Review title is Comes in a piercing device. [SEP] Exactly as listed BUT I DO NOT recommend these for the actual piercing with the device! … the earrings are in the cartridge UPSIDE DOWN!!! By being upside down, it makes it next to impossible to pierce ears with. I finally got the first one to go in but it was crooked and the second one (top one) I tried for 10 minutes before I could get it into position and it went in sideways, shallow & barely under the surface of my skin! It hurt SOOOOO BADLY! It was all I could do to muster up the courage to get it out, then I took the first hoop back out also. After about 20 minutes of using ice on my ear & putting peroxide on it, it finally quit bleeding so I just pushed them through by hand, since my ear was already numb from the ice. I will never purchase these again & do NOT recommend for upper lobe piercings. They may work okay for lower lobe area (the normal piercing spot) but it’ll hafta be done upside down or at a weird angle so just be aware of that. Not sure if Studex has any suggestions on successful piercings with these or not, if so, perhaps they can post a video.