Procedure
The procedure is done similarly to other piercings of the cartilage of the ear. Clamps may be used but it is usually done freehand. Once the area is cleaned, the piercer and the client will agree on placement, although because of its location it can be difficult to see exactly where the entrance and exit holes will be. Generally the piercer will advise the client on the best location. The entrance and exit holes are marked, and a hollow needle is pushed through. Many professional piercers will use either a 14g or 16g needle by default, although it is possible to use even larger gauges. The jewelry is then inserted, and the piercing complete.
Pain is very subjective and it is difficult to ascertain how much the initial piercing will hurt to a given person. Some people experience pain comparable to that of an average cartilage piercing to the helix or tragus, and others have described it as one of the most painful piercings they've ever received, either in the ear or their whole body. A few individuals have remarked that their rook piercing hurt more than their nipple piercings (generally regarded as one of the most painful areas of the entire body to be pierced).
Read more about this topic: Rook (piercing)