This product is designed to pierce your own ear or someone else's ear. Each ear piercing stud is set in a cartridge that is sterilized and can't be touched by your hand. Any product that pierces the skin is required by the AMA (AMERICAN MEDICAL ASSOCIATION) to be sterilized. Wearing gloves is not considered sterilization. Your hands cannot be sterilized. Any product that only touches the skin should be sanitized. The cartridge does not require an ear piercing instrument (used in malls). Instructions are included on the package, but the basic procedure is to squeeze your thumb and fore finger together to pierce the ear. The process is silent and very effective. The studs/styles used to pierce the ear are made out of surgical stainless steel (same material as a surgical instrument), which is also an AMA requirement. If the piercing stud is gold, it is 24 ct. gold that is electro- plated over the surgical steel. Electro-plating is a process where the gold is attached to the surgical steel with an electrical current in water. The bond is very strong and the gold should stay on for at least a year or longer. 24 ct. gold is the only gold that is pure and does contain nickel. Nickel is an alloy (Copper, iron, etc. are other examples) that is used to harden pure gold and metals. People have varying degrees of sensitivities to nickel and thus the 24 ct. (no nickel) should prevent sensitivities on a newly pierced ear. This training stud should be worn for 3-4 weeks without removal. At that time it should be replaced with a similar material (no nickel) earring. This replacement earring (can be interchanged) should be worn day and night for the following 4 months. The total healing time for a newly pierced ear is about 5-6 months. Very important, the replacement earrings for the 4 month period should be at least 14 ct. gold or higher. 2 advantages-low cost and same as malls