Large guage piercings look pretty cool, but it can take years of slow stretches and gradual jewelry changes to achieve them. Not only is this time consuming but it can cost a fortune in jewelry that once you've stretched up becomes useless. Many people who plan on getting large guage piercings choose to shortcut this process by getting their piercings scalpelled or punched instead. Scalpelling is not ideal for this and should actually be used to fix problems with piercings instead. Both procedures have a higher risk of infection because of the level of damage to the skin compared to ordinary piercing needles.
As the name says, this uses a surgical scalpel and is most often done on the ears. The most common request for people who scalpel is when they want to skip the process of gradual ear stretching. The problem with this is that if they plan on stretching further the ear has not created enough tissue (as it would using the stretching process) and it will cause the lobes to be very thin. This means that stretching further may be impossible without damaging the lobe or tearing it completely. If someone already has a piercing which has already been stretched but their original piercing was done too low (meaning there is excess skin and tissue above the top line of the piercing) and they want to stretch further then they may be an ideal candidate for scalpelling.
The cut for scalpelling is done straight up in the center of the existing hole to gain 1 to 3 sizes. Scalpelling can also be done to realign a piercing that is crooked for the same reason. Instead of cutting straight in the center the cut is done at an angle or to the side to help the piercing sit more centered once it is healed, but this is rare.
Extreme Scalpelling Modifications
Scalpelling can also be used in extreme modifications like tongue splitting, surgical implants and ear pointing. These are considered minor surgical procedures and are quite different from piercings though they are usually done by experienced professional piercers called modification artists. For those piercers willing to offer these modifications a scalpel makes more sense because of the surgical nature of the procedure, however, they are often illegal even if the piercer has the experience to do the piercing because of local laws. In almost all states a piercer must be licensed to use a dermal punch. Unlike ear scalpelling, this type of scalpelling usually requires the cut to be sutured together to heal properly.
A dermal punch or a biopsy punch is a large gauge piercing needle that has no bevel. It is used to remove a circle of skin or tissue and is ideal for flat areas like upper ears, nostrils, and even dermal anchors using a smaller punch. It works best on dense cartilage since these piercings are not usually stretched and will be harder and is not suitable for soft tissue like lobes or lips. When it is used on these areas the tissue is too soft and will become distorted and destroyed while trying to push the punch through which will not make for a healthy piercing. It can cause thin lobes, especially if you're trying to stretch the piercing later. Unlike piercing needles dermal punches are not commonly used by piercers and should only be used by those with experience and training using punches.
It is important to ask your piercer which they use, and why they specifically want to use that method for your piercing to make sure they know what they are doing. Artistic dermal punches have also been fashionable at times. This is a punch with a shape that is not intended to hold jewelry but simply to heal as a shaped (often a star or heart) hole in the upper ear.
The aftercare for both dermal punches and scalpelling is similar, however you are going to see more bleeding from a scalpelling than a dermal punch because of the area it is used on. It is very important if you have bleeding issues or are on medication for bleeding that you consult a doctor before getting scalpelled or dermal punched because of this.