closeup of microdermal neck piercingShare on Pinterest
Molodid Studio/Shutterstock

When people talk about a neck piercing, they’re often referring to a piercing on the nape — the back of the neck. While this is the most commonly pierced piece of neck real estate, it’s not your only placement option.

The Madison piercing is another type of neck piercing done on the front of the lower neck, between the collarbones.

Both types can be surface or dermal piercings. Read on to learn the difference and everything else you should know before committing to a neck piercing.

Surface piercings have an entry and exit point that’s made through a small portion is skin using a needle. A surface bar is then pushed in one end and out the other.

Each end has an adornment (think ball or gemstone) that remains exposed, while the bar stays just under the skin.

Surface piercings are notorious for migration and rejection because of how close they are to the skin’s surface. That said, there’s some evidence that when it comes to surface piercings, the nape is one of the areas less likely to reject.

Having a skilled piercer and following proper aftercare protocols are key for any piercing but especially with surface piercings.

Dermal piercings pierce the dermis, which is the deeper layer of the skin.

Unlike a surface neck piercing, a dermal neck piercing only has a single point and one adornment. The decorative end sits on the surface of the skin while the other end is embedded in a pocket in the dermis.

This type of piercing can be done with a dermal punch and a type of jewelry called a diver, which has a pointed end and a decorative top already attached.

It can also be done by using a needle or small scalpel to create a tiny pocket deep in the skin. An anchor is then inserted into the pocket so that it runs parallel under the skin. A decorative top gets threaded onto the anchor.

Anchors tend to be the preferred method for dermal piercings because the tops are interchangeable, so you can mix things up. And speaking of mixing it up, some people get multiple piercings in a row or another design.

If you go with the dermal punch and diver, keep in mind that you’ll need to remove the jewelry entirely if you want to change things up.

The type of jewelry you choose depends on whether you have a surface or dermal piercing.

Curved barbells are the most common type of jewelry used for surface neck piercings.

Divers or anchors are used for dermal neck piercings.

They’re available in different materials, but it’s best to stick with quality materials recommended by the Association of Professional Piercers (APP). Cheap materials can expose you to potentially harmful toxins and increase your chances of an allergic reaction and other complications.

Your best options are:

  • Implant-grade steel. It’s affordable and suitable for most unless you have a nickel allergy.
  • Implant-grade titanium. It costs more than steel but is hypoallergenic and nickel-free.
  • 14-karat or higher gold. It’s safe for most as long as it’s not gold-plated, which can flake and contain nickel underneath.

Things like your location and the experience of the piercer will impact how much you’ll pay. Whether you get a surface or dermal piercing also matters.

Generally, a neck piercing costs between $50 and $75 but can cost up to $100 in some places.

The cost doesn’t usually include jewelry, so expect to pay another $20 to $30 on top of that.

Don’t forget to factor in a tip, too. At least 20 percent is customary.

Yep. You’re puncturing tissue, so at least some pain is a given.

The actual piercing of the skin is said to be moderate and somewhere between a 3 and 5 on a scale of 1 to 10, according to anecdotal reports.

Keep in mind the procedure only takes a few seconds, so the pain will be over fast. Plus, pain is subjective and not everyone’s experience is the same.

To help keep the ouch factor down, go into your appointment well-rested and relaxed.

All piercings carry risks, but having a skilled and experienced piercer and taking good care of your piercing can help mitigate some of these.

Here are risks to be aware of when you get a neck piercing:

  • Infection. Any open wound can allow bacteria into the body, including a piercing. There’s also a risk of contracting a bloodborne disease like tetanus or HIV if contaminated needles are used. This is why having a reputable piercer and insisting on sterile equipment is a must.
  • Allergic reaction. You can have an allergic reaction to nickel and other alloys in jewelry.
  • Bleeding. A hole in bodily tissue is going to bleed, and dermal piercings done with a scalpel or needle tend to bleed more because they run deeper.
  • Displacement. An anchor that isn’t inserted deep enough may become displaced and move to another area of skin.
  • Rejection. Surface piercings have a higher risk of rejecting, but it can happen to dermal piercings, too, if they aren’t properly cared for. It also happens when the body sees the jewelry as a foreign object and tries to push it out. Flaking, redness, and a change in hole size or placement are signs of rejection.
  • Trauma and tearing. Your neck piercing can snag on your collar, scarf, or hair, leading to irritation. It’s also possible to tear the skin and — yikes — the jewelry out of your body.
  • Hypergranulation. A red bump can form around the piercing site if your piercing becomes irritated or the jewelry is too tight.
  • Tissue damage. If an anchor is inserted too deeply, there’s a risk of damaging surrounding blood vessels or nerves.

Several factors can interfere with the healing process and impact the time it takes a piercing to heal.

These include:

  • your overall state of health
  • the skill of the piercer
  • how well you care for the piercing
  • whether you have a surface or dermal piercing

Typically, neck piercings take from 2 to 6 months to heal but can take up to 12 months for some people.

Good aftercare is crucial to avoid complications. Here are some do’s and don’ts to help you care for your neck piercing.

While healing, DO the following:

  • Leave your piercing alone except when cleaning.
  • Wash your hands with soap and warm water before cleaning or otherwise touching the piercing.
  • Use saline rinse or spray 3 or 4 times a day or as directed by your piercer.
  • Use gauze soaked with saline solution if it’s easier to reach.
  • Rinse the site with warm water as needed to remove cleaning solution or soap.
  • Gently pat dry using a paper towel.

But here are the DON’TS:

  • Don’t play with or rotate your jewelry.
  • Don’t wear clothing that irritates the area.
  • Don’t remove your jewelry.
  • Don’t use harsh soaps or other products, like alcohol or betadine, on your piercing.
  • Don’t let your partner’s saliva or other body fluids come into contact with your piercing.
  • Don’t submerge the area in pools and hot tubs or bodies of water, like lakes and oceans.

You can expect some mild discomfort, clear discharge and crusting, and bleeding in the first few days after a neck piercing, but other symptoms can indicate a problem.

Here are signs of infection to look out for:

  • increasing pain, redness, or swelling around the piercing
  • bleeding that doesn’t stop
  • skin that’s hot to the touch
  • yellow, green, or thick discharge
  • a foul smell coming from the piercing
  • fever, body aches, and other flu-like symptoms

If you notice any of these, call your healthcare provider.

While it’s tempting to experiment with different jewelry in a new piercing, avoid doing so until the piercing is fully healed.

Once healed, it’s best to have your piercer change the jewelry for you. This is especially the case for nape piercings, which can be hard to get to and change safely, or dermal piercings, since the anchor can dislodge.

As long as you wait until it’s fully healed, retiring your piercing is just a matter of removing the jewelry and letting the hole grow over.

It will leave a tiny scar at where the hole has closed.

Think a neck piercing is right for you? You can find a reputable piercer in your area through the APP.

Once you’ve narrowed down your choice, book a consultation and be sure to:

  • check the studio for cleanliness
  • ask about their sterilization process
  • ask to see their portfolio of healed client piercings

Adrienne Santos-Longhurst is a Canada-based freelance writer and author who has written extensively on all things health and lifestyle for more than a decade. When she’s not holed-up in her writing shed researching an article or off interviewing health professionals, she can be found frolicking around her beach town with husband and dogs in tow or splashing about the lake trying to master the stand-up paddle board.