Permanent body piercings are performed by creating an opening in the body using a sharp object through the area to be pierced. This can either be done by puncturing an opening using a needle (usually a hollow medical needle) or scalpel or by removing tissue, either with a dermal punch or through scalpelling.

Tools used in body piercing include:

The piercing needle

The standard method in the United States involves making an opening using a beveled-tip hollow medical needle, which is available in different lengths, gauges and even shapes. While straight needles are useful for many body parts, curved needles are manufactured for areas where straight needles are not ideal. The needle selected is typically the same gauge (or sometimes larger as with cartilage piercings) as the initial body jewelry to be worn, with higher gauges indicating thinner needles. The needle is inserted into the body part being pierced, frequently by hand but sometimes with the aid of a needle holder or pusher. While the needle is still in the body, the initial body jewelry to be worn in the piercing is pushed through the opening, following the back of the needle. Body Jewelry is often inserted into the hollow end of a needle, so that as the needle pulls through the body jewelry is left behind.

The indwelling cannula

Outside of the United States, many piercers use a needle containing a cannula (or catheter), a hollow plastic tube placed at the end of the needle. In some countries, the piercing needle favoured in the United States is regarded as a medical device and is illegal for body piercers. The procedure is similar to the piercing needle method, but the initial jewelry is inserted into the back of the cannula and the cannula and the body piericing jewelry are then pulled through the piercing. More bleeding may follow, as the piercing is larger than the Body Jewelry.

The dermal punch

A dermal punch is used to remove a circular area of tissue, into which body jewelry is placed, and may be useful for larger cartilage piercing jewelry. They are popular for use in ears, though not legal for use by nonmedical personnel in some parts of the United States.

Piercing Gun

Piercing guns, which were originally developed for tagging livestock, are typically used for ear piercing, but may be used for other body parts as well. Piercing guns are generally not favoured by professional body piercers. Guns use relatively blunt, solid studs that punch through tissue; thus they cause more trauma to tissue than proper piercing needles, which are sharp and hollow and remove tissue cleanly rather than crush it. They are also considered unsuitable for hygienic reasons. Piercing with a piercing gun causes microsprays of plasma and blood; the guns frequently contain plastic components which are unable to be cleaned in an autoclave system, while surface cleansers do not kill all bacteria.[ Piercing guns are frequently encountered in retail outlets, where those wielding them may be inadequately trained. The Association of Professional Piercers recommends that piercing guns not be used for any piercing, including ears body jewelry.

Cork

Cork may be placed on the opposite side of the body part being pierced to receive the needle.

Forceps

Forceps, or clamps, may be used to hold and stabilize the tissue to be pierced. Most piercings that are stabilized with forceps use the triangular-headed "Pennington" forcep, while tongues are usually stabilized with an oval-headed forcep. Most forceps have large enough openings in their jaws to permit the needle and jewellery to pass directly through, though some slotted forceps are designed with a removable segment instead for removal after the piercing. Forceps are not used in the freehand method, in which the piercer supports the tissue by hand.

Needle receiving tubes

A hollow tube made of metal, shatter-resistant glass or plastic, needle receiving tubes, like forceps, are used to support the tissue at the piercing jewelry site and are common in septum and some cartilage piercings. Not only are these tubes intended to support the tissue, but they also receive the needle once it has passed through the tissue, offering protection from the sharp point. Needle receiving tubes are not used in the freehand piercing method.

Anaesthesia

Anaesthesia is supplied by some piercers, particularly in the United Kingdom and Europe. The anaesthesia may be topical or injected. Piercers and other non-medical personnel are not legally permitted to administer anaesthetics in the United States.