In the Salish Sea region, labret adornment with lip plugs signify particular identities, and they are interpreted as emblematic of both membership in horizontal relationships and achieved status for traditional cultures associated with labret wearing on the Northwest Coast (NWC) of North America. Labrets are part of a shared symbolic language in the region, one that we argue facilitated access to beneficial horizontal relationships (e.g., Angelbeck and Grier 2012; Rorabaugh and Shantry 2017). We employ social network analysis (SNA) to examine labrets from 31 dated site components in the Salish Sea region spanning between 3500 and 1500 cal BP. Following this period, the more widely distributed practice of cranial modification as a social marker of status developed in the region. The SNA of labret data shows an elaboration and expansion of antecedent social networks prior to the practice of cranial modification. Understandings of status on the NWC work backward from direct contact with Indigenous societies. Labret wearing begins at the Middle-Late Holocene transition, setting an earlier stage for the horizontal social relationships seen in the ethnohistoric period. These findings are consistent with the practice as signifying restricted group membership based on affinal ties and achieved social status.