The Outer Conch piercing is a perforation of the outer ear cartilage, in the flat part of the top, outer ear, for the purpose of inserting and wearing a piece of jewelry. They can be done in any position within the flat plane of cartilage. Once the piercing goes to the "curled" edge of the ear it is no longer an outer conch piercing, but a helix piercing. They are generally done at a gauge of no less than 16. When the piercing is smaller than a 16 gauge there is a risk of having it pulled out, rip, or become irritated much more easily.

This piercing is done with a large gauge piercing needle (usually not hollow, but either way is fine) and a curved barbell or a large CBR (captive bead ring). A dermal punch may also be used to bypass streching. With both stretching and dermal punching, this becomes nearly permanent as the body cannot replace cartilage, and the skin will only cover so much of the hole.

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