What some call mutilation, they call modification. Meet four women who literally wear their art on their sleeves: Anne and her husband run two piercing salons in Los Angeles, California. But they aren’t exactly piercing ears. No, Anne is a play piercer. She’ll pierce legs, necks, arms, and backs. She also runs “suspension parties” where participants pierce thick hooks through their skin and hang from the ceiling. It’s not for the faint of heart.

By day, Heather is in charge of multi-million dollar properties. But when the workday is done, this mother-of-one sheds her conservative image and becomes her alter-ego, Cookie. Cookie’s journey through body modification started with pierced ears, but it didn’t end there. Now, she’s covered with tattoos and has a collection of sub-dermal implants that each have a specific and special meaning behind them.

Michelle was a wild child rebel who shocked her mother when she got a tattoo as a teenager. She went off to Parsons School of Design and majored in painting, but Michelle’s love of tattoos never waned. Despite opposition from her Mom and resistance from the male-dominated tattoo world Michelle pressed on. Now she’s the only female tattoo artist in New York City to own not one, but two thriving tattoo parlors.

Natalie loves body art and Natalie loves her freedom. So much so that she’s about to exercise it in an extreme way. She’s about to undergo a scarification, which is the process of cutting something into one’s skin in order to create a raised and permanent scar. It’s a painful process, but Natalie is willing to withstand the pain for something that she considers an artistic expression of herself.