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Haworth smears antibacterial gel on the hook. His voice is confident and reassuring, his face a passive expression of polite concern. It's impossible not to think "doctor."
"Okay, what you're going to do is take a very deep breath," he says. "Tell me when you're ready."
"I'm ready," Gesaman says, voice muffled from the headrest.
Haworth places the needle against Gesaman's skin, the tip poking the pen dot.
"Deep breath . . . big exhale . . . and here we go . . ."
"I don't have a problem putting people in pain," Haworth says later, "because there's a difference between hurting somebody and putting them in pain for a consensual goal."
Steve Haworth grew up around the aesthetics of surgery. He helped his father, an engineer, design medical instruments for plastic surgery. Watching surgeons try out his instruments on patients in the operating room, Haworth learned secondhand about human physiology -- and about the human desire for bodily enhancement.
In 1991, he began using his family's machine shop to manufacture stainless-steel jewelry for body piercings. It was actually a friend's idea for a business venture, but Haworth found the work artistically fulfilling as well as profitable. Soon Haworth could afford to open a handful of piercing studios and tattoo parlors of his own.
"I wasn't driven from childhood to modify my body like the vast majority of people into this," he says, noting his first modification was after he began producing jewelry. "I grew up very sheltered."
As so-called alternative culture of the 1990s became increasingly mainstream, a mere tattoo or nose ring was no longer considered shocking. Haworth's most hard-core clients would ask him for something new, something different.
The clients represented the final tumbler in Haworth's destiny. Three unique variables -- Haworth's knowledge of human physiology, the ability to custom-design medical instruments and access to willing clients -- had aligned.
In 1995, Haworth made headlines around the world when he successfully transplanted threaded implants through the scalp of Valley resident Joe Aylward. The threads support a variety of spikes that can be screwed onto his head.
Aylward's modification was billed as the world's first metal Mohawk. And Haworth's business, already resented by his body jewelry rivals, became a controversy within the modification industry.
His critics attacked. They said body piercers should not put implants into people.
Haworth agreed. So Haworth quit piercing and changed his title to "3-D Modification Artist."
Today, common client requests include implanted beads and bracelets, pointed "Vulcan" ears and genital alterations such as having a ribbed penis. One Church member recently had a doughnutlike hole cut into his scrotum because he wanted to be able to stick his finger though it.
"I am proud that these people come to me and ask me to guide their journey," Haworth says. "It's not a sadistic kind of thing."
Haworth's own modifications include extensive tattoo work, extended incisor teeth and a partially split urethra -- meaning the bottom inch or so of the penis is permanently filleted open so the urethra can rub directly against a partner and enhance Haworth's sexual pleasure (yes, Haworth can still manage to urinate standing up . . . if he just . . . well . . . let's just say a certain degree of pinching is required).
"There's a lot of controversy around Steve; there always has been," says Buelow. "He does something that most people wouldn't even begin to imagine."
Eric Silverman, an assistant professor of sociology and anthropology at DePauw University who studies and writes about body modification, says Haworth's customers are an example of how certain segments of society are resisting the norms of Hollywood-endorsed beauty.
"The body is increasingly treated like any sort of commodity," Silverman says. "If a part fails, you replace it. If you don't like a part, you modify it. Which is ironic because a lot of people who have extreme forms of body modification say they're resisting the dominant norms of body beauty fueled by capitalism. But body modification is a form of hypercapitalism -- now everything can be bought and sold and replaced."
To what extent a person without a medical degree should be allowed to modify a body is another question.
Dr. Armando Favazza, a psychiatrist at the University of Missouri and author of Bodies Under Siege: Self-Mutilation and Body Modification in Culture and Psychiatry, says legal constraints on body modification are inevitable.
"When is it surgery?" Favazza asks. "That's a line that society will decide. [Haworth] has been lucky so far, and it sounds like he's pretty good, but he's also been taking a lot of gambles."
Favazza notes a case in Indiana where a body modifier was charged with practicing surgery without a license after he performed a castration.
Haworth, sitting in an interview along with several other Church members, says he draws his own line.
"I love the controversy, I live for the controversy," Haworth says. "One thing I always say is, 'Let my work speak for itself.'"
What if, say, somebody wants him to cut off a finger?
"People ask me for selective digit removal all the time," he says. "But removing a finger from a hand would change somebody's ability to function."