Drilling South Sea pearls is a very tedious process. Many South Sea Pearls are very precious, and therefore the driller must be extra careful with them. The pearls can be drilled fully or they can be half-drilled. Fully-drilled pearls have their hole drilled completely through the pearls. These pearls are usually for strung jewelry, such as pearl necklaces and/or bracelets. These are drilled using two drill bits from either side. They do this because the nacre may be damaged if the drill comes out the other side. One mistake might destroy the pearl all together. Half-drilled pearls are used for jewelry such as earrings, rings, pendants, tie tacks, etc.. They are only drilled half way through so that most of the surface of the pearl is undisturbed.

South Sea pearls with small blemishes can be used to make certain kinds of jewelry. The blemish is usually cut flat, and the pearl is then half-drilled so that they are still useful. Usually pearl rings have pearls that have been cut on the one side. The pearl is attached on that side in order to make a beautiful piece of pearl jewelry. However for South Sea Pearl Earrings flawless AAA quality pearls are often used, as they are very visible next to the face.