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Examples:

She looked tough: pieced nose, broad eyebrows, tousled hair, almost spiky.

I tried picturing him: his tiny body swinging above the ground, his eyes bloodshot, almost popping out, his tongue hanging to the side like a dead worm.

Are lists like these confusing? If so, how can I improve their clarity?

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    That's perfectly fine. -- You can insert an "and" between the last to items, depending on the rhythm and style you want. Without "and" the effect is that of brevity and "dryness". I wouldn't add "and" here (just wanted to mention it). – user5645 Aug 3 '15 at 7:15
  • I find the list perfectly descriptive, and not confusing at all. I would suggest pierced nose rather than pieced though. :) – Thomas Reinstate Monica Myron Aug 4 '15 at 21:26
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You can use semi-colons when you want to use commas as well. For example:

He had three ties: a red one, which he hated; a striped one, which he loved; and a green one that had been given to him by his aunt.

Sometimes you can enclose extra information in parentheses. For example:

I like several different dishes: lasagne (only if it is made with beef); pizza (has to have cheddar on it); and, chops (pork, of course).

Punctuation isn't always an exact science. People disagree over how to do it 'correctly'. Yes, there are some places the majority of people would say you need a full stop, etc. but in other places different people would insist that their method of doing it is correct while others disagree. In these situations make sure that your meaning is clear to the reader, be consistent in what you do and just get on with it.

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    The semi-colon would not fit Alexandro's examples. You'd only use it if you appose full sentences (with finite verb and subject), as in your examples ("which he hated"). Punctuation is as exact a science as physics, which isn't as exact as laymen sometimes believe (look up theory of measurement). – user5645 Aug 3 '15 at 7:13
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Your sentences are exactly right, Alexandro. In each case what follows the comma is a list of sentence elements in apposition to each other, one that is appropriately punctuated with commas. In the first example, you have noun phrase appositives, and in the second, absolute phrases in apposition. One item in each list has a comma within it : hair, almost spiky, and bloodshot eyes, almost popping out. To me, these are not sufficiently complex to trigger the use of semicolons -- the lists are not confusing. If the items in your lists were more complex, with commas within each element, then you might want to avoid confusion by using semicolons.

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Another option (although I can't speak for its grammatical propriety) that might help guide the reader through different pauses that help distinguish items on the list from the side descriptions of them would be to use dashes.

She looked tough: pierced nose, broad eyebrows, tousled hair - almost spiky.

I tried picturing him: his tiny body swinging above the ground, his eyes bloodshot - almost popping out - and his tongue hanging to the side like a dead worm.

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