Devotees pierced their cheeks with ever-more extreme items at the Vegetarian Festival in Thailand today.

Footage shows locals being stabbed in the face with metal skewers, wooden umbrellas, and even hula hoops, before parading on the streets in a gruesome show of religious devotion in Trang province on October 7.

The stomach-turning sight is a mainstay of the festival, also known as the Nine Emperor Gods Festival.

The self-flagellating devotees are locally called 'mah song' or 'horses of the gods'.

During the procession, they are said to be possessed by deities. They then mutilate themselves without anesthetic, believing they are protected from pain during the trance.

The practice is said to purify the participants and ward away evil from the community.

Spirit mediums also visited houses and stores, where spreads of vegetarian food and offerings of incense, gold, and silver, were laid out to invite good fortune.

The Vegetarian Festival takes place in the ninth lunar month of each year, usually in September or October, and is celebrated by the country's Thai-Chinese community.

Participants also observe a strict vegetarian or vegan diet for nine days.