Body Modification

Does California’s body art law cover tongue splitting, ear pointing, or implants?

No. Section 119301(c) of the Health and Safety Code defines body art as a closed list of four procedures: body piercing, tattooing, branding, and application of permanent cosmetics. Tongue splitting, ear pointing and subdermal implants appear nowhere in the chapter. They fall outside the Safe Body Art Act entirely, which is not the same thing as being legal.

What follows is a reference on three procedures — lingual bifurcation, cosmetic ear reshaping, and subdermal and transdermal implants — assembled from the statutes, the professional-body policies, and the entire published medical literature, which is smaller than almost anyone expects. Where a number does not exist, this page says that instead of estimating one.

What Apollo does, and what this page is

The Apollo Tattoo & Piercing Studio does not perform tongue splitting, ear pointing, ear reshaping, subdermal implants or transdermal implants. We do not offer them, recommend them, arrange them, or refer anyone for them. We perform tattooing and body piercing, which are two of the four procedures California licenses, and nothing on this page should be read as an offer of anything else.

This page exists because these procedures are searched for constantly and written about badly. The material below is what the primary sources say — statutes read from the legislature’s own site, policies read from each organisation’s own document, and studies counted one at a time after the search results were triaged. Our own reference work on the procedures we do perform is at piercing safety statistics, and the rest of the library is indexed at body art facts.

A four-item definition, and everything it leaves out

California’s Safe Body Art Act runs from section 119300 to section 119328 of the Health and Safety Code. The complete chapter was read and searched. The words tongue, subdermal, scarification, ear pointing and reshaping do not appear anywhere in it as regulated procedures, and implant appears only as a jewelry-material specification.

The provisions that set the Act’s boundary

Provision	Text	Effect
Section 119300(b)	The chapter’s stated purpose is to set minimum statewide standards for four named procedures, and it names the same four that appear in the definition below	The scope clause and the definition agree
Section 119301(c)	“‘Body art’ means body piercing, tattooing, branding, or application of permanent cosmetics.”	A closed four-item definition
Section 119301(e)	Defines body piercing as making an opening in the body in order to insert jewelry or other decoration	Reaches a tongue piercing. A tongue split makes no opening and holds no jewelry
Section 119301(f)	Defines branding by the instrument and the mechanism: a permanent scar deliberately produced by burning	Scarring by heat is inside the Act. Scarring by blade is not named anywhere in the chapter
Section 119301(t)	“‘Practitioner’ means a person who performs body art on a client.”	A registration authorises the four listed procedures and nothing else

Both of those sections were last amended by AB 1168 in 2013, taking effect at the start of 2014, and the chapter as a whole was repealed and re-enacted in 2011. Nothing in either round of drafting added a fifth procedure.

Falling outside the Act is not the same as being permitted, and the distinction matters in a practical way. It means the Act’s permitting, registration, bloodborne-pathogen training and inspection regime does not reach these procedures at all. A California body art practitioner’s registration confers no authority to perform them, and the county health permit that covers a tattoo studio does not cover them either. There is no inspection, no required training, no consent form and no complaint route, because there is no scheme.

What reaches these procedures instead

With no procedure-specific statute, what applies is general law. Two California provisions matter, and one of them is startling to read.

Unlicensed practice of medicine

Business and Professions Code section 2052(a) reaches any person who “diagnoses, treats, operates for, or prescribes for any ailment, blemish, deformity, disease, disfigurement, disorder, injury, or other physical or mental condition of any person” without a valid certificate, and provides that such a person “is guilty of a public offense, punishable by a fine not exceeding ten thousand dollars ($10,000), by imprisonment pursuant to subdivision (h) of Section 1170 of the Penal Code, by imprisonment in a county jail not exceeding one year, or by both the fine and either imprisonment.” Subdivision (b) extends the offence to anyone who conspires with, aids or abets another.

The breadth is the point. Cutting a tongue in two, excising a wedge of ear cartilage, and opening a pocket beneath the skin to seat a silicone shape are all within the words “operates for… deformity… disfigurement” on their face.

Mayhem, and the word that limits it

Every person who unlawfully and maliciously deprives a human being of a member of his body, or disables, disfigures, or renders it useless, or cuts or disables the tongue, or puts out an eye, or slits the nose, ear, or lip, is guilty of mayhem.

That is Penal Code section 203, and it names two of the three procedures on this page almost literally. Section 204 sets the punishment at “imprisonment in the state prison for two, four, or eight years.” Section 205 creates aggravated mayhem, punishable by life with the possibility of parole, for causing permanent disability or disfigurement “under circumstances manifesting extreme indifference to the physical or psychological well-being of another person.”

The limit travels with the text. Section 203 requires the act be done “unlawfully and maliciously.” Whether a client’s consent negates malice in this setting has not, so far as this research could establish, been tested against a body modifier in a reported California decision — and no reported California prosecution of a body modification practitioner under section 203 or section 2052 was located. The honest description is exposure, not outcome. The statutory language fits; nobody has found out what a court would do with it.

One thing California is not

Delaware and Illinois route tongue splitting through their dental practice acts. California’s does not obviously reach it: Business and Professions Code section 1625 defines dentistry as diagnosis or treatment “of diseases and lesions and the correction of malpositions of the human teeth, alveolar process, gums, jaws, or associated structures,” and the tongue is not expressly named. Section 1626 makes unlicensed practice of dentistry unlawful. Do not repeat the claim that California treats tongue splitting as unlicensed dentistry. The medicine statute is the cleaner hook.

Other states, and one English case

The United States picture is a genuine patchwork with no federal scheme: some states criminalise tongue splitting outright, some license scarification, one built licence categories for implanting and then suspended them. That state-by-state detail belongs to the US body art law reference in this library and is not duplicated here.

One foreign authority is worth knowing about because it is what anyone checking this subject will find. In R v BM [2018] EWCA Crim 560, the Court of Appeal of England and Wales considered a Wolverhampton tattooist and piercer who had removed an ear, removed a nipple, and divided a tongue to create a forked effect, all on consenting adult customers and without anaesthetic. The certified question was whether consent could be a defence. It could not:

In short, we can see no good reason why body modification should be placed in a special category of exemption from the general rule that the consent of an individual to injury provides no defence to the person who inflicts that injury if the violence causes actual bodily harm or more serious injury.

Two cautions. This is English law and binds nothing in California. And it did not settle the law on body modification generally — the three procedures charged are the three it decided, and it left the earlier English branding authority standing. Our scarification reference carries that analysis.

The whole tongue-splitting literature is six items

Raw database counts for this subject overstate the real literature by roughly twenty times, and the contamination is systematic rather than random. Queries were run against the PubMed E-utilities service on August 29, 2026 and every result set was triaged by title rather than accepted at face value.

Why the raw counts are useless

Query	Raw count	What the records actually are
tongue splitting, unquoted	455	Split-mouth randomised dental trials, sagittal split osteotomy, cheek-splitting cancer approaches
“tongue splitting”, title and abstract	22	Mostly median labiomandibular glossotomy, a surgical access technique for the cervical spine
tongue bifurcation, forked tongue, title and abstract	13	Snake neurobiology and metaphor
tongue bifurcation, unquoted	175	Overwhelmingly Arnold tongues, a term from nonlinear dynamics, plus vascular bifurcations
lingual bifurcation, unquoted	232	Vascular and dental-canal anatomy. Zero body modification

After triage, six items remain. That is the entire deliberate-tongue-splitting literature.

Every located study of deliberate tongue splitting

Study	Type and size	Finding
Budd, Schellenberg & Gick, 2017	Case-control acoustic study, 12 bifurcated against 12 matched controls	The only study of split tongues with a control group ever published. Speech “while intelligible, shows a higher proportion of perceptibly atypical fricatives and significantly greater variance than seen in the control group.” The authors note the implications for speech “have not been systematically studied”
Lee, Bhujel, Bennett & Singh, 2022	Case report, 1	A 29-year-old woman had repeated bleeding and worsening chest pain after a tongue split, and was diagnosed with acute pulmonary embolism three days after the procedure
Bressmann, 2004	Case report, 1	“Tongue motility was mildly reduced as a result of tissue scarring. Speech was rated to be fully intelligible and highly acceptable by 4 raters, although 2 raters noticed slight distortions of the sibilants /s/ and /z/”
Bressmann, 2006	Case study, 1	The split “did not significantly affect the participant’s speech intelligibility and tongue motility”; “the synergy of the 2 sides of the tongue was preserved”
Benecke, 1999	Case report, 1	A 28-year-old woman with “a ‘split tongue’ (a tongue split to the base), which does not interfere with speaking and eating”
Aga & Harris, 2013	One-page letter to the editor	Full text paywalled and not read. Notable only because it is the single clinical reference the Royal College of Surgeons and the American Academy of Pediatric Dentistry cite for tongue-split risk

Do not count the two Bressmann papers as two patients. Same author, same self-operated participant, same design of four raters with two noticing distortion of /s/ and /z/, near-identical concluding sentences, published two years apart in a dental journal and then a phonetics journal. Neither paper states that they describe the same person; the inference is strong enough that two separate research passes reached it independently, and weak enough that it should be labelled an inference. What it is not is two cases.

What six items can and cannot support

They can support this: that a split tongue generally remains intelligible in speech, which all five substantive items agree on; that fricatives are the specific and repeated speech finding, appearing in both the single-patient reports and the twelve-person controlled study; that eating was unaffected in both cases where it was assessed; and that at least one person suffered severe bleeding and a pulmonary embolism.

They cannot support a rate of anything. There is no denominator anywhere in this literature. One published complication does not make a complication rate, and the largest study ever conducted enrolled twelve people to measure the acoustics of fricatives, not to measure safety. Case reports are also published because they are dramatic, so the literature is systematically weighted toward the worst outcomes while saying nothing at all about the ordinary ones.

Four risks routinely attributed to splitting that come from piercing

• Ludwig’s angina. Traces to a 1997 case report in the British Dental Journal titled “A complication of tongue piercing.” One patient, and a piercing.
• Bifid tongue as a complication. Traces to a 2005 British Dental Journal report of a tongue that split unintentionally from a piercing. That is the opposite of the deliberate procedure.
• Gingival recession and tooth fracture percentages. These come from oral piercing systematic reviews: a 2016 review of 15 studies reporting recession in “50% in subjects with lip piercings and 44% in subjects with a tongue piercing” and tooth injuries in “26% individuals with lip piercings and in up to 37% of individuals with tongue piercings,” and a 2022 review of 54 studies whose own verdict was that “certainty of evidence was very low.” They are piercing figures and say nothing about splitting. Note also that the American Dental Association’s own web page misstates the 2016 recession figure, so cite the primary abstract rather than the summary of it.
• Lingual nerve damage. Asserted by every professional body quoted further down this page. Not documented in a single published case of tongue splitting. It is an anatomical inference, and a reasonable one, but an inference is what it is.

Ear pointing has no peer-reviewed literature at all

There is no peer-reviewed case report, no case series and no technique paper on cosmetic ear pointing performed as body modification. Not a thin literature — none. Eight distinct search strategies were run across PubMed and Europe PMC full-text search on August 29, 2026.

Eight searches for ear-pointing literature

Search	Result
PubMed: ear pointing, pointed ear, pointed ears, elf ear, elf ears, in title and abstract	2 records, both irrelevant — a helical adhesion malformation paper and a lung-disease morphology study
Europe PMC full text: “ear pointing”	26 hits, zero relevant, including veterinary papers about animals’ ears pointing
Europe PMC full text: “elf ear”	1 hit, unrelated
Europe PMC: pointed ears with cosmetic, surgery or body modification	20 hits, zero relevant — congenital syndromes and dysmorphology
Europe PMC: auricle, auricular, pinna or helix with body modification and reshaping, pointing, excision or cosmetic	10 hits, zero relevant
PubMed: six further keyword combinations covering helix wedge excision, auricular reduction, ear cropping, perichondritis and otoplasty as body art	All zero
Full text of the one review covering surgical challenges in body modification, 2025	Ear pointing not covered

The consequence should be stated in exactly these terms: there are no published complication data, no healing times, no revision rates and no outcome data for ear pointing. Any number attached to this procedure is unsourced. Not poorly sourced — unsourced, by construction, because there is no literature for it to have come from.

Two adjacent things exist and neither fills the gap. A 2022 letter to the editor in Aesthetic Plastic Surgery is titled “Rationality and Regulation Needed to Contain China’s Dangerous Infatuation with ‘Elf Ears’”; its full text is behind a publisher wall and was not read, and the Chinese trend it names is widely described as filler injection behind the ear to make it protrude, which is a different procedure from excising a wedge of helix cartilage. We cite it only as existing. And the wedge-excision technique description in circulation traces to a plastic surgeon’s blog, a page that refused automated retrieval, so it has not been verified firsthand and is attributed to a blog rather than to literature.

The cartilage risk is real, and it is about piercing

There is a substantial, high-quality literature on infection and cartilage destruction from ear cartilage piercing. None of it studied ear pointing. It establishes a mechanism — traumatising auricular cartilage carries a documented and sometimes deforming infection risk — and a mechanism argument is legitimate. A transferred rate is not.

Auricular cartilage infection evidence, all of it from piercing

Study	Design and size	Finding
Ungar et al., Laryngoscope, 2025	Retrospective chart review 2006 to 2021, 217 patients, 120 piercing-induced	The largest cohort available. Piercing-induced cases were younger and more localised, with significantly more abscess formation, which was the dominant complication predictor at an odds ratio of 35.75
Fisher, Kacica & Bennett, Am J Prev Med, 2005	Outbreak with case-control, 15 cases and 61 controls	“Of 15 confirmed cases, nine (60%) were hospitalized”, median stay 4.4 days. Contaminated aftercare solution implicated
Sandhu et al., Can J Public Health, 2007	Case report, 1	An 11-year-old whose high helical piercing infection failed cephalexin and “required debridement and removal of necrotic cartilage”

The outbreak evidence, the organism data and the needle-against-gun question are set out with their sources on our piercing safety statistics page and are not restated here. One point carries across and is worth repeating: the two largest published outbreaks were caused by contaminated aftercare solution and by a contaminated water system, not by piercing technique. That is the finding most often left out of popular coverage.

Implants: three papers, and one dataset from a prison

The peer-reviewed literature on decorative subdermal implants is three items, two of which describe a single patient each.

What the one detailed case describes

A 2026 case report in Eplasty was read in full. A woman “had custom silicone body-modification implants placed under her clavicles.” Four days later she developed “a progressive increase in redness and pain associated with grossly purulent drainage.” On examination there was “erythema and crepitus over the bilateral chest wall, as well as a Laboratory Risk Indicator for Necrotizing Fasciitis score of 7 and subcutaneous gas on computed tomography.” Because of concern for necrotizing soft tissue infection the surgical team “emergently undertook foreign body removal and debridement of the chest wall.” Cultures grew Streptococcus pyogenes. She returned to theatre on the first and third postoperative days for further debridement, underwent complex chest wound repair with haematoma evacuation on day nine, and was discharged on day eleven.

That is one patient. It establishes that this outcome is possible and that it is severe. It establishes nothing whatever about how often it happens.

The imaging claim, and what the imaging paper actually says

A 2016 forensic case report in Legal Medicine described subdermal three-dimensional art implants as an aid to radiological identification, stating “to the best of our knowledge, this is the first case of radiological identification with a subdermal 3D art implant.” Its full text is paywalled and was not read. It reports identifiability, not artifact. The frequently repeated claim that these implants distort fluoroscopy or magnetic resonance images traces to a 2016 nursing practice review, where it is an unreferenced assertion. No published case of a body-modification implant causing imaging artifact was located, and the ferromagnetic status of these implants has never been tested or reported.

One controlled finding does exist and it points the other way. A 2019 animal study placed stainless steel microdermal anchors in four pigs and measured skin temperature during electrocautery: 1.58°C at the implant against 2.03°C at control, a difference that did not reach significance. “Histologic review of excised tissue samples showed no evidence of thermal injury,” and the authors concluded that “aggressive steps to remove microdermal implants before surgery may be unnecessary.” Four pigs. Report it as one small animal study, not as settled perioperative guidance.

The one substantial dataset, and why it must be labelled

Migration, extrusion, granuloma, late infection and removal difficulty are documented for decorative objects in the subcutaneous plane — but in one specific anatomical context, genital “pearling,” and mostly in a prison population. That label has to travel with every number from it.

Genital pearling: the closest thing to an implant dataset

Study	Design and size	Finding
Vergez et al., Sexual Medicine, 2025	Self-administered survey of detainees, 132 respondents of 779 eligible, a 17% response rate, French Guiana penitentiary	“69% reported having APNs, with a median of 5.2 nodules per user (range: 1-22)”; “complications were reported by 25%, including pain (52%), bleeding (41%), and infections (35%)”
Vella et al., Urology Case Reports, 2021	Case report, 1	The only verified published instance of spontaneous extrusion, exiting in a granuloma of the inner face of the foreskin
Xu et al., Cureus, 2023	Case report, 1	A penile abscess “five years after insertion”. Establishes delayed, years-later infection
Murfi & Adi, Urology Case Reports, 2026	Case report, 1	A 63-year-old with 90 subcutaneous beads made from modified toothbrush handles; removal required penile degloving
Ramirez et al., Cureus, 2023	Case report, 1	An incidental, asymptomatic finding, arguing for a lack of chronic symptoms. A useful counterweight: not every implant becomes symptomatic

The 25% is not a rate. It is a within-survey proportion from a self-selected 17% of an eligible prison population, self-reported. It cannot be published as “one in four implants develops a complication,” and it describes a procedure performed with improvised objects in a custodial setting, which is not the same procedure as a carved silicone piece placed by a practitioner.

Removal, and permanence

A 2023 technique paper in Cureus is the best-verified source on removal difficulty for dermal anchors, and what it says is that removal is not standardised: “there is limited dermatologic literature detailing a standard removal technique,” and emergency-department removal by rocking with non-serrated hemostats “may lead to unnecessary damage to the skin, infections, and scarring.” A 2025 review in Missouri Medicine adds the plainest statement available on permanence: “it is often impossible to completely erase all clinical evidence of a piercing, particularly for large-gauge piercings or those that have been in place for many years,” and “residual scar tissue remains.”

Materials: nobody has published one

No peer-reviewed source specifies materials, grades or durometers for body-modification subdermal implants. Every material claim in circulation rests on practitioner and community sources, and those sources are thinner than they look — the main encyclopedia entry’s only citation for materials is a magazine article from 2006, and the site itself refused automated retrieval, so it was not verified firsthand. Three specific points are worth having straight:

• PTFE and Teflon are the same polymer. Teflon is a brand name for PTFE, and community sources generally write it correctly. The real trap is that “Teflon” is also used loosely for non-implant fluoropolymer coatings, and no source specifies an implant-grade PTFE standard for this use.
• No verifiable source states a silicone durometer or Shore hardness value for these implants. If a number appears anywhere, it has no source behind it.
• The history is trade lore. The attribution of three-dimensional subdermal implants to a named pioneer, and the progression from steel and Teflon to carved and then cast silicone, comes from community sources that could not be verified. It may well be right. It is not established.

What the FDA does and does not say

The FDA has issued no statement about solid decorative subdermal implants. What it has stated concerns injected silicone, which is a different thing and must be labelled as such. On its dermal fillers page the agency says: “Injectable silicone is not approved for any aesthetic procedure including facial and body contouring or enhancement. Silicone injections can lead to long term pain, infections, and serious injuries, such as scarring and permanent disfigurement, embolism (blockage of a blood vessel), stroke, and death.” A 2017 press release adds that injectable silicone “is currently only approved by the FDA for a specific use inside the eye (intraocular ophthalmic use),” and that such procedures are “often performed by unlicensed and non-medical practitioners in non-clinical settings such as residential homes or hotels.”

The most useful sentence in the entire FDA record on this subject is the regulator describing the limits of its own knowledge:

The FDA does not know the true extent of these injuries caused by these procedures because unlicensed practitioners do not report injuries incurred from their illegal practice and patients who are harmed may not know to alert the FDA.

That generalises honestly to every procedure on this page. Beyond it, the device record is empty. Direct queries to the openFDA device APIs on August 29, 2026 returned no classification for a decorative subdermal or transdermal implant, no approved premarket application for injectable liquid silicone, and no adverse-event report involving a body-modification implant. The agency classifies the ear-piercing instrument as a Class I device; it classifies no body jewelry at all, which is why “FDA-approved body jewelry” is a phrase that cannot be true. Whether a decorative implant is a “device” at all under the statutory definition, which covers an article “intended to affect the structure or any function of the body of man,” is an open and unadjudicated question. No FDA guidance applying that definition to body modification was located. The FDA has not taken a position, and nobody should write that it has.

Four dental bodies, one risk list, and where the list came from

Unlike scarification, where the leading trade body expressly declines to hold a position, tongue splitting has formally adopted positions from major dental organisations. Each was read from the organisation’s own document.

American Dental Association

Resolved, that the American Dental Association advises against the practices of cosmetic intraoral/perioral piercing, tooth gems/jewelry and tongue splitting, due to the increased risk of negative health outcomes.

The policy’s Transactions trail reads 1998, 2000, 2004, 2012, 2016 and 2021. It originated in 1998 and was amended in five later years. The widely repeated claim that the ADA adopted it in 2004 is a misdating — a 2004 House of Delegates action on the policy is real and documented, but what that amendment changed could not be established, because the ADA blocks automated retrieval of the 2004 transaction. Write it as adopted 1998, amended through 2021.

The ADA is also candid about what its position rests on. From its own Oral Health Topics page: “Reports describing the morbidity and mortality associated with tongue splitting are relatively sparse in the research literature, but the risk of complications secondary to surgical procedures (including pain, swelling and infection) is well known.” That is the association stating that its concern comes from general surgical principle rather than from tongue-split data.

The other three, verbatim

• American Academy of Pediatric Dentistry, policy on oral piercing and oral jewelry, adopted 2000 and revised through 2025: tongue splitting is “an invasive procedure with no medical benefit that renders the tongue susceptible to severe bleeding and pain, bacterial infection, lingual nerve damage, and other adverse effects.”
• Royal College of Surgeons Faculty of Dental Surgery with BAPRAS, joint statement of 30 August 2018: “We strongly advise people against undergoing a tongue splitting procedure, and to be aware that in England and Wales body modification practitioners who offer this service are likely to be acting illegally as the law currently stands.” On haemorrhage: “The tongue is the site of several major veins and arteries. Splitting the tongue can therefore cause considerable bleeding and carries a risk of significant blood loss.” On nerve damage: it “can result in pain, altered sensation or numbness which in some cases can be permanent.” On anaesthesia: “local anaesthetic toxicity leading potentially to seizures, coma, respiratory and cardiac arrest.”
• Australian Dental Association, policy statement 2.2.9, adopted 2008 and amended through 2023: “Tongue splitting procedures carry the risk of swelling, infection and of causing medium to long-term difficulties with speaking and eating. Maintaining good oral health and hygiene may also become more challenging after a tongue split.”

A striking parallel sits inside the British statement. It describes the English legal position in words that could have been written about California: tongue splitting “is not covered under any existing legislation, so is in effect entirely unregulated.” Two jurisdictions, two regulators, the same structural gap — the procedure falls between the body-art scheme and the medical scheme in both.

One verified absence

The American Association of Oral and Maxillofacial Surgeons has no position statement on tongue splitting. Its complete published listings were enumerated, twenty advocacy papers and sixteen white papers, and neither contains anything on tongue splitting, tongue bifurcation, body modification or oral piercing. That is an absence established by counting, not an oversight, and no position should be attributed to that body.

The pattern, stated plainly

Every organisation above recites the same four risks: haemorrhage, infection, lingual nerve damage, and change to speech or swallowing. That list is not derived from studies of tongue splitting. The American Academy of Pediatric Dentistry sources its tongue-splitting sentence to three references — the British joint statement, the ADA statement, and the one-page 2013 letter to the editor. The British statement’s only tongue-split clinical citation is that same letter. The chain terminates in a one-page letter whose full text is paywalled.

The honest formulation, and it is a stronger sentence than any invented statistic: major dental bodies uniformly advise against tongue splitting, and they are candid that the evidence behind that advice is sparse. The opposition rests on anatomy and general surgical principle rather than on published outcome data, because almost none exists.

Nobody certifies this, and the leading trade body says so itself

There is no certification for these procedures. Not a weak one or a lapsed one — none. This is one of the few flat statements on this page, and it can be made flatly because the relevant professional body says it in its own words. The Association of Professional Piercers publishes a list headed “THE APP DOES NOT,” which includes:

License or certify piercers. Members do receive an affirmation of membership which must be renewed every year. Attendees of APP classes receive a seminar certificate.

Have a position on tattooing, branding, scarification, dermal punching, scalpelling, implants, or other types of body art. Members are not precluded from also practicing these types of body modification where they are allowed by law.

Two things follow. The APP certifies nobody for anything, including for piercing, its own field — so the phrase “APP certified” is a category error wherever it appears. And the leading professional body in the adjacent trade has expressly declined to set any standard for implants, scalpelling or dermal punching, leaving them to whatever local law permits.

The training route that does exist is apprenticeship, and it is a route into piercing rather than into any of this. The APP’s published position, dated 22 September 2025, is that training programmes advertised as schools “are suitable only for an introduction to the trade of professional body piercing,” and that “the pathway to a professional body piercing career is the completion of a thorough apprenticeship under the supervision of a qualified mentor.” Its suggested minimum criteria for a mentor are five years’ professional experience in a licensed studio, current CPR, first aid and bloodborne pathogens certificates, and a written curriculum. Note carefully that this is the standard for piercing. There is no equivalent for splitting, implanting or ear reshaping, because the body that would write it holds no position on them.

The state that built a shelf and never found anything to put on it

Oregon is the only US jurisdiction located in this research that created statutory licence categories for dermal implanting and scarification, at ORS 690.350(6)(e) and (f). Both were then prohibited by rule. Oregon Administrative Rules 331-920-0000 and 331-920-0005 read, in identical form, that these services “are prohibited until education and training programs can be implemented.” That language carries a rule history running back to 2012 and it still stands in the rules effective 17 June 2025.

So Oregon has had licence categories that nobody can be licensed in for roughly fourteen years. The regulator does not say that no curriculum exists; that is a reading of the rule’s continued existence plus the elapsed time, and it is offered as a reading. But it is the closest thing to evidence available on the question of whether a recognised curriculum for these procedures exists anywhere in the United States.

The register of what has never been measured

Each line below is an absence established by search rather than assumed. Where a query produced it, the query is in the section it belongs to.

Questions with no published answer

Subject	No evidence exists for
Tongue splitting	Any randomised trial or cohort study. Trial registries return nothing
Tongue splitting	Any healing time or healing-course description, by any study design
Tongue splitting	Any complication rate. No denominator exists in this literature
Tongue splitting	Any reversal, revision or surgical re-joining. The procedure is publicly presented as reversible and no published account of a reversal exists
Tongue splitting	Lingual nerve damage from splitting, as opposed to asserted by policy
Tongue splitting	Airway compromise or infection from splitting. Every such case in the literature is from piercing
Tongue splitting	Taste change, tooth fracture or gingival recession from splitting
Tongue splitting	Any survey of people with split tongues reporting their own outcomes
Tongue splitting	Any non-English literature. German and Spanish search terms return nothing
Ear pointing	Any peer-reviewed case report, case series or technique paper at all
Ear pointing	Any complication, healing-time, revision or outcome datum. This follows from the line above
Ear pointing	Any perichondritis or cartilage-necrosis case attributed to pointing rather than to piercing
Implants	Any published case of a body-modification implant causing imaging artifact
Implants	Any assessment of whether these implants are ferromagnetic, for magnetic resonance safety
Implants	Any published case of capsular contracture, fibrous encapsulation or migration of a decorative art implant
Implants	Any published case of tissue necrosis attributed to a decorative silicone implant. The one severe case is a necrotizing infection, which is a different claim
Implants	Any peer-reviewed specification of materials, grades or durometers
Implants	Any FDA device classification, approved premarket application for injectable liquid silicone, or adverse-event report involving a body-modification implant
Legal	Any California statute or regulation addressing these three procedures
Legal	Any reported California prosecution of a body modification practitioner under the mayhem or unlicensed-medicine statutes
Legal	Any national US standard, curriculum or certification. The trade body certifies nobody; Oregon’s categories have sat unopened since 2012

Three further items are honestly labelled as not found rather than proven absent, because the search budget ran out before the question was closed: whether the American Medical Association holds a policy, whether any FDA warning letter concerns body jewelry or implants, and whether body-modification implants appear in the security-screening literature. Saying “we did not find it” and saying “it does not exist” are different claims and this page keeps them apart.

Two state laws that do not exist

Both of the claims below are widely repeated online, including by sources that look current. Both are wrong, and both failed for the same reason: an introduced bill was reported as though it were an enacted statute.

Tennessee

Senate Bill 3229 and House Bill 3302 of the 103rd General Assembly, captioned “Creates Class A misdemeanor offense of ‘tongue splitting’ by a person other than a licensed physician,” did not become law. The Senate passed its version 30 votes to nil on 31 March 2004. The House companion died a week later, and the legislature’s own bill history records the reason: “Failed for Lack of Motion in: Budget of FW&M,” 7 April 2004. No Tennessee Code provision on tongue splitting was located. Tennessee does not prohibit tongue splitting.

Michigan

The Michigan claim traces to a House Legislative Analysis of House Bill 4688 from the 2001 to 2002 session, which gets passed around online with the authority of a statute. It was never enacted. Michigan’s current body-art provisions, sections 333.13101 and 333.13102 of the Compiled Laws, retrieved from the legislature’s own document service and stamped “Michigan Compiled Laws Complete Through PA 91 of 2026,” contain no tongue-splitting provision at all. A bill analysis is not a statute.

The check that catches this is reading the bill history on the legislature’s own site, not the statute summary on an aggregator. It is worth applying to any state anyone adds to a list like this, including the states on our US body art law page, where each entry is sourced to a legislature or code site rather than to a summary of one.

Sources

Statutes were read from each legislature’s or code publisher’s own site on August 29, 2026. Policies were read from each organisation’s own published document. Studies were verified against the published record rather than against a search summary.

Statutes and regulations

• California Health and Safety Code sections 119300 and 119301, Safe Body Art Act purpose and definitions. leginfo.legislature.ca.gov
• California Business and Professions Code section 2052, unlicensed practice of medicine. leginfo.legislature.ca.gov
• California Business and Professions Code sections 1625 and 1626, definition of dentistry and unlicensed practice.
• California Penal Code sections 203, 204 and 205, mayhem and aggravated mayhem. leginfo.legislature.ca.gov
• Oregon Revised Statutes chapter 690, sections 690.350 and 690.360, fields of practice. oregonlegislature.gov
• Oregon Administrative Rules 331-920-0000 and 331-920-0005, dermal implanting and scarification prohibitions, in the permanent rules effective 17 June 2025. oregon.gov
• Michigan Compiled Laws sections 333.13101 and 333.13102, complete through Public Act 91 of 2026. legislature.mi.gov
• Tennessee General Assembly bill history, Senate Bill 3229 of the 103rd General Assembly. capitol.tn.gov
• R v BM [2018] EWCA Crim 560, Court of Appeal of England and Wales, judgment 22 March 2018. caselaw.nationalarchives.gov.uk

Peer-reviewed literature

• Budd A, Schellenberg M, Gick B. Effects of cosmetic tongue bifurcation on English fricative production. Clinical Linguistics & Phonetics. 2017;31(4):283–292. doi:10.1080/02699206.2016.1255782 · PMID 27858466
• Lee J, Bhujel N, Bennett K, Singh RP. Dangerous body modification: a case report of pulmonary embolism and surgical site bleeding following tongue split procedure. Oral Surgery. 2022;15(4):669–671. doi:10.1111/ors.12746. Not indexed in PubMed; clinical detail corroborated through the ADA’s description of it.
• Bressmann T. Self-inflicted cosmetic tongue split: a case report. Journal of the Canadian Dental Association. 2004;70(3):156–157. PMID 15003161
• Bressmann T. Speech adaptation to a self-inflicted cosmetic tongue split. Clinical Linguistics & Phonetics. 2006;20(2-3):205–210. PMID 16428238
• Benecke M. First report of nonpsychotic self-cannibalism (autophagy), tongue splitting, and scar patterns (scarification). American Journal of Forensic Medicine and Pathology. 1999;20(3):281–285. PMID 10507799
• Aga F, Harris R. Cosmetic tongue split. British Dental Journal. 2013;214(6):275. doi:10.1038/sj.bdj.2013.284 · PMID 23518960. One-page letter; full text paywalled and not read.
• Perkins CS, Meisner J, Harrison JM. A complication of tongue piercing. British Dental Journal. 1997;182(4):147–148. PMID 9062002
• Fleming PS, Flood TR. Bifid tongue: a complication of tongue piercing. British Dental Journal. 2005;198(5):265–266. PMID 15870744
• Hennequin-Hoenderdos NL, Slot DE, Van der Weijden GA. The incidence of complications associated with lip and/or tongue piercings: a systematic review. International Journal of Dental Hygiene. 2016;14(1):62–73. PMID 25690049
• Passos PF, et al. Oral piercing: a systematic review of adverse effects. Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 2022;134(3):327–341. PMID 35773168
• Chen X, Zhang R, Zhang Q, et al. Rationality and Regulation Needed to Contain China’s Dangerous Infatuation with “Elf Ears”. Aesthetic Plastic Surgery. 2022;46(1):537–538. PMID 34331097. Letter to the editor; full text not read.
• Ungar OJ, Bursztyn N, Shilo S, et al. Auricular Perichondritis in the Cartilage Piercing Era. The Laryngoscope. 2025;135(12):4693–4702. PMID 40631793
• Fisher CG, Kacica MA, Bennett NM. Risk factors for cartilage infections of the ear. American Journal of Preventive Medicine. 2005;29(3):204–209. PMID 16168869
• Sandhu A, Gross M, Wylie J, et al. Pseudomonas aeruginosa necrotizing chondritis complicating high helical ear piercing. Canadian Journal of Public Health. 2007;98(1):74–77. PMID 17278683
• Mostovych AL, Fell C, Spiegel JD, et al. An Interesting Case of a Tattoo Artist’s Subdermal Chest Implants. Eplasty. 2026;26:QA2. PMID 42577750
• Schaerli S, Berger F, Thali MJ, Gascho D. Ankh in the depth: subdermal 3D art implants, radiological identification with body modification. Legal Medicine. 2016;20:12–14. PMID 27161914. Full text paywalled and not read.
• Dunn D. Body Art and the Perioperative Process. AORN Journal. 2016;104(4):326–340. PMID 27692079. Narrative review; the imaging claim is unreferenced.
• Sheldon RR, Loughren MJ, Marenco CW, et al. Microdermal Implants Show No Effect on Surrounding Tissue During Surgery With Electrocautery. Journal of Surgical Research. 2019;241:72–77. PMID 31009888. Four swine.
• Vergez J, Baudot A, Epelboin L, et al. Methods, practices, and complications related to the use of artificial penile nodules within the French Guiana penitentiary. Sexual Medicine. 2025;13(2):qfaf022. PMID 40259992
• Vella M, Abrate A, Zerbo S, et al. Spontaneous extrusion of male genital pearling. Urology Case Reports. 2021;38:101728. PMID 34094880
• Xu R, Wolff D, Deebel NA, et al. A Case Report on “Pearling”: Removal of Infected Objects During Circumcision. Cureus. 2023;15(6):e40700. PMID 37485088
• Murfi MR, Adi K. Genital pearling: how many can fit? A case report. Urology Case Reports. 2026;66:103436. PMID 42005291
• Ramirez JC, Wickremasinghe PD, Mayol-Velez LX, Izquierdo-Pretel G. “La Perla Del Mar”: A Case Report on Subcutaneous Penile Implants. Cureus. 2023;15(4):e37155. PMID 37153248
• Elder AJ, Deirawan H, Adlam T, Moossavi M. Step-by-Step Guide to the Punch Removal Technique for Dermal Piercing. Cureus. 2023;15(8):e43516. PMID 37719601
• Malik A, Council ML. From Ancient Traditions to Modern Medicine. Missouri Medicine. 2025;122(5):410–416. PMID 41132470

Professional bodies and agencies

• American Dental Association, Current Policies, Adopted 1954–2025, page 157, policy statement on intraoral and perioral piercing, tooth gems and tongue splitting. ada.org
• American Dental Association, Oral Health Topics, oral piercing and jewelry. ada.org
• American Academy of Pediatric Dentistry, policy on oral piercing and oral jewelry or accessories, Reference Manual of Pediatric Dentistry, 2025, pages 152 to 154.
• Royal College of Surgeons Faculty of Dental Surgery and BAPRAS, joint statement on oral piercing and tongue splitting, 30 August 2018. rcseng.ac.uk
• Australian Dental Association, policy statement 2.2.9, body modification and dentistry.
• American Association of Oral and Maxillofacial Surgeons, complete advocacy paper and white paper listings, enumerated to establish the absence of a position.
• Association of Professional Piercers, About Us, and the position on piercing mentorship dated 22 September 2025. safepiercing.org
• US Food and Drug Administration, Dermal Fillers (Soft Tissue Fillers), content current as of 6 July 2023. fda.gov
• US Food and Drug Administration, press release on the illegal use of injectable silicone for body contouring, 13 November 2017. fda.gov
• openFDA device classification, premarket approval and adverse event APIs, queried directly on 29 August 2026. open.fda.gov

Corrections are welcome. If a citation here is wrong, or a policy has been revised since it was read, tell us and we will change it and say what changed.

Frequently asked questions

Does Apollo perform tongue splitting, ear pointing, or implants?

No. The Apollo Tattoo & Piercing Studio performs tattooing and body piercing only. We do not perform tongue splitting, ear pointing, ear reshaping, subdermal implants or transdermal implants, we do not recommend or arrange them, and we do not refer anyone for them. What follows sets out what the law and the published literature say. It is not a description of anything we offer.

Does California law regulate tongue splitting, ear pointing, or subdermal implants?

No. Health and Safety Code section 119301(c) defines body art as a closed list of four procedures: body piercing, tattooing, branding, and application of permanent cosmetics. None of these three is mentioned anywhere in the chapter, so the Safe Body Art Act does not reach them. That means there is no permit, no registration, no required training and no inspection covering them, which is not the same as their being permitted. What reaches them instead is general law, principally Business and Professions Code section 2052 on unlicensed practice of medicine and Penal Code section 203 on mayhem.

Is tongue splitting illegal in Tennessee or Michigan?

Neither state prohibits it. Both claims circulate widely and both trace to bills that were never enacted. Tennessee's Senate Bill 3229 of the 103rd General Assembly passed the Senate 30 to nil in March 2004, and the House companion then died, recorded on the legislature's own bill history as failed for lack of motion in committee on 7 April 2004. Michigan's claim traces to a House Legislative Analysis of a 2001 bill; the current Michigan Compiled Laws, complete through Public Act 91 of 2026, contain no tongue-splitting provision.

How many studies of tongue splitting exist?

Six, and two of those are almost certainly the same person published twice. Raw database searches return counts in the hundreds, but those results are dominated by unrelated terms: split-mouth dental trials, sagittal split osteotomy, snake neurobiology and Arnold tongues from nonlinear dynamics. After triage the literature is one case-control acoustic study of twelve people against twelve controls, four single-patient case reports, and one paywalled one-page letter to the editor. No study in that set has a denominator, so no rate of anything can be calculated from it.

Is there any research on ear pointing?

None. Eight distinct search strategies across PubMed and Europe PMC full-text search returned no peer-reviewed case report, case series or technique paper on cosmetic ear pointing as body modification. There are therefore no complication data, no healing times, no revision rates and no outcome data. Any number attached to this procedure is unsourced by construction, because there is no literature it could have come from. The cartilage infection literature that does exist studied ear piercing, not pointing.

Does the FDA approve body modification implants or body jewelry?

No, and it classifies neither. Direct queries to the openFDA device databases returned no classification for a decorative subdermal or transdermal implant and no adverse-event report involving one. The agency classifies the ear-piercing instrument as a Class I device but classifies no body jewelry at all, so the phrase "FDA-approved body jewelry" cannot be true. The FDA has stated that injectable silicone is not approved for any aesthetic procedure, but that concerns injected material rather than a solid carved implant, and no FDA position on solid decorative implants exists.

Is anyone certified to perform these procedures?

No. The Association of Professional Piercers states in its own published list of what it does not do that it does not license or certify piercers, and that it holds no position on implants, scalpelling, dermal punching, branding or scarification. Membership is an annually renewed affirmation and class attendees receive a seminar certificate, so "APP certified" is a category error. Oregon is the only state to have created licence categories for dermal implanting and scarification, and it has prohibited both by rule since 2012 pending training programmes that have not been implemented.

What do dental organisations say about tongue splitting?

They advise against it, and they are candid about the evidence. The American Dental Association's policy, which originated in 1998 and was amended through 2021, advises against tongue splitting due to increased risk of negative health outcomes. The American Academy of Pediatric Dentistry, the Royal College of Surgeons with BAPRAS, and the Australian Dental Association all take the same position and recite the same four risks: haemorrhage, infection, lingual nerve damage, and change to speech or swallowing. That risk list is inferred from oral piercing research and anatomy rather than from tongue-split data, which the ADA states in its own words.