This week a girl came in just for aftercare spray. Pierced elsewhere, six weeks in, already doing her research. She mentioned her piercer had told her to make saltwater at home — and that set off alarm bells immediately. In my experience, a piercer who gives that advice in 2026 is likely making other choices I wouldn't agree with either. So before I handed her the NeilMed and let her walk out, I asked if I could take a look.
There was a nostril screw in her helix.
In eight years of piercing I have never seen a trained piercer voluntarily put a nostril screw in a cartilage piercing. This isn't about quality, or material, or grade. This is about jewelry style — and it's the thing that gets talked about the least.
Luckily she'd done some digging and found my website, which told her sterile saline was the standard — and that led her here. If you're reading this because you're in a similar situation, I hope this article finds you before things get worse. We can sort it out.
This article covers: nostril, lobe, helix, mid helix, forward helix, low helix, conch, flat, faux rook and tragus. Other piercings — daith, rook, septum, navel — work with different jewelry styles by nature of their anatomy. That's a different conversation.
The flat back labret: what it is and why we use it
A flat back labret is a post — a straight stem in a specific gauge — with a flat disc at the back that sits flush against the skin. The decorative top attaches at the front, either threadless (friction / click / press pin) or internally threaded (screw). That's it. Simple, stable, functional. Also called a labret post, flatback or labret stud.
For the piercings listed above, this is the default. Not a preference, not a style choice — the standard. In Europe most piercers work in 16G (1.2mm) on average, though we can and do pierce at other gauges depending on placement, anatomy, and the jewelry you want to wear. I've started piercings at 14G (1.6mm) knowing it would heal more smoothly, then downsized to 18G (1mm) later because the end result simply looks better at that size — and by that point, in this climate, it's safe to do so.
Gauge selection is always a conversation we have before piercing. A larger gauge will always heal better — that's a fact, not a rule of thumb. But if you want a delicate top, I use the gauge that top requires. I will never let you choose a top that's too delicate for the placement, and I won't push a gauge that doesn't suit the jewelry you actually want to wear. What I won't do is pierce you at a gauge that makes your chosen top unstable or unsafe.
What never changes is the relationship between your top and your post. Your top needs to be at least as wide as your gauge — never smaller. A 1mm top cannot go on a 1.2mm post, because the post is wider than the top and would push straight through. A round 1.5mm prong or bezel on a 1.2mm post leaves just 0.15mm on each side — barely anything. Put it on a 1mm post and it sits correctly.
On the other end, a large piece like a BVLA Athena — 12.5mm x 5mm, substantial weight — needs a 1.2mm post minimum and a larger disc at the back to balance it. I usually work with 3–4mm discs, but for a piece like that I'd go to 5 or 6mm. The jewelry needs to be balanced on both sides to sit properly.
One more thing worth knowing: you are not stuck to your current gauge. A healed piercing will stretch or shrink to accommodate a new gauge. I pierce most helix piercings at 16G (1.2mm) on average, but if after healing you want a thin ring, we can absolutely make that happen — the hole will adjust to the new size. Your options stay open.
"But I always get pierced with a ball back"
Yes. A lot of piercers use ball backs. Here's why — and why it's not ideal.
In cheaper jewelry, the stem is attached to the top, not the back. The back screws on. And because these pieces are externally threaded, a flat disc doesn't work — the threads on the outside of the stem make it impossible. So the only option is a ball. Everything about this construction is a problem, but the ball back itself is part of the issue.
A ball back offers no stability. Think of it this way: a flat disc has a wide, flat contact point against the skin — like balancing something on the palm of your hand. A ball has a single small point of contact — like balancing something on the tip of your finger. Both touch the skin, but one is stable and one isn't. When pressure is applied — sleeping on it, catching it on your hair, your pillow — the disc can't be pushed sideways easily. A ball can, and will.
When jewelry shifts under pressure it can migrate — the piercing starts to grow at an angle rather than healing straight through. It's also one of the clearest paths to the bump people dread. With a disc, if you accidentally sleep on your piercing — and I know you will, because you're human — there's at least a fighting chance. With a ball back it's almost guaranteed you'll have a reaction. That said, neither is safe to sleep on while healing. Just to be clear. 😉
Some piercers do prefer to start with a ball back because the logic is that it's slightly easier to clean around and less likely for crusts to get stuck on it. I understand the reasoning — I just don't share the opinion. In my experience a ball back gets consumed by buildup just as easily, and the stability advantage of a flat disc outweighs the cleaning argument every time. If you're struggling to clean around the disc in the beginning, book a check-up and we'll sort it out together — that's what I'm here for.
I never start a fresh piercing with a ball back.
When I do use a ball back
There are exceptions. I use them at downsize — and only at downsize — in specific placements where the disc becomes the problem rather than the solution.
The two situations where I'll reach for a ball:
1. When the disc creates wounds. In a conch, the back of the disc can sit too close to the helix rim. I've seen this enough times — the edge of the disc makes a small wound in the rim every time the client sleeps on it. A ball is softer, rounder, and when pressed against other parts of the ear it doesn't cut.
2. When the anatomy squishes. In flat, faux rook, or outer conch piercings, the back of the piercing sits in an area with folds and curves. When a client lies on that ear and the whole ear compresses against the head, I check where the disc would land. Sometimes — not always, but sometimes — the disc ends up wedged between folds and causes discomfort every single time they sleep on that side. In those cases, a ball sits more gently. If anything gets pressed against it, it's smooth.
I have clients who come in with healed flat piercings pierced elsewhere, years old, good quality — and they say it's perfect except they can never sleep on it. Nine times out of ten it's the disc getting squished into the wrong part of their ear. That's the only reason to switch.
For everything else — helix, tragus, nostril, lobe — a properly sized disc is what you want. Flush against the skin, nothing to catch, nothing to pull. Your jewelry should disappear into your ear when it's healed. Not sit on top of it.
On this outer conch we used a barbell or ball back. You can tell by just this picture if she sleeps on this ear, the back of that piercing will get squished, so a ball is a great solution for her.
What about earring backs?
While we're here — butterfly backs, push backs, and silicone earring stoppers. Let's talk about those too, because the answer is simple: don't.
Not on piercings. And honestly, not on earrings either if you can avoid it.
The same catching and pulling hazard that makes a ball back problematic gets significantly worse with an earring back. Butterfly backs, push backs, silicone stoppers — none of them have a smooth, polished surface. They're often ridged, sometimes stamped with a brand name, and that uneven texture is a problem. Skin is more sensitive than you think or feel. Even when an earring back isn't visibly moving, the friction from an unpolished surface against healing or healed tissue is enough to cause low-level irritation that never fully resolves. Your body doesn't stop trying to protect itself just because a piercing is healed.
The bigger issue is hygiene. Earring backs are essentially little dirt traps. Hair products, natural body discharge, dead skin cells, dried lymph fluid — all of it collects in and around the back and compacts over time. At a certain point there's nowhere for it to go except into the piercing channel itself. When that happens, the buildup can stretch the channel, cause irritation ranging from mild to severe, and when you finally remove the jewelry the hole can look far larger than it should. What looks like a stretched piercing is often just packed buildup that's been sitting there for months.
Taking these out regularly to clean them properly sounds like a solution — but cartilage piercings don't like having their jewelry removed repeatedly, even when fully healed. And neither do a lot of lobe piercings, if we're being honest. Switching jewelry frequently leads to irritation, inflammation, and sometimes bleeding even in piercings that have been healed for years.
There is not one advantage to earring backs. Not for piercings, not for earrings. A flat disc does everything better — smooth, flush against the skin, easy to keep clean, nothing to catch on. It disappears behind your ear the way jewelry should. A butterfly back does the opposite. It sits there, collects everything, and reminds your skin it exists every single time you move.
The short version
99% of the piercings listed at the top of this article should be pierced with a flat back labret. The gauge, disc size, and post length all have a purpose and your piercer should be making those decisions deliberately. A ball back is a tool for specific situations at downsize — not a great starting point, and not a substitute.
If your piercing has anything other than a disc back and it's not healing, that might be why. Send me a photo or come in for a look.
If it has a nostril screw in it, come in immediately. That ancient piece of jewelry shouldn't even be in your nostril.
Book your appointment, or get in touch if you want to talk through your jewelry before you commit to anything.
