For me tattoos would be a big one.
Yes, and there are lots of variations to randomly select between. A high quality artistic sleeve, shitty school made tattoos with knife and ballpen ink, overtly sexual designs with dicks and demeaning text, childish yet gay/porny designs like bronie or furry stuff, tough guy shitty tattoos with tribal shoulder tattoo or barb wire around the arm, or the full deal including face and hands.
All changes so far has been just the mind and body, so piercings perhaps is out of scope, but he could certainly get stretched ears with the roughest tattoo (or as another change predicated on it).