At first, Jean M Loftus, MD, seems like a garden-variety plastic surgeon. She’s based in Northern Kentucky, and her work days are filled with the bread and butter procedures that typify aesthetic surgery: breast implants, tummy tucks, blepharoplasties, and liposuction.
A couple of times a month, however, Dr. Loftus performs a surgery that very few other plastic surgeons offer: She splits tongues.
When she first began offering tongue splitting, or bifurcation, 15 years ago, Dr. Loftus was under the impression that the candidates would be a largely young segment of the population. She was wrong. “It crosses every demographic, from 18 to 70 [years old]. They’re male, female, educated, uneducated. I just split the tongue of a 55-year-old business owner, and a 65-year-old engineer. [I’ve had] a truck driver and a woman who specializes in healing arts,” she says. Dr. Loftus is one of the few surgeons who’s repeatedly referenced for tongue splitting on Reddit’s r/bodymods subreddit.
A brief history of tongue splitting
A split tongue might seem radical (and reptilian) to most of us, but this type of body modification isn’t something new, or even niche. Humans have been altering their bodies for eons, be it for beauty, religion, or storytelling. Scarring was practiced by Indigenous Australians, tribes in Africa and Asia stretched their necks, earlobes and lips, and a sect of Hindus still practice skin piercing and suspension rituals at religious festivals. In fact, the oldest discovered incidence of ear stretching, piercing and tattooing dates back to a frozen mummy from 3300 BCE.
Though forked tongues have been widely depicted in religious and folk imagery for centuries, documentation of the actual practice is nearly nonexistent, possibly because split tongues have been viewed in several cultures as having a negative connotation. Ancient Roman poet Prudentius even blames a bifurcated tongue as the very origin of sin. According to the Cultural Encyclopedia of the Body, “On his fall, Satan’s tongue becomes forked, and as the physical division both literally and metaphorically corrupts his speech, he is consequently able to lead humanity astray.”
According to Guinness World Records (which keeps tracks of notable firsts) the first modern-day recorded tongue bifurcation can be traced to an anonymous Italian man who had a dentist friend perform the procedure in 1994. But the first person to do it and be identified by name was Dustin Allor, an American piercer who used her existing piercings as a jumping off point to split her own tongue with the help of some fishing line.
Anthony Youn, MD, a board-certified plastic surgeon based in Troy, Michigan, defines this type of extreme body modification as “changing the body to look completely different from a natural human appearance.” He cites changes like cutaneous horns, severe earlobe gauging, forked tongues, removal of body parts (like fingers), and even complete coverage tattoos as examples of extreme modifications. There are more: subdermal implants that create raised shapes or patterns under the skin, scarification and branding, and corset piercings, a series of rings down the back that allow you to cinch your body like a built-in corset. On a similar track, tech bros and biohackers implant magnets, radio-frequency identification chips and LEDs into their bodies.
Today, extreme body mods are not exactly as commonplace as tattoos or piercings, though they have been normalized enough that even mainstream celebrities talk about getting them: Last August Grimes tweeted about wanting elf ears her whole life and tried crowdsourcing recommendations for someone who would do the modification for her. Megan Fox also showed interest in surgically-peaked ears after wearing faux versions while cosplaying as Zelda for Halloween. This movement has obviously grown way beyond Comic Con.
Why Dr. Loftus started splitting
Dr. Loftus’s tongue splitting seems relatively tame by comparison to some of these modifications. The board-certified plastic surgeon noticed a shift in beauty standards and social mores, and started offering the surgery circa 2007. She estimates that she was the first in the state to offer this procedure.
“I did it because around that time stories started coming out of people getting their tongue split by their friends, or doing it in tattoo parlors. The tongue is very bloody and [that can cause] all sorts of problems,” she says. Dr. Loftus is also a board-certified otolaryngologist (or ENT) who has previously performed many oral surgeries including tongue reconstruction on cancer patients, so she felt she was uniquely qualified to offer bifurcation. “This is not a hard operation for me, so I offered it as a procedure that can be done in a safe environment.”
Other plastic surgeons are more hesitant, citing ethical or medical lines they refuse to cross, and as a result, moral dilemmas related to body mods are popping up. The social norms around beauty standards is another reason surgeons abstain. “Society has general guidelines of what is considered reasonable and what is out of the ordinary. In general, physicians try to stay within the boundaries set by society,” says Dr. Youn. He does note that social mores do shift and expand, based on popular opinion. “At one point tattoo sleeves were considered extreme, but it's much more accepted now,” he says.
Doctors also admit to avoiding these surgeries to safeguard their reputation or “aesthetic.” A physician’s surgical skill is not the only thing their patients are paying for; equally important is their aesthetic judgment and an eye for making artful and natural-looking choices. They may not want a one-off case of extreme surgery disrupting an otherwise more traditional track record. “The surgeon needs to be comfortable having their imprimatur on that particular outcome. Many surgeons would not want ‘unusual’-looking patients, even those ecstatic with the outcome, spreading their name as the surgeon that created that look,” says L. Mike Nayak, MD, a board-certified plastic surgeon based in St. Louis, Missouri.
Dr. Loftus has no such reservations. Over the years, she’s had candidates from all over the country come to receive the surgery, and she currently has about one or two tongue-splitting cases a month. It’s a relatively small part of the business. According to her website, the surgery costs a total of $3,375. By contrast, a breast augmentation is $7,575, of which she performs between ten and 20 monthly. (This is another way Dr. Loftus differs; most plastic surgeons don’t have such an extensive, clearly laid out list of how much their procedures will cost on their website.) But she seems to have a soft spot for her tongue-splitting patients. The procedure is typically performed under local anesthesia, or a nerve block, so the entire tongue is numb. A small percentage of patients choose general anesthesia so that they’re not conscious during the procedure.
Why you should let a surgeon split your tongue
A qualified surgeon like Dr. Loftus wielding the scalpel is more likely to achieve results with safer outcomes compared to “body modification artists” who routinely do this without a medical degree (and without any anesthesia stronger than over-the-counter anesthetics). “Most of the risks of ‘grievous bodily harm’ are negated by having the [tongue splitting] procedure done by a surgeon, respecting vital structures and controlling bleeding,” says Dr. Nayak. “The patient is much safer having this performed by a surgeon than by a piercer or body modification artist,” says Dr. Nayak. He thinks revulsion issues might be the reason it’s not commonly offered by aesthetic surgeons, since the surgery is inherently not any riskier than most other facial cosmetic procedures. “There may be some mild functional impact long term, but the patient is aware and chooses to accept it,” he explains. “Even large breast implants have functional consequences that people willingly take on to get the look that they want.”
Dr. Loftus’ expertise really comes into play because she knows when to stop. “Every patient wants their tongue split really deeply. As far as they're concerned, it can't be deep enough,” she says. “I, as the doctor, have to make sure that I am only splitting it as far as it's technically advisable.” she says. If it’s split too far back, speech can be affected and scarring can occur. “Overdoing it increases the risk of healing problems and function afterwards,” she says.
One question Dr. Loftus doesn’t ask these patients is why they chose to get the surgery. “I kind of stay out of that,” she says. “I look at my role as [someone offering] it safely in an environment where they can choose to get it done. And I’m also concerned that if I ask why, that will alienate them and make them defensive. So, I generally don't.” Body dysmorphic disorder (BDD) is the first thing some surgeons worry about when faced with a tongue splitting patient, but in Dr. Loftus’ experience, BDD depends on the patient and the circumstance, not on the operation. “There are plenty of people who I might see either for a face-lift, a breast augmentation, or maybe a tongue splitting, where it is evident to me that they either have body dysmorphic disorder or there are other factors that make me concerned that they're not simply doing this for themselves. And in any of those circumstances, I would not operate on them,” she explains. “I don't have a different set of criteria for tongue splitting than I do that I do for other operations.”
Her staff especially enjoys working with these patients. “Our tongue splitting patients are wonderful,” she says. “It's interesting that there is such a prejudice against them by society. They tend to be people who are heavily tattooed and pierced, but they're just as nice as everybody else.”
The only type of patient she hasn’t had, she jokes, is an actor who wants to split their tongue for a role. That might not actually be as bananas as it sounds, as reversing a tongue splitting surgery is surprisingly easy. “We're not damaging the tissue. We're not creating any problems,” Dr. Loftus explains. “This is easier to reverse than just about any other operation that we do.”
It’s a useful fact for hesitant patients to have in their back pocket, but, in her years of offering this surgery, she’s never gotten any requests for a reversal. “Not a single person has come back to me to have it reversed. I assumed that would happen all the time but I never get a call for it.”
More stories about plastic surgery and cosmetic treatments:
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