If you have ever wanted to look different than you currently appear, you’re not alone: more than 12 million cosmetic surgical and non-surgical procedures were performed in the US alone in 2008. That number includes everything from liposuction to Botox, but doesn’t include bariatric (weight loss) surgery or body art like tattoos and piercings. Most cosmetic procedures are not covered by health insurance, which means that regular people are willing to endure an awful lot of financial—not to mention physical—pain in order to look younger, slimmer and healthier; in other words, they wish to look more like the status quo, or, conversely, they wish to reject it. So what type of body modification is popular in the 21^st century, and is it a sign of shifts in our culture and our status quo?

At a time like this, there’s a divergence between conforming to the status quo and rejecting it, and that comes into play in body modification. There’s a difference between wanting to get breast implants to “feel better about yourself,” and wanting body art so you can shock people with it and show your support for the shift of culture.

Tattoos date back to ancient times and are one of the oldest forms of body modification. Today, in Western culture, they are probably the most famous example of our changing status quo: teardrops on cheekbones and faded, blurred anchors on forearms were, until twenty years ago, the badges of prison and military service. Then, in the nineties, rock groups who danced the line between mainstream culture and underground cool popularized tattoos and piercings; now, supermodels, CEOs, and actors get body art at boutique studios that purvey luxury and the gritty underside of street cool in one powerful status statement.

“When I started tattooing, it was illegal in New York City,” says Michelle Miles, owner of Daredevil Tattoo, now one of the most famous tattoo shops in the world. She worked in New Jersey independently until tattooing was legalized in New York City in 1997, when she opened her own shop in Manhattan’s Lower East Side. She says the biggest change she has witnessed in her work is the growing acceptance of tattoos in mainstream culture; she’s even tattooed a few Wall Street CEOs. Still, even in a clean, safe, world-famous tattoo shop, tattoos keep throwing social norms for a loop: devils and skulls abound, and if you don’t already have a certain level of street credibility before you get a tattoo, most people will agree that getting one elevates you a notch or two.

You can even get techno-trendy cool with a black light tattoo, which adds a nice touch to a traditional tattoo.

There’s some disagreement between artists about how well the black light tattoos glow and how long the glow lasts, but most people agree that the baby-blue look of the ink is not very tough-looking on its own, so if you’re interested, do some thorough research first.

Newly introduced are white ink tattoos: petal-soft and nearly invisible, they are a statement that’s as equally in-your-face as it is stealthy, like the surreptitious rebellion of the teenage girls who might be inclined to get them. “It looks more like a birthmark than an actual tattoo; it’s just a lightening of the skin, kind of an embossed effect: very, very subtle. Perfect for, say, the white collar professional or fashionista,” says Friday Jones, a tattoo artist in New York City who has tattooed Angelina Jolie and Lydia Hearst. Jones says that white tattoos need to be planned with forethought and performed by an artist experienced in working with the thick white pigment, which requires some skill. “White tattoos can’t be exposed to much sun because your melanin will naturally discolor the white ink like an overlay,” and you’ll be left with a brown tattoo, she cautions. White tattoos turn out a lighter version of your own skin tone. Consequently, when the status quo has already been so trampled by others before you, all you need to do to join the rebellion is tiptoe.

On the other hand, you could push the envelope with body piercing. Body piercing is also an old practice: for hundreds of years, pirates and sailors wore a single gold earring as currency so whomever found their body when it washed up on shore could pay for their burial. It’s interesting that the single earring became representative of pirates’ swashbuckling lawlessness, and that single ear piercing in modern times still carries that rebellious connotation. Yet, when body art exploded in the nineties, the connotation spread to all forms of piercing, except the traditional one-hole-in-each-earlobe style on girls. Beyond that, however, wearing body art says “insurrection.” One person’s piercing might communicate a small amount of insurrection, such as, “I can wear something shocking, and so what?” or, “I might be a little kinky,” while another’s piercing might communicate, “I hate this society and its rules, and I won’t obey them.” Yet, the next thing you know, everybody jumps on the bandwagon and a septum piercing is no longer a big deal, forcing you to do more to show you’re pushing for change.

Enter surface anchors, a new trend in piercing. “Basically, the technique is called single-point piercing,” explains Terry Leroy, President and CEO of LeRoi Inc, which was one of the first companies to make jewelry for body piercing and that now has an upscale room inside Daredevil’s shop. Most traditional piercings have been through places on the body where skin forms a flap or a body part protrudes—earlobes, tongues, genitals—but surface anchors are implanted on a smooth, flat surface, such as the chest, and are often used to augment tattoos. “You can put them anywhere, practically,” he says. The trend has been in full force for a couple of years now. The anchors have a hole in the “foot,” the part placed under the skin. Tissue then grows through the hole, truly “anchoring” it. So, while the anchor can be removed, it’s best to consider it a semi-permanent piece of jewelry, as removal results in more scarring than the removal of traditional and small-gauge jewelry.

Anchoring jewelry attempts to defeat the body’s natural reaction to reject it as a foreign object, so a low-level inflammatory response can be ongoing as long as the jewelry is in place. That’s just one reason that Colonel Norvell Coots, CEO of the Army’s Walter Reed Health Care System and a dermatologist, says that there’s no good place on your skin to put a dermal anchor. “Your glands and all of the bases of the hair follicles are there; the blood vessels are all located in the dermis, as well as some of the small muscles that are in the skin. You can disrupt blood vessels and disrupt glandular structures; there are a number of potential medical problems just from the destruction of the normal architecture of the skin,” he cautions. In addition, there is always a low-level inflammatory response as the body tries to rid itself of the foreign object.

Next is a more extreme form of body modification: labiaplasty. It’s a cosmetic surgery for the female genitals, and we have the porn industry to thank for its increasing popularity. An estimated twelve percent of all websites are porn sites, and with millions of people viewing porn where waxing is the norm, there has been a rising trend in Brazilian waxing since the internet boom. Like suburban white kids spouting Jay-Z lyrics as the offbeat becomes mainstream, waxing has become increasingly popular in women of all ages and all levels of sexual promiscuity.

Now that people have had a close, unobstructed view of female genitals, the question of how a woman’s genitals stack up to those of porn stars’ is increasingly popular. Like it or not, there is a standard of genital beauty in porn: the labia minora cannot protrude past the labia majora, and there must not be “excess flesh” in the genitals. This standard, which has permeated the rest of our culture, leads women with large labia minora to desire labiaplasty: the removal and/or contouring of the excess tissue. Andrea Stapleton, a certified plastic surgery nurse and aesthetic nurse specialist at Pearl Women’s Center in Portland, Oregon, says that most of the patients they see for labiaplasty are middle aged (the few young women who have the procedure are those with excessively long labia minora that make wearing tight clothing or riding a bike uncomfortable). “I think that women are divorcing more, so they’re back out in the dating scene,” and want to impress new partners, she says. She believes that enhanced sexuality results from less inhibition when women feel better about the way they look after a skillfully executed procedure that contours the flesh and removes as little as possible to preserve sensation, and from hairlessness, which enhances sensitivity. In addition, some women opt for a procedure called clitoral unhooding, which is performed when excess flesh over the clitoris prohibits or impedes orgasm.

“I’ve had a lot of patients lately get the labia reconstructed,” says Mary Jo Rapini, a psychotherapist in Houston who has worked with TLC’s Big Medicine and sees many patients who have had bariatric surgery. She says women who are, or who have been heavy have more flesh in their genital areas, which is not representative of today’s standard of beauty; nevertheless, the irony is that there are now more than four-hundred million obese adults worldwide. With easy access to a high-calorie, low-nutrient diet, and exercise becoming something of a luxury, the status quo of fit and slim is difficult for most people to reach, and it’s especially hard for those who are already overweight. No wonder, then, that bariatric surgery is becoming increasingly common: despite its risks and demand for radical lifestyle changes, it works.

Bariatric surgery isn’t for the faint of heart: the most effective procedures permanently alter the anatomy of the stomach and other organs. For example, Roux-en-Y gastric bypass surgery, which is the most common procedure, involves cutting most of the stomach away to leave only a small pouch, then rerouting the small intestine so food from the pouch can flow out. Recovery takes several weeks, and the individual must eat very small meals that conform to a strict dietary regimen—protein powder becomes a staple—in order to avoid nutritional deficiency or painful cramping while losing and keeping off hundreds of pounds of excess weight. However, biomedical engineers are working on several devices and systems to make bariatric surgery less “medieval,” and, hopefully, unnecessary.

All body modification procedures carry inherent risks, and these risks, along with the pain of the procedure, are part of its shock value. One person may respond to body modification with enthusiasm, while another with horror; response depends largely on what kind of procedure it is, how much it alters the body, and where the person stands philosophically on what the status quo should or shouldn’t be. Things are different today than they were years ago; anyone can tell you that. It is obvious that the status quo for beauty and aesthetic is different than it was at the height of cultural conformity fifty years ago. A quick glance at bestselling non-fiction, and you’ll see titles that scream, “The world is changing! Everything is, or will soon be different!” Bodies are the living billboards for the same message that tells us, “This is what conformity looks like, this is what insurrection looks like; here’s where we’re headed, and here’s where I stand.”

Before any body modification procedure, you should think carefully about your motives and your health, both physical and emotional/mental. The riskier, more painful, more permanent the procedure, and the more it rejects the status quo than conforming to it, the greater the possibility that you may need a professional to evaluate your mental and emotional state before proceeding. People undergoing radical body modification may take offense at the suggestion that their mental or emotional health might be unstable, but it’s not a stretch: some procedures, like sex change operations, legally require counseling before a surgeon is allowed to proceed.

There’s seemingly no end to the body mutilation procedures that are touted as stylish or sexually enhancing. Surgical and quasi-surgical procedures must be performed by an accredited surgeon. Reputable plastic surgeons turn patients away all the time, so it may not be easy to find a surgeon who will implant eyeball jewelry, undertake scarification, or flay open a penis for enhanced sensitivity. This refusal should be a red flag that the health risks probably outweigh any potential benefit.

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