Why Are Cartilage Piercings So Hard To Heal?

Of all the piercings I offer, and of all the piercings I have, cartilage seems to stand out as the most frustrating to heal across the board. All day I hear clients lament the struggles of healing cartilage, from not being able to sleep on their ear piercings to nostril piercings that get irritated after every runny nose. Online you’ll constantly see threads of folks lamenting the difficulty of healing cartilage piercings. And a quick poll in a piercer forum found most piercers seeing the highest instances of issues with cartilage piercings. So what gives? What is making this particular type of tissue so difficult to heal? Well, turns out there is a great scientific explanation for it, so let's jump right in!

Cartilage is Avascular

When it comes to wound healing, one of the main considerations is blood flow to the area. Many of us have seen medical dramas or shows where they talk about an injury or wound needing blood flow, or a patient needing a blood transfusion. This is because blood is a crucial part of how all of our bodily systems function and run, and healing is no exception. Cartilage however is considered an avascular tissue, meaning it lacks blood vessels. Avascular cartilage means it does not receive nutrients and oxygen directly from the bloodstream, and instead relies on surrounding fluids to obtain essential components. In the ear, the perichondrium, a layer of connective tissue covering the cartilage, is the primary supply of nutrients and oxygen. This lack of direct blood supply leads to slower healing when cartilage is injured.

“The cartilage that makes up the auricle is relatively avascular, dependent upon a watershed blood supply, and in continuity with the cartilage of the external auditory canal. The cartilage relies on the perichondrium, the connective tissue that covers the cartilage, for its blood supply. In the absence of trauma, the perichondrium is tightly adherent to the underlying cartilage but has an areolar layer allowing some motion between the perichondrium and overlying skin. The ear is particularly susceptible to lacerations, avulsions, and blunt trauma due to the prominent position of the ears overlying a bony surface. Additionally, the unique composition and relatively tenuous blood supply to the structures of the pinna create challenges and considerations unique to ear laceration repair.” - Williams and Sternad, Complex Ear Lacerations

This means when we injure the ear, such as in a piercing, the skin of the ear has a direct blood supply, but the cartilage does not. It relies on the connective tissue to bring nutrients and necessary elements to the wound to allow scar tissue to form and heal the channel. You may hear piercers discuss piercings healing from the outside in, and this is extra true for cartilage. The skin of the outer sections heals first and easiest, while the middle portion of your piercing, the part through the cartilage, takes much longer to fully heal.

I’ve always loved the metaphor of blood flow as highways through the body. The skin has direct blood flow- there's a main highway from your heart to the skin of your ear, and very rarely is there traffic. The cartilage, however, doesn’t have that. Nutrients, oxygen, and white blood cells that are all essential to wound healing can get kinda close but then have to get out and walk the rest of the way. And as you might imagine, this slows everything down.

For any piercing, regardless of placement, getting snagged very hard, knocked around, slept on weirdly, or generally irritated (ie from you getting sick or changing medications) can cause irritation and issues. But whereas a lip piercing or a lobe piercing has that primary blood supply to help it bounce back, cartilage doesn’t. So every bump, every snag, and every awkward sleep causes more irritation that cartilage piercings have a harder time recovering from.

All of this combines to make cartilage uniquely challenging to heal. Now this by no means makes it impossible, the hundreds of healed cartilage piercings in my and other piercers portfolios can attest to that. But I do think understanding the fundamental difference in blood supply to the area, and how that impacts healing, is important! We should go into any piercing through cartilage expecting a slower heal, needing to be patient, and doing our best to baby the piercing. Hopefully this understanding helps you feel better equipped for future cartilage piercing adventures! Happy healing!

Williams CH, Sternard BT. Complex Ear Lacerations. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525973/#