Surface vs Dermal Piercings: What’s the Difference?

Introduction

Surface and dermal piercings are often confused with one another, and I have to be honest, even people who already have several piercings sometimes book in unsure which one they actually want. In my experience this confusion is completely understandable because both styles sit on flatter areas of the body rather than passing straight through like a traditional piercing. Understanding the difference is important, not just for how the piercing looks but for how it heals, how long it lasts, and how it fits into your lifestyle. I would say that choosing between the two becomes much easier once you know how each one works and what to realistically expect.

What Is a Surface Piercing?

A surface piercing is designed to sit along the surface of the skin rather than passing straight through a body part. It uses a specially shaped piece of jewellery known as a surface bar, which has two entry points and a flat section that sits under the skin. In my view this jewellery design is essential because it helps reduce pressure on the skin and gives the piercing a better chance of settling.

Surface piercings are commonly placed on areas such as the nape of the neck, collarbone, hip, chest or eyebrow area when done as a surface placement rather than a traditional eyebrow piercing. I have seen clients choose surface piercings because they like the symmetrical look of two visible ends sitting flush against the skin.

However, I always explain that surface piercings can be temperamental. Because they sit in areas where the skin moves and stretches, they are more prone to migration and rejection over time. That does not mean they cannot heal well, but it does mean they require careful placement, correct jewellery, and realistic expectations.

What Is a Dermal Piercing?

A dermal piercing, sometimes called a microdermal, works very differently. Instead of having two visible entry points, a dermal piercing has a single point on the surface of the skin. Underneath, a small anchor sits beneath the skin, and the visible jewellery screws into that anchor.

In my experience dermal piercings are popular because they create the illusion of jewellery floating on the skin. They are often placed on areas such as the cheekbone, collarbone, lower back, chest, or even the face. I would say many people are drawn to dermals because of how minimal and neat they can look once healed.

Dermals require precision and experience from the piercer. The anchor must sit at the correct depth and angle to give the piercing the best chance of staying in place. While dermals can be long lasting, I always remind clients that they are not necessarily permanent and may need removal or replacement in the future.

Key Differences in Placement and Appearance

The most obvious difference between surface and dermal piercings is how they look on the skin. A surface piercing shows two ends of jewellery, which gives a balanced and symmetrical appearance. A dermal piercing shows only one decorative top, which often looks more subtle.

Placement options also vary. Surface piercings need a flat area with enough skin to support the bar underneath. Dermals can be placed in areas where a surface bar would not sit comfortably. In my view this makes dermals more versatile in terms of creative placement, but it also means they need extra care to avoid snagging.

Healing Time and Aftercare Expectations

Healing is one of the biggest considerations when choosing between these two styles. In my experience surface piercings usually take longer to settle. They can appear calm on the outside while still healing internally, which is why patience is so important.

Dermal piercings often look settled more quickly, but that does not mean they are fully healed straight away. The anchor needs time to stabilise under the skin, and during that period it is essential to avoid knocks, pressure, and unnecessary movement.

Aftercare for both styles focuses on gentle cleaning with a saline based solution and leaving the jewellery alone as much as possible. I always tell clients that over cleaning or fiddling can cause more problems than it solves. Clothing choice also matters. Tight fabrics and repeated friction can irritate both surface and dermal piercings, especially in the early weeks.

Risks, Rejection, and Long Term Outcomes

I think it is important to be upfront about risks because informed clients make better decisions. Surface piercings are more prone to rejection due to the way the body responds to foreign objects close to the surface of the skin. Over time the body may slowly push the jewellery out.

Dermal piercings can also reject, but in my view this often happens when the anchor experiences repeated trauma or pressure. Snagging is a common issue, particularly with raised jewellery tops.

Neither option should be considered completely permanent. Some people enjoy their piercing for many years, while others choose to remove it once their style or circumstances change. Removal should always be carried out by a professional to minimise scarring and discomfort.

Pain and Procedure Experience

People often ask me which piercing hurts more. I would say pain perception is very personal, but both procedures are generally quick. A surface piercing involves creating two entry points, while a dermal piercing involves creating a pocket for the anchor.

Most clients describe the sensation as sharp but brief. The anticipation is often worse than the procedure itself. What matters more is how comfortable you feel with your piercer and how well the aftercare instructions are explained.

Lifestyle and Practical Considerations

In my opinion lifestyle plays a huge role in deciding between surface and dermal piercings. If you are very active, wear tight clothing, or have a job that involves physical movement or contact, these factors need to be discussed before choosing a placement.

Surface piercings in high movement areas may struggle long term. Dermals placed where they are likely to be knocked may also cause frustration. I always encourage clients to be honest about how they live day to day so the piercing choice supports their lifestyle rather than clashes with it.

Choosing the Right Option for You

Choosing between a surface and a dermal piercing should never feel rushed. In my view the best decisions come from a proper consultation where placement, anatomy, healing ability, and expectations are discussed openly.

Some people love the look of surface bars and accept the maintenance that comes with them. Others prefer the minimal look of a dermal and are happy to be mindful of clothing and movement. Neither choice is better than the other. It simply depends on what suits your body and your goals.

A Confident Decision Starts With Understanding

Surface and dermal piercings both offer unique and striking ways to decorate the body. I would say the key difference lies in how they are constructed, how they heal, and how they interact with everyday life. When you understand those factors clearly, the decision becomes far less daunting. With realistic expectations, professional placement, and proper aftercare, either option can be a positive and rewarding part of your piercing journey.