The dermal jewelry has a shoe shaped bottom, which holds the post at a 90 degree angle.
This shoe has holes in it, some small and some larger size holes.
Once the shoe is put into place under the skin (laying the same direction as the skins surface) it will begin to heal.
As the piercing heals, your skin will attach itself through the hole openings to the skin on the opposite side.
It is wise to hold down the piercing jewelry with a band aid until the healing process is secure.