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The pen won’t tighten enough to pierce the cartridge and no gas comes out.

This can be because...

The silicone coating on the threads in the device has been removed. There is a silicone coating on the threads of the CryoPen® devices. This MUST NOT be removed. It makes piercing the cartridge impossible if removed. This coating may be accidentally removed by someone cleaning the device in-between treatments. You can purchase a silicone lubricant to re-apply to the threads (Halfords Silicone Spray)