A dermal punch is a medical instrument used for removing tissue. They look like a sharp-edged metal cylinder on the end of a handle, and range in size from 1mm (18 gauge) or so to 4mm (6 gauge) to larger. You use them almost like you'd use an apple corer - press down and pop!

Although dermal punches were designed to obtain tissue samples for biopsy, they're also used by some piercers because

Still, not every piercer uses dermal punches, and some strongly dislike them. Whatever works for you...

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