and got questions about them constantly. My cheeks had also had quite the journey- originally pierced at a 14g with low quality jewelry and then salvaged after 8 months, stretched to a 10g, and forced to heal basically out of persistence and spite on my behalf. It was a long story to tell to every person who asked, so I made a blog that covered the basics. It touched on important information but only in a few sentences. It was basically a watered down version of the in person consultation we did for them, designed to weed out the dozens of messages we would get about these piercings from clients who had no idea the complexity level of the piercings they were offering. At the time I also did not offer these piercings- I was learning about them and I wore them, but I wasn’t doing them yet. In hindsight I think it’s one of my weakest blog posts to date, and I wish I had written it from an entirely different, more in-depth, more educational place. So that’s exactly what we are going to do today!
Welcome to Cheeks 201- And In-depth Look!
Cheeks piercings, sometimes referred to as dimple piercings, are piercing that pass through the tissue of the cheeks into the mouth. They are fun, glittering dimples that add some shine to any smile. While the aesthetic of these piercings is unmatched, they are not seen too often. And this is because cheek piercings are among the more difficult piercings to heal, and the risks they carry are among the most serious. Today we will discuss what the risks with cheek piercings are, how we can minimize them, and what you can expect if these piercings are on your wishlist.
Anatomy
Cheeks rank above many other piercings when it comes to the importance of proper anatomy and considerations for these piercings. There are multiple key anatomy considerations when we are doing cheeks. First and foremost is finding a “sweet spot” or a safe spot for piercing in the cheeks. Key muscles including the orbicularis oris and zygomatius muscles as well as parotid ducts, transverse and inferior facial arteries, and salivary ducts all run along the insides of our cheeks. There is a lot of important anatomical features we have too be mindful of working around when we pierce cheeks. Some folks have a natural “sweet spot” or a soft area of primarily skin and fatty tissue with no major blood flow, salivary ducts, and minimal musculature that we can pierce through. Some folks do not have this area, and anywhere on their cheeks contains important structures. If you lack this “sweet spot”, cheek piercings are likely not safe for you to get pierced.
The next important consideration of anatomy is your bite line. When we do these piercings we want to ensure the inside ends are places in such a way that when you eat, drink, and talk you don’t constantly bite down on them. This means we need to assess your bite, how your teeth sit together when closed, and the angle of your bite- how your teeth open and how they come together. If you have any irregularities to your bite, how your teeth lay, and how they move, cheeks piercings may be severely damaging to your mouth, and it may not be safe for you to get these piercings.
As a general rule of thumb cheek piercings should not be placed further back then the first molar. Back that far on the cheeks are larger more structural muscles like the maseter muscle, more salivary ducts and glands, and major arteries that bring blood to the face. If these piercings are done too far back, then can cause severe damage to your teeth and gums, and damage the muscles of your face. You also risk them bisecting a salivary gland and leaking saliva- permanently. There have been some famous cases of too far back cheeks that ended up needing multiple rounds of surgery in order to correct the leaking.
Your piercer will likely massage and feel around inside your mouth quite a bit in order to feel for these internal structures. They may also inspect your mouth with a headlamp or penlight to look for internal structures. You’ll be instructed to open and close your jaw multiple times and possibly in different positions while your piercer looks at your bite line. It’s very important that this consultation is through, and your piercer is looking at all of these factors.
You’ll notice we’ve mentioned a ton about anatomy and structured before ever mentioning placement. This is because with piercings like cheeks, these anatomical features are the most important factor for piercing placement. Quite often I see clients come to see me for cheek piercings who are looking for a very specific placemet- perhaps they have dimples and they want these piercings to rest precieslty in their existing dimples. They want an exact placement in regard to their smile or their eyes. But with cheeks where the piercing goes is less about where you want it or think it looks the cutest, and far more about where it is safe for it to be placed and won’t cause serious damage to your mouth. The anatomical structure of the cheek is our determining factor fort placement. If these are piercings you want, I would go into it accepting that placement may vary from your “ideal” spot and be willing to accept placements that are different then what you may have envisioned for yourself for these piercings.
A Note on Dimples
When considering cheeks piercings a large number of clients say they love the dimpled effect that these piercings create and that is why they want these done. The “dimples” that are created from cheek piercings come from a variety of casues- sometimes this happens from natural scar tissue that forms during the healing process, sometimes it happens because of the way these piercings bisect the muscles and tissue of the face. Sometimes it doesn’t happen. Sometimes it only happens on one side. See, with piercings there are many variables to how they heal and how they look. I know clients who have deep, prominent dimples from cheek piercings. I personally have one very deep dimple on my right side and no dimple at all on my left. I know others whose cheeks have never formed dimples. So it is not a guarantee that getting these piercings will leave you with dimples- you may just be left with large scars, hyperpigmentation, or nothing at all. If your only desire for these piercings is to get dimples I would encourage you to look into cosmetic surgery procedures that create dimples. These procedures are much safer, much easier to get and heal, and honestly can often be more affordable (I’ve seen prices around 800$ for surgeons to create perfect dimples which is often less then you spend over the full timeline of cheeks healing). These procedures also create symmetrical, even dimples unlike the large variation you see with cheek piercings.
Jewelry Considerations
When getting cheek piercings, it is very important to ensure you get appropriate jewelry for these for healing. Cheeks are an incredibly high movement area, we are talking, eating, and drinking all day long and this means movement on these piercings. If these are pierced too thin this constant movement can cause the piercings to become irritated and have issues healing. You can learn more about this here. Because of all of this movement, cheeks are much more stable pierced at a 12g or 10g minimum. They should never be pierced any smaller then this, and I often see clients pierced at 14g and 16g struggle constantly with irritation bumps and drainage issues. If you are considering getting cheek piercings, a great question to ask your piercer is what gauge they plan to pierce you with. Anything smaller then 12g is a red flag.
Beyond the thickness of the jewelry, the length of the bars is also a major factor. As we’ve discussed previously on this blog, many piercings swell initially and need longer jewelry for healing. Cheeks are among the piercings that swell the most when they are initially pierced. Your first bars are going to be comically long- you will look like you have little antennas sticking out of your face. But I assure you, you will need every last bit of that length for the swelling that will set in over the following days. You should expect your initial barbells to be quite long, and be prepared for the unique experience of eating and drinking with them over the coming days. As the swelling sets it they will become manageable, but as it goes down it will become a fun game of trying not to bite or catch them all the time.
Unlike other oral piercings which tend to swell quite a bit, then go down and get downsized, cheeks tend to have a bit of a different process for their healing…
Downsizing
I can confidently say that out of all the piercings we do, Cheeks get the most downsizes. On average clients can expect 4-6 downsizes for their cheeks, with many clients ending up getting 10+. This is because cheeks swell an enormous amount when they are first done and they need very very long bars to accommodate for that. But the swelling doesn’t go down all at once- rather it tends to go down slowly over time. As it goes down, the bars become long again. You may think to yourself ok, I’ll just leave those super long bars in for long enough to go right to shorter bars like lip piercing. But with cheeks if you leave them long you can and will bite and catch them when you eat. Not only can this chip and damage your teeth, but this can cause the piercings to become very irritated and angry. So as your swelling goes down, you need to downsize your cheeks to keep them happy and healing well, and your teeth in one piece.
Now sometimes this process is straight forward. Get pierced with long bars, swelling goes down, downsize. Wait a bit, more swelling goes down, downsize. Wait longer, more swelling goes down, downsize again. Rinse and repeat till they are no longer swollen at all and just healing well. And some folks are fortunate and this is how the process goes- which is great! But….not everyone has luck on their side.
Sometimes we do what I like to call the downsize dance. That means we have some swelling that’s gone down, and we downsize, but sometimes even with the most gentle and cautious piercer just the act of downsizing causes your cheeks to swell. They become irritated, and now the downsized bars are too short- and we have to go longer. Sometimes we downsize and then we eat some food that irritated our cheeks, or we get hit in the face by our dog and bam. Swollen and long again. So then we decide to play it safe and wait longer between downsizing so we are super sure they are ready to downsize and won’t swell. But, oops! They were long and you bit them eating dinner and now they are irritated and swollen, and can’t be downsized. Weight gain, weight loss, getting sick, seasonal allergies, oral hygiene, eating spicy food, cold weather, hot weather, going swimming, kissing your partner, makeup, skincare, soap- these are just some of the things that can effect your cheek piercings and cause them to have a poor reaction.
We end up dancing between sizing, going smaller, then longer, then even longer, then back down. We deal with accidental catches and snags, bumps and bruises, and all of life’s little accidents that can make healing more complicated. This process is honestly fairly common with cheeks, and its important if you are getting pierced to realize you may be spending months and even years bouncing around between sizes and figuring out what works for you.
And its not just about dealing with this often frustrating back and forth. It’s also about the investment of time and money. It’s a lot of checkups, a lot of going back to see your piercer, and a lot of time spent going to the studio and following up. These different sizes aren’t free- you need to purchase all of these different barbells. Even in an ideal healing situation you will purchase 10 separate 12g implant grade titanium barbells, sometimes in custom half sizes. And that’s for a client who only needed 4 downsizes and nothing else. Someone who deals with more back and forth, might get 6 or 10 downsizes and be looking at purchasing 20 different barbells. You also may end up needing different ends for the inside of your mouth- discs, mnm ends, balls, and even cabs can all be called for at different times of healing cheeks to deal with irritations and issues they are encountering. While we always hope clients have the smoothest, easiest healing process, many of us don’t with these piercings! You need to be prepared for the expenses associated with all of this different jewelry you may need to get these piercings to heal well. I have had my cheeks pierced for a decade and I have over 20 barbells and ends in my collection that I’ve worn or needed at various times in my life. It’s literally hundreds and hundreds of dollars in just plain titanium pieces- but I needed all of them at one point or another in order to keep my cheek piercings happy and healthy and my teeth in one piece.
Healing Timelines
Cheeks in general take 1-3 years to fully heal, and some peoples cheeks may never “heal” the way other piercings do. My cheeks for example still flare up when I get sick, have bad allergies, irritate them with makeup or spicy food. A few times a year I deal with a few days to a week or so of a swollen, leaky, grumpy cheek piercing. I get crusties regularly and always have. I also had an abscess happen 5 years into having my cheeks, when a stray piece of food became trapped in the piercing channel. Are my piercings healed in the sense they aren’t an open wound anymore? Yes. Are they healed like all my other piercings are? Not at all.
Dermals?
One thing I often get asked is what about dermals- could you do surface piercings in the same placement and get the same look? And this is something piercers have experimented with- and it hasn't really ended well. Surface piercings do best in areas of low movement- the opposite of our constantly moving and talking cheeks. Surface work is long term temporary, meaning it often only lasts a few years. The higher the area of movement, the shorter the lifespan- I've seen cheek anchors last people less than a month. The other issue is the scarring surface anchors can leave, which I have often seen worse than the scars from actual cheek piercings. While Joelteon of Opal Heart has had some success using custom designed macrodermals in cheek placements, this is still something I would consider highly experimental (if you are in Australia and you are interested in this, hit them up for sure!). With traditional surface anchors however, there has not been much success and sadly just been a lot of clients left with bad scars after short time periods. When we consider the success actual cheek piercings can have in comparison, it's clear that it's much much better to just pierce through the cheek.
Risks
We of course can not discuss cheek piercings without having a frank conversation about the risks of these piercings. The following is an incomplete list of the very real risks with cheek piercings:
Drainage Issues- perhaps the most common and prominent issue with cheek piercings is drainage issues. Piercings in general produce natural secretions as part of the healing process which drain from the piercings and form that crust you are used to cleaning away. Cheeks produce a large amount of secretion, and are known for struggling with naturally draining this. This issue is made worse with improper jewelry and placement. Drainage issues can present as irritation bumps, excessive goopy secretions, large swollen areas around the cheeks, and abscesses.
Abscess- an abscess is defined as a swollen area of tissue filled with pus and discharge. Mild drainage issues in cheeks can quickly become an abscess if not treated, and these often require medical intervention. In severe enough cases you may need to have your cheek cut open, drained, and packed with gauze. An abscess can travel to your jaw and teeth and cause serious, even life threatening oral health concerns, if not treated.
Chipped Teeth- Because of the need for longer barbells and excess swelling cheek piercings can easily cause a chipped tooth. This risk can be minimized a lot by proper placement according to your bite line, and by being cautious when you eat and keeping on top of downsizing, but it is a serious risk.
Gum Loss- Much like chipped teeth, gum damage is a risk. Proper placement, good downsizing, and nesting can minimize this risk, but it remains a serious risk.
Leakage- Cheeks can end up leaking saliva constantly. When I cay constantly mean a drip every 5-10 minutes. This happens most often due to poor placement and jewelry that is too thin, but to can happen even with the most well done and cared for cheeks.
Scarring- Cheeks sometimes leave cute perfect dimples- but they also sometimes leave severe, large, and obvious scars. Discolored or hyper pigmented scars are also not uncommon from cheek piercings.
Surgical Closure- If cheeks are allowed to fully heal, they sometimes won’t close naturally. This can particularly be an issue if you are dealing with leakage. Then just removing the jewelry will not be enough to stop these piercings from leaking- you will need to see a surgeon to have them surgically closed to stop the leaks.
These risks are all real, and all genuine concerns to be aware of if these are piercings you are considering. You should not sign up for these piercings if you aren’t 100% confident you ca. handle it if any of these things happens to you.
So most people ask me, if these piercings have so many risks, why will I still offer them? Especially when I am so outspoken about other piercings that are dangerous that I don’t offer?
Risk Management and Informed Consent
I have cheek piercings. I offer cheek piercings (honestly, it feels a bit hypocritical to wear them but refuse to do them.) And this is thanks to two main factors.
The first is risk management. There is so much we as piercers can do to really greatly reduce the risks and concerns from cheek piercings. They are still a pain in the ass to heal, but with a good and truly experienced piercer, high quality jewelry of an appropriate thickness, good placement along your teeth and bite, and following good, modern aftercare, many of the worst risks of cheek piercings are almost entirely eliminated. Many of the risks can never be fully eliminated, but we can get them down to very, very low numbers.
The second is informed consent. I am a big believer in allowing clients to make informed choices about how they want to modify their bodies. If people understand the risks, and the risks have been managed down to a very reasonable level, then I believe folks have the right to agree to these risks. I certainly have, and I am going on 12 years with cheek piercings and they are among my favorite piercings I have.
There are a lot of piercings out there where it just isn’t possible to reduce the risks this low- horizontal tongue piercings spring to mind since there isn’t any way to keep the beads and jewelry off your teeth the way there is with well placed and healed cheek piercings. There are also many piercings like simile’s where even with risk management I still see large amount of clients experiencing lasting permanent damage (I’ve seen infinitely more lost and damaged teeth from smilies then I have from cheeks).
I am also fairly picky about what clients I will do cheeks for, and my process of piercing and healing them. Anyone who works with me can expect getting long discussions about risks and healing for these, required regular virtual followups during the first year to monitor the health and safety of your piercings and your teeth, and very strict guidelines about jewelry we use, downsizing, and aftercare. I treat doing cheek piercings an an active collaboration in healing between the piercer and the client and I am very very hands on for the healing of these piercings.
I have had my cheeks pierced for 12 years, and they are among my favorite of all of my piercings. They make my face feel like me when I look in the mirror, I am in love with the way they accent my smile. Out of the dozens and dozens of piercings I have had in my life, I cherish my cheek piercings in a way unlike most of my others. They have also easily been the most difficult to heal, cost me the most money (by a long shot) and brought me the most frustration, anger, and stress out of all of my piercings. I wouldn’t trade having them for the world, but I hope that in this blog and in the content I make about them I can help prepare others for the reality of getting and healing these piercings, and save them from the mistakes I made as well.