The Karankawa were remarkable to Spanish explorers who encountered them. They are believed to be the first mainland tribe to encounter Europeans, and through exposure to disease, enslavement and other factors, they died out eventually.

They were physically striking in many ways. They were tall, between six and seven feet, more closely resembling Caribbean tribes than others on the mainland. Due to their territory along the coast of Texas, it has been theorized that they journeyed to the North American continent from the islands.

Secondly, they were heavily modified. Perhaps their most lasting contribution to modern piercing was their nipples, which the men all had pierced through with pieces of cane. They are believed to be the only native tribe who practiced this form of body art for males. The men also had their lower lips pierced, also with small pieces of cane placed through the holes for decoration.

Females were not pierced, though they were tattooed and painted. The Karankawa also underwent a skull flattening modification, contributing to their unique appearance.