Open box, never used Includes two sealed/new needle heads (12 needles) ORA Electric Microneedle Derma Pen System includes: Electric Microneedle Derma Pen: features 5 adjustable speed settings 2 Replaceable Needle Tips: each with 12 needles AC Adapter and Wall Charger Tip: ORA recommends using a serum or cream after the needling treatment, as this will enhance the absorption of the skincare product. Some users use the cream or serum prior to the roller treatment. However, the use of creams or serums is not necessary with the rollers—meaning you can use the rollers on their own. The roller dramatically enhances the absorption of your skin care products when you follow up the treatment with your favorite serum or cream.