ArticlePDF Available

The Charming Tale of Charm Needles!


Abstract and Figures

Charm needles or susuk are needle-shaped metallic objects inserted subcutaneously in different parts of the body. The practice of inserting susuk is, an indisputably cultural and superstitious traditional belief common in the south-east Asian region, especially to the people of Malaysia, Thailand, Singapore, Indonesia and Brunei. With increased use of diagnostic radiographs in dental or medical practice, the discovery of charm needles has become more frequent. We report one such case of charm needles inserted in oro-facial region which was discovered in routine dental radiograph, with emphasis on cultural and traditional belief.
Content may be subject to copyright.
Nitte University Journal of Health Science
NUJHS Vol. 7, No.2, June 2017, ISSN 2249-7110
Intentional modifications of the body for non-medical
reasons like aesthetic reasons, religious reasons, and to
show self-expression is called body modification. Piercing,
Tattooing, branding, scarification and surgical implants are
few examples for body modification. Not all of them
originated at the same time, while some practices have
been around for thousands of years, others have just begun
to gain fame in recent years. One such practice of piercing
foreign objects especially in the cranio-facial region is
called 'Susuk' or 'Charm needles'. Their insertion in the
body is a superstitious, cultural and traditional belief,
which is common in the south-east Asian region, especially
to the people of Malaysia, Thailand, Singapore, Indonesia
and Brunei [1, 2].It is usually seen in Malay Muslim women
and to a lesser extent in Chinese and Indian women [3, 4].
Most needle-wearers wish to keep the existence of the
needles a secret [5]. Unavoidably, some susuk wearers
seek medical and dental treatment and this secret is
revealed on the radiographs. The purpose of this article is
to present a case of charm needles inserted in oro-facial
region and discuss the cultural and traditional aspect of
such practice.
Case Report
A 38-year-old Malaysian Chinese woman reported to a
Dental Institute of Malaysia, complaining of stains over her
teeth. Routine diagnostic panoramic radiograph revealed
multiple linear radio-opacities of about 10 mm size
distributed in several areas (n=11) throughout the image
[over the right zygomatic buttress (2), left maxillary sinus
(3), cervical third of root of 16 (1), cervical third of root of 27
(1), posterior to 38 at external oblique ridge (1), below the
The Charming Tale of Charm Needles!
1 2 3
Sham Kishor Kanneppady , Sowmya Sham Kanneppady , Anusha Rangare Lakshman , Khoo Suan
4 5
Phaik , Shishir Ram Shetty
1 4
Senior Lecturer, Professor and Associate Dean, Division of Oral Diagnostic Sciences, School of Dentistry, International
Medical University, Kuala Lumpur, Malaysia. Senior Lecturer and Head, Department of Pharmacology, Faculty of
Medicine, Lincoln University College, Selangor, Malaysia, Reader, Department of Oral Medicine and Radiology, Century
International Institute of Dental Science and Research Centre, Kasaragod, India, Assistant Professor, Department of Oral
Medicine and Radiology, College of dentistry, Gulf medical University, Ajman, United Arab Emirates.
*Corresponding Author : Sham Kishor Kanneppady, Senior Lecturer, Division of Oral Diagnostic Sciences, School of Dentistry,
International Medical University, Kuala Lumpur, Malaysia. E-mail :
Case Report
Received :
Review Completed : 06.05.2017
Accepted : 18.05.2017
04.03.2017 Abstract
Charm needles or susuk are needle-shaped metallic objects inserted subcutaneously in
different parts of the body. The practice of inserting susuk is, an indisputably cultural and
superstitious traditional belief common in the south-east Asian region, especially to the people
of Malaysia, Thailand, Singapore, Indonesia and Brunei. With increased use of diagnostic
radiographs in dental or medical practice, the discovery of charm needles has become more
frequent. We report one such case of charm needles inserted in oro-facial region which was
discovered in routine dental radiograph, with emphasis on cultural and traditional belief.
Keywords : Susuk, charm needles,
spiritual healing, traditional belief,
panoramic radiograph
Access this article online
Quick Response Code
Nitte University Journal of Health Science
NUJHS Vol. 7, No.2, June 2017, ISSN 2249-7110
apex of 33 and 34 (1), at the symphysis region close to lower
border of mandible (1) and below the apex of 44 and 45 (1)]
(Fig. 1). Intra oral periapical radiograph of maxillary right
posterior region was taken to confirm the existence of
radio-opaque objects (Fig 2). Its density was comparable
with that of silver amalgam. On close examination of the
object using magnifying glass it was observed that the
material is of fine needle-shape with a broader base and
pointed tapered tip (Fig. 3).
Fig. 1 : Panoramic radiograph showing multiple (n=11) charm
needles over the mandible, maxillary molars and maxillary sinus
region (needles are highlighted with white circles).
Fig. 2 : Intra oral peri apical radiograph showing charm needle
over the root of 27 (needle is highlighted with black rectangle);
the density of the object is comparable to that of silver amalgam
Fig. 3: Magnified image of a linear radio-opaque charm needle
revealing its fine needle shape with broader base and pointed
tapering tip.
After confirming the absence of any foreign objects either
in the film cassette or in the film and ensuring the proper
radiographic technique, the patient was interviewed
regarding these multiple needle-like objects over her face.
The patient hesitated to report that the insertion of small
needles over her face about 10 years ago to maintain and
improve her facial aesthetics. After discussing with the
local staffs and considering the radiographic findings, we
came to the conclusion that the needle-like objects could
be charm needles or more popularly known as Susuk. On
palpation of the facial tissues, the needles could not be felt.
As the patient neither had any discomfort nor pain with
their presence, no surgical intervention was performed. As
a treatment for her complaint, oral prophylaxis was done
and oral hygiene instructions were given.
Charm needles or susuk are needle-shaped metallic
objects inserted subcutaneously in different parts of the
body. Unlike other types of body modifications, charm
needles are not visible over the body surface. They are
inserted in the body as talismans and they are assumed to
improve the health and beauty of the wearer, cure
headaches and joint pains, protect the wearer from hurt
and accidents, improve relationship or attain success in
business and career [5-7]. Charm needles are generally
inserted in the cranio-facial region, and less often in other
areas of the body like the breasts, chest, abdomen, limbs,
spine and mons pubis [2-4, 6]. In the cranio-facial region,
the most common sites for insertion are over the mandible
followed by forehead, cheeks and lips [1, 4]. In the present
case, the insertion was at the middle and lower third of
Charm needles are inserted in the soft tissues of the body
by 'bomoh', also called traditional healers (who practice
herbal medicine), magician, medicine man, shaman, native
practitioner or Malay medicine man. Their main task is
spiritual healing and prediction [1, 2, and 8]. The needles
are inserted subcutaneously by gentle rubbing on the skin
such that it is painless and leaves no puncture marks or
blood [1, 4]. The method used for insertion is traditionally
passed down over generations. It is not sure whether
Nitte University Journal of Health Science
NUJHS Vol. 7, No.2, June 2017, ISSN 2249-7110
hypnotism is used during the procedure. It is predicted
that as susuk is inserted without anaesthesia, on insertion,
the patient may feel pain, depending on size and shape of
susuk. Some patients may come upon mild bleeding on
insertion of larger susuk [2]. Susuk is usually needle or pin
shaped, measuring about 0.5 mm in diameter and about
0.5–1.0 cm in length [2, 8].
Susuk are mostly made of gold, followed by silver and often
mixed with copper. The analysis of the chemical
composition found an average gold content of 89.75% and
copper content of 10.25% [2, 6]. Gold is preferably used as
it is biocompatible with tissues and noncorrosive while
copper is used to increase its hardness and malleability [4,
6]. There are also other forms of talisman made of diamond
and shaped by means of the normal diamond cut.
Acupuncture needles can be differentiated by charm
needles as they are usually longer and finer and are not
normally embedded in the subcutaneous tissue.
Radiographs are the ideal diagnostic tools for confirmation
of the presence of susuk. There are no reported artifacts
observed in radiographs due to the presence of charm. of A
study by Balasundram et al [9] stated that the ultrasound
imaging which was done in their patients to detect the
needles was disrupted due to echo reflection and images of
white striations that resembled reflective figures of metal
made the localization of charm needles in the soft tissue a
difficult task. Nambiar et al [3] in his study using 1.5-T MRI
machine stated that charm needles showed no
ferromagnetic characteristics and it was safe for patients to
undergo MRI. However, it is plausible that an object that
exhibits “no ferromagnetism” or weak ferromagnetic
qualities in association with a 1.5-T MR system may be
attracted with sufficient force to pose a hazard to an
individual in an MR environment that has a magnet
operating at 2.0-T or higher [9]. At present, the pertinent
literature does not contain carefully controlled studies that
establish the absolute safety of charm needle exposure to
powerful magnetic fields.
The number of needle insertion varies. In a study of 33
susuk wearers, Nambiar et al [3]observed between 1 to 39
needles in the cranio-facial region while Oon [10] had
reported between 1 to 47 susuk in a patient. Nor et al [2]
reported 80 susuk noted in the face of a single patient. In
our case, there were 11 charm needles in oro facial region.
Susuk usually remain intact for many years but can break
into smaller pieces due to corrosion and muscle
contractions [5]. The threat of foreign bodies in modern
day surgical practice is evident. Migration of these
substances causing vascular and nerve injuries in the
extremities have been reported [7, 11]. These foreign
bodies also cause increase risk of infection whether
immediately upon insertion or at a later date, which
requires their surgical removal. However, it is suggested
that they should be left alone, unless they lead to infection
or complications.
In conclusion, a wide range of surveys in literature suggests
that religious, spiritual, and traditional beliefs and
practices may provide positive benefits, although in some
cases mixed or negative consequences to mental and
physical health. There is no study done to prove that susuk
placement sustains/improves facial aesthetics. But
certainly, it gives a strong psychological benefit for the
1. Shanmuhasuntharam P, Ghani SH. Susuks: charm needles in facial
soft tissues. Br Dent J 1991; 20: 309–311.
2. Nor MM, Yushar A, Razali M, Rahman RA, Ramli R. Incidental
radiological findings of susuk in the orofacial region. Dentomaxillofac
Radiol 2006; 35: 472-474.
3. Nambiar P, Ibrahim N, Tandjung YR, Shanmuhasuntharam P. Susuk
(charm needles) in the craniofacial region. Oral Radiol 2008; 24: 10-15.
4. Pande S. Incidental findings of Susuk in Orthopaedic patients. Brunei
Int Med J. 2011; 7 (3): 177-180.
5. SK Teo. A woman with hidden charm needles. J R Coll Physicians Edinb
2006; 36: 211–212.
6. Pothiawala S. Incidental radiological finding of charm needles. Hong
Kong 2012; 19: 141-143.
7. Rampal S, Shukur MH, Sikkandar MF. Incidental radiological finding of
charm needles in the hip region: a potential surgical precaution. J
Intercult Ethnopharmacol 2012; 1(1): 66-67.
8. Loh FC, Yeo JF. Talisman in the oro-facial region. Oral Surg Oral Med
Oral Pathol 1989; 68: 252–255.
9. Balasundram S, Chong Mei Yee S, Shanmuhasuntharam P. Susuk:
Charm needles in orofacial soft tissues. Open Journal of Stomatology
2013; 3: 155-162.
10. Oon CL. Correspondence: charm needles. Med J Malaysia 1973; 27:
11. Teo LL, Seto KY, Chai P, Venkatesh SK. Embolised injection needle
fragment to the heart, mimicking a subcutaneous charm needle. Ann
Acad Med Singapore. 2010; 39: 499-500.
... 7 The insertion of susuk is a common practice in the Southeast Asia region, especially to the people of Malaysia, Indonesia, Thailand, Brunei and Singapore. 8 ...
... The usually reported types in the literature comprise small, often needle-like structures of varying lengths that are implanted subcutaneously primarily in the facial region [10]. The numbers of needles inserted in an individual have been reported to vary in number from a single one to as many as 80 needles [2,6]. ...
Full-text available
The occurrence of radio-opaque embedded foreign entities on dental radiographs, especially after dental treatment or maxillofacial trauma is not uncommon. Alongside such commonplace radiopacities, there is the occasional report of disparate artifacts being observed as incidental findings on dental pantomographs. One such entity is Susuk, or charm needles that are implanted subcutaneously in the facial region and elsewhere in the body. While this phenomenon has been reported primarily from the Southeast Asian region; increasing international travel in the modern Case Study Umesan et al.; IJRRD, 3(2): 30-34, 2020; Article no.IJRRD.59325 31 age could render these radiopaque entities a diagnostic challenge for the unacquainted clinician. In a deviation from the classically reported needle-type susuks, this paper reports a case involving insertion of multiple, springy type, filamentous, strands in the orofacial region; manifesting on the pantomograph as a meshed-veil that has never been reported in the literature.
... These needles, 5-10 mm in length and about 0.5 mm in diameter, are inserted slowly and gently under the skin leaving no external puncture marks. [2,3] Susuk is claimed to be embedded accompanied by invocations and chanting and is usually done at a particular time to increase its effectiveness. Placement of charm needles will traditionally be done during a special ritual which may include rubbing of oil over the site before the needles are inserted through the skin into orofacial soft tissues. ...
Full-text available
Susuk, or charm needles, are needles made up of gold or other precious metals, which are inserted into the soft tissues of the body to act as talismans. Susuk has various supposed purposes, ranging from the purely esthetic to the treatment of joint pains and other minor ailments. This practice is also used as protection against injury and accidents. This obscured secret of inserting charm needles is a traditional belief and a cultural phenomenon, commonly practiced among Southeast Asian women. Here, we present two such interesting cases of this concealed art as the incidental radiographic finding, which was done on a routine basis as a part of diagnostic workup at our SEGi Oral Health Center
Full-text available
The purpose of this study was to integrate the available data published to date on susuk or charm needles into a comprehensive analysis of their clinical/radiological features. An electronic search was undertaken in September 2019. Eligibility criteria included publications having enough clinical and radiological to confirm a definite diagnosis. The initial literature search resulted in 48 publications. Ten publications were excluded for duplicates, and another 17 excluded after a screening of the abstract. Besides, the screening of the abstract shows that five publications were not meeting the inclusion criteria, resulting in a total of 14 publications of susuk that were included in the systematic review. Bias analysis was conducted according to Oxford Center for Evidence-Based Medicine. The resulting total of 78 cases from the selected publications were analysed, showing a wide age range with different distribution among gender and ethnicity. Three cases reported in the literature having symptoms related to susuk. Susuk can be seen as an incidental finding during a routine radiographic assessment, and clinicians should be able to differentiate it from other radiopaque foreign bodies. The practice is not limited to South East Asian population and can be seen in wide racial profiles.
Full-text available
Objectives We conducted a study to determine the numbers of susuks (charm needles) and their distribution in the craniofacial region of susuk wearers, and the sex, racial affiliation, and age of the wearers. In addition, we sought to determine whether the presence of susuks posed any potential hazard to patients undergoing magnetic resonance imaging (MRI). Methods We studied various radiographs of 33 susuk wearers (age range, 33–69 years) and investigated the most common sites of insertion in the craniofacial region. A susuk was also suspended inside a 1.5-T MRI machine to determined whether it was attracted by the machine’s magnet. Results The largest number of susuks that we observed in the craniofacial region was 39 pins, and susuks were particularly numerous in Malay Muslim women. Other sites with susuks were the maxillofacial region (except the temporomandibular region) and the forehead. The susuks showed no ferromagnetic characteristics. Conclusions As susuks are made from gold, they are generally biocompatible with human tissue and do not cause problems to their wearers. Gold and the other minor metal constituents found in susuks have no ferromagnetic characteristics and therefore pose no hazard to patients undergoing MRI.
Full-text available
We report an unusual incidental radiographic finding of this 71 year old Malay lady who suffered a closed neck of femur fracture due a fall at home which had undergone total hip replacement at our establishment .This is one of the only papers showing incidental occurrence of susuk or charm needles in hip region in orthopaedic field. © 2012 GESDAV A 71 year old Malay woman was admitted with pain in the left hip. She suffered a closed neck of femur fracture, due to a fall at home one month prior to the admission, and was bed ridden. The woman had a history of diabetes mellitus type 2, bronchial asthma, left hemi paresis secondary to stroke and right breast carcinoma treated with mastectomy 24 years ago. Despite these co-morbidities, she was able to ambulate with bearable pain and limping before she became bed-ridden a week prior to admission due to localized unbearable pain aggravated by movement and not responding to analgesics. Past history was non contributory. Clinical examination revealed an obese woman with normal vital signs. The lungs were clear. Examination of the right breast revealed a previous mastectomy scar with intact skin without any sign of local recurrent axillary lymphadenopathy. The diffusely swollen left hip was tender on palpation, held in partial flexion position with its motion restricted by pain. The left
Full-text available
The charm needles, or susuks, are small, needle-shaped metallic talismans inserted subcutaneously in different parts of the body. This is a traditional practice, occasionally encountered in the Southeast Asian region. This case report describes two patients who were evaluated in the emergency department and incidentally found to have charm needles on the plain radiographs. These needles are not visible externally and have not been reported to cause any adverse effects. Emergency physicians should be aware of the existence of this traditional practice and chances of its incidental detection on radiographs. This would help avoid misdiagnosis and further investigations. It would also avoid susuks being considered as foreign bodies responsible for the patient's symptoms. (Hong Kong 2012;19:141-143)
Full-text available
Susuk, or charm needles, are inserted and worn subcutaneously in the face and other parts of the body, as they are believed to enhance beauty and youth, and for many other reasons such as treatment of headache, aches and pains in the joints, back or abdomen. The practice of inserting susuk is a traditional belief, genuinely cultural and superstitious, and common in the south-east Asian region. We present 13 cases of susuk, which was found incidentally on the radiographs as the patients came for various types of treatment at our centre.
The insertion of 'susuk' or charm needles is a practice common in Southeast Asia. It is a form of metal-lic talisman inserted subcutaneously in different parts of the body. This case report describes three patients (an 85-year-old Chinese man, a 53-year-old Malaysian woman and a 74-year-old Chinese woman) who were evaluated for knee and low back pain and were incidentally to have charm needles on their radiographs. None of these patients complained of any problem related to these charm nee-dles.
Susuks or charm needles are a form of talisman inserted and worn subcutaneously, in the face and other parts of the body, in the belief that they will enhance or preserve the wearer's beauty, youth, charisma, strength or health, or bring success in business. This mystic practice is found among some south-east Asian people, especially Malayan and Muslim females. Most susuk wearers are secretive about their hidden talismans, but these gold or silver needles are being discovered with increasing frequency now that radiographs are used more widely. An understanding of this practice and an awareness of its existence is important to avoid misdiagnosis and mismanagement of these patients. The practice of susuk wearing and its relevance to dentistry is discussed. Nine cases of facial susuk wearers are presented and previous reports are reviewed.
Among the various traditional beliefs and practices of the peoples of the Southeast Asia region is the practice of inserting talismans under the skin in various parts of the human body. In the orofacial region, these talismans (also called charm needles or charm pins) are also seen, usually as incidental radiographic findings. These talismans are believed to enhance the beauty of the wearers, as well as to provide protection to the wearers against harm. It is also believed that they could help the wearer obtain favorable business deals inasmuch as they are believed to have a "spell-like" influence on the business counterparts. In the present series, 67% of the patients are female and 66% of them are Muslim. Very little is known about the possible ill effects of these talismans because there is no report of these radiographic findings in major dental journals. In the present series of 12 cases representing a total of 65 talismans, only one talisman was surgically removed. We believe that generally no definitive treatment is required. However, we believe that the existence of these talismans should be made known so that they will not be misdiagnosed and mismanaged.