Trust me, guys, the caking process does the trick. Poor Jim had bleeding open areas around his opening (remember he's an innie like a 2nd bellybutton no rosebud for Jim). I called his stoma nurse from the hospital while he was a chemo I met with her and she showed me how to do it. It works like a charm. 1st powder, 2nd skin barrier prep, then repeat about 3 times. Dab at the powder without blowing or wiping excess off where the sore/red areas are. You will see it does sort of cake up. Then apply the wafer. Last layer will be the skin prep to keep the stickiness going. Also, we have found Jim does better with the flanges with the paper around it and they are 5x5s not 4x4. The all "putty" type 4x4 flanges just didn't work for him. It seems the paper edged type don't irritate as much and stick just as well if not better. But, that's on Jim. We took a long time to get the final best fit for him.