Surface verses dermal piercings

You might have noticed the seemingly magical piercings appearing on chests, cheeks, arms, and even fingers and hips. Somehow, gemstones beautifully adorn areas of the body that seem impossible to pierce. What is this magic?

As it turns out, getting these areas pierced isn’t as magical as it seems. More and more people are choosing to pierce unique areas that haven’t seen piercings in the past. These are made possible with surface piercings and dermal piercings.

Since surface piercings and dermal piercings look similar and often appear in the same areas of the body, they are commonly confused with each other. Despite their similarity of appearance, they are actually quite different piercings.

It’s important to understand the distinction between these two popular piercing types as well as their risks and complications so that you can make the right decision on which piercing is best for you. Here’s everything you need to know to decide whether you want a dermal piercing or a surface piercing.

What is a dermal piercing?

A dermal piercing is a single-point surface piercing. This means that there’s one entry point and no exit point. Instead of securing the jewelry with a backing located behind the piercing, a dermal anchor is inserted beneath the dermal layer of tissue, leaving the dermal top to sit atop your skin.

There are a few dermal anchor types to choose from. The two most common dermal anchors are footed anchors and round base anchors.

Round base anchors are circular in shape and tend to be a little smaller than footed anchors, making them slightly less invasive and a little less secure than footed anchors.

Footed anchors resemble a foot; a longer end extends beneath the skin for a more secure hold.

Both anchor types come smooth or with small holes in them. The holes allow healing tissue to come through the holes, holding the anchor securely in place. However, some prefer the smoother styles for a less permanent option.

Dermal piercings are done with either a needle or dermal punch. With a needle, the piercer will slip the piercing needle beneath the skin, separating the tissue and providing space to place the dermal anchor. With a dermal punch, the piercer will remove a chunk of tissue in order to make space for the dermal anchor. The dermal punch is less painful than a piercing needle, and it often reduces the risk of rejection, but in some states, this method is illegal unless conducted by a medical professional, so be sure to check state standards.

What is a surface piercing?

The main difference between a surface piercing and a dermal piercing is that the surface piercing has an exit point, while the dermal piercing does not.

A surface piercing consists of any piercing done on flat areas of skin, like the cheekbone or the nape of the neck. Technically, eyebrow piercings and belly button piercings are included in surface piercings, but since they’re so popular, they’ve earned piercing categories of their own.

To complete a surface piercing, the piercer will pinch the skin in the area where you want to be pierced and stick the needle straight through. The puncture will then be filled with either a curved barbell or surface/staple barbell, depending on where you got pierced.

Since the surface piercing features entry and exit points, it will have a double-pierced aesthetic. In some areas, like the back or eyebrow, you can choose hoop styles for your surface piercing, but talk to your piercer before choosing this option; some surface piercings won’t allow for hoop styles.

Choosing a surface piercing or a dermal piercing

When deciding whether to go for a surface piercing or a dermal piercing, there are a few things that you need to consider. Besides aesthetics, certain areas of your body might prefer one over the other. Both piercing types have a high risk of piercing rejection, and often one piercing type will have a better chance of success.

Style considerations

The dermal piercing allows you to have only one piercing point, while the surface piercing requires two. If you want only one charm or gemstone in your piercing, then the dermal piercing is the one for you.

The surface piercing will have a barbell beneath the skin that connects the two piercing points. Although it’s subtle, it will be seen. If it’s important to you that your skin stays flat, then you can choose to go for two dermal piercings instead. Keep in mind that this option will be slightly more invasive than if you had gone for a single surface piercing, since two piercings will be required.

Health considerations

The dermal piercing, while mild, enters into the realm of body modification. The procedure will feel a little more medical in nature, and when you want to have your dermal piercing removed, you’ll have to have it done by a professional, since the anchor sits within your body.

The surface piercing acts more like a standard piercing, but in some areas, a scalpel might be used in order to get the piercing done deeply enough. Once healed, you’ll be able to change the jewelry yourself, and when you’re done with your surface piercing, all you have to do is take out the jewelry. There’s no need to see a professional.

What about rejection?

Both surface piercings and dermal piercings have a higher risk of rejection than other piercing types. The jewelry feels more invasive to your body, and your body will be keen to have it removed. Some areas of the body will prefer surface piercings over dermal piercings and vice versa.

For example, if you’d like a piercing on your arm, piercers often recommend dermal piercings over surface piercings. Since you move your arms quite a bit during healing, surface piercings tend to see more tugging and snagging, which can contribute to piercing rejection. While dermal piercings will also see tugging and snagging, the single point gives a little leeway when it comes to movement.


If you’re unsure, tell your piercer where you want to get pierced, and they can recommend whether you should get a dermal piercing or a surface piercing.

When making the decision between the two piercing types, health considerations always trump aesthetics; if you had your heart set on a dermal piercing, but your piercer recommends the surface piercing, listen to the professional.

Both dermal piercings and surface piercings have the potential to completely transform your pierced look. Look around for inspiration, decide the look that you want, then talk to your piercer about which piercing type they recommend.

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