How to Get Rid of Milia: Dermatologist-Approved Removal Methods

Title: The Definitive Guide to Milia Removal: A Dermatologist-Approved Approach

Are those tiny, white bumps under your eyes or on your cheeks causing frustration? You’re likely dealing with milia—and you’re not alone. Milia are common, harmless, and often mistaken for whiteheads. However, unlike a pimple, you can’t simply squeeze them out. Attempting to do so can lead to skin damage, infection, and scarring. This guide provides a comprehensive, dermatologist-approved roadmap for safely and effectively getting rid of milia, focusing on practical, actionable methods you can use at home and in a professional setting.

What Exactly Are Milia?

Before we dive into removal, it’s crucial to understand what you’re dealing with. Milia are small, dome-shaped cysts that form when keratin—a protein found in your hair, skin, and nails—gets trapped under the surface of the skin. They are typically pearly white or yellowish and range from 1 to 2 millimeters in size. They can appear anywhere on the face, but are most common around the eyes, cheeks, nose, and forehead.

Milia are classified into two main types:

  • Primary Milia: These form directly from trapped keratin and are the most common type. They can affect people of all ages, from newborns to adults.

  • Secondary Milia: These develop after a skin injury, such as a burn, rash, or blistering. They can also appear following laser resurfacing, dermabrasion, or long-term use of certain topical steroids.

The key takeaway is that milia are not caused by oil or bacteria, so traditional acne treatments are ineffective. This is why a different, targeted approach is necessary for removal.

The Golden Rule: Do Not Squeeze!

This cannot be stressed enough. Milia are encapsulated cysts. Unlike a pimple, which has a pore or opening, a milium has no such exit point. Squeezing or picking at it will only cause trauma to the skin, leading to:

  • Inflammation and Redness: You’ll irritate the surrounding tissue, making the area look worse.

  • Skin Tearing and Damage: The delicate skin around the eyes is particularly susceptible to tearing.

  • Infection: Introducing bacteria from your fingers can lead to a secondary infection.

  • Scarring: The most serious consequence, as picking can permanently damage the skin’s structure.

The correct approach involves creating a tiny opening in the skin to gently extract the keratin plug, a process that should be done with sterile tools and proper technique.

At-Home Strategies for Milia Prevention and Management

While professional removal is the most direct solution, a consistent at-home skincare routine can significantly help prevent new milia from forming and may even help some existing ones resolve on their own.

Strategy 1: Gentle Exfoliation is Key

Exfoliation is the cornerstone of milia prevention. By regularly sloughing off dead skin cells, you prevent the keratin from getting trapped under the skin’s surface. However, not all exfoliants are created equal. You need to choose the right type and use it correctly.

  • Chemical Exfoliants: These are far superior to physical scrubs for milia. Physical scrubs, with their rough granules, can be too harsh, causing micro-tears and irritation, especially on the delicate skin around the eyes. Chemical exfoliants use acids to dissolve the “glue” that holds dead skin cells together.
    • Alpha Hydroxy Acids (AHAs): Glycolic acid and lactic acid are excellent choices. Glycolic acid, in particular, has a small molecular size that allows it to penetrate the skin effectively. Start with a low concentration (around 5-10%) in a toner, serum, or gentle peel pad. Apply 2-3 times a week at night.

    • Beta Hydroxy Acids (BHAs): Salicylic acid is a BHA known for its ability to penetrate oil and pores. While milia aren’t caused by oil, salicylic acid can still be beneficial for overall skin texture and preventing other types of blemishes. Look for a salicylic acid cleanser or toner to use a few times a week.

Concrete Example: After cleansing your face in the evening, apply a toner with 7% glycolic acid to a cotton pad and gently swipe it over your face, avoiding the immediate eye area. Follow with a gentle, non-comedogenic moisturizer.

Strategy 2: Incorporate Retinoids

Retinoids (vitamin A derivatives) are powerful ingredients that accelerate cell turnover. This means your skin produces new cells faster and sheds dead cells more efficiently, preventing the buildup that leads to milia.

  • Retinol: This is an over-the-counter retinoid. Start with a low concentration (0.25% or 0.5%) to allow your skin to acclimate. Apply a pea-sized amount to your entire face at night, 2-3 times a week, gradually increasing frequency as your skin tolerates it.

  • Adapalene (Differin Gel): Once a prescription-only retinoid, Adapalene is now available over the counter and is highly effective for cell turnover and acne. It’s a great option for preventing milia.

Concrete Example: In your evening routine, after cleansing and drying your skin, apply a small, pea-sized amount of a 0.5% retinol serum to your face, avoiding the delicate skin directly around your eyes. Follow with a hydrating moisturizer to minimize dryness. Always use sunscreen the next morning, as retinoids make your skin more sensitive to the sun.

Strategy 3: Be Mindful of Your Skincare Products

Heavy, occlusive creams and makeup can contribute to milia formation by trapping dead skin cells.

  • Choose Non-Comedogenic Products: The term “non-comedogenic” means the product is formulated to not clog pores. Look for this label on your moisturizers, sunscreens, and foundations.

  • Avoid Rich Eye Creams: The skin around the eyes is thin and delicate. Using thick, heavy eye creams can be a common cause of milia in this area. Opt for lighter, gel-based eye creams or serums, and avoid those with petrolatum or mineral oil if you are prone to milia.

Concrete Example: If you are currently using a thick eye cream with shea butter, try switching to a lightweight eye gel with hyaluronic acid. Apply it with your ring finger using a gentle tapping motion.

Professional Milia Removal Methods

For existing milia that are stubborn or widespread, professional removal is the most effective and safest option. A dermatologist or a trained aesthetician can perform these procedures in a sterile environment with the proper tools.

Method 1: Deroofing or Manual Extraction

This is the most common and direct method for removing individual milia.

  • The Procedure: The dermatologist will first cleanse and sterilize the area. Using a sterile lancet, a tiny incision or “roof” is made over the milium. A comedone extractor or a small tool is then used to gently press out the keratin plug.

  • What to Expect: The procedure is quick and relatively painless. You might feel a slight pinch or pressure. There is usually no bleeding, and the area will heal within a day or two with no scarring.

  • Why It’s Safe: A professional uses sterilized, single-use tools, minimizing the risk of infection. They have the expertise to make the incision correctly without damaging the surrounding tissue.

Concrete Example: A patient with three persistent milia under their eye will have the area cleansed and prepped. The dermatologist uses a fine, sterile lancet to make a micro-incision on the top of each milium, then applies gentle pressure with a sterile extractor to pop out the small, hard keratin ball.

Method 2: Chemical Peels

Professional chemical peels use a higher concentration of AHAs or BHAs than at-home products. They work by exfoliating multiple layers of the skin, which can help bring milia to the surface to be extracted or to resolve on their own.

  • The Procedure: A professional applies a chemical solution (e.g., glycolic, salicylic, or lactic acid) to the skin for a specified amount of time. You may feel a tingling or stinging sensation. The peel is then neutralized and removed.

  • What to Expect: The skin may be red and sensitive for a few days after the peel. Over the next week, you may experience some peeling or flaking. The results are not immediate; it often takes a series of peels to see a significant reduction in milia.

  • Why It’s Safe: A professional selects the correct type and strength of the peel for your skin type and concerns. They are trained to monitor your skin’s reaction and prevent complications like burns or hyperpigmentation.

Concrete Example: A dermatologist recommends a series of four light glycolic acid peels, spaced three weeks apart, to a patient with widespread milia on their cheeks and forehead. This helps to shed the outer layer of skin and release the trapped keratin plugs over time.

Method 3: Microdermabrasion

Microdermabrasion is a non-invasive procedure that uses a machine to spray fine crystals or use a diamond-tipped wand to exfoliate the top layer of the skin.

  • The Procedure: A wand is passed over the skin, gently abrading the surface and vacuuming away the dead skin cells. This process stimulates cell renewal.

  • What to Expect: The procedure is painless and feels like a light scratching or massaging. Your skin may be slightly red afterward, but there is no downtime.

  • Why It’s Safe: This is a gentle physical exfoliation method that, when done professionally, can help with milia. The vacuum suction also helps to stimulate blood flow and improve overall skin texture.

Concrete Example: A person with fine, scattered milia on their nose and cheeks undergoes a microdermabrasion session. The procedure helps to smooth the skin and, over several sessions, can help some of the superficial milia resolve as the outer layer of skin is gently removed.

Method 4: Cryotherapy

This method is less common for milia but can be used for larger, more persistent cysts. It involves freezing the milium with liquid nitrogen.

  • The Procedure: A tiny amount of liquid nitrogen is applied directly to the milium using a cotton swab or a spray. This freezes and destroys the cyst.

  • What to Expect: You will feel a brief, intense cold sensation. The area may form a small blister or scab and heal in about a week. There is a slight risk of hyperpigmentation or hypopigmentation, which is why it is not typically a first-line treatment for milia, especially on darker skin tones.

  • Why It’s Safe: This procedure must be performed by a medical professional who can precisely control the amount and duration of the cryogen to avoid damaging the surrounding skin.

Concrete Example: A dermatologist uses cryotherapy on a large, solitary milium on a patient’s temple. A quick application of liquid nitrogen freezes the cyst, causing it to scab over and fall off within a week, leaving smooth skin underneath.

Method 5: Diathermy or Electrocautery

This method uses heat to destroy the milium.

  • The Procedure: A tiny, fine needle that conducts a low-level electrical current is used to heat and destroy the milium.

  • What to Expect: The procedure is very precise and quick. You may feel a tiny flick or warmth. A small scab forms, which falls off in a few days.

  • Why It’s Safe: This method is highly effective for stubborn, individual milia and allows for very precise targeting, minimizing damage to surrounding tissue. It is performed by a professional with specialized equipment.

Concrete Example: An aesthetician uses a fine-tipped diathermy tool to carefully treat five milia on a client’s eyelid. The process is quick and precise, targeting each milium individually and leaving behind a small, temporary crust that heals quickly.

Post-Treatment Care and Long-Term Prevention

Once you’ve had your milia professionally removed, proper aftercare is crucial to ensure smooth healing and prevent new ones from forming.

  • Keep the Area Clean: Gently cleanse the treated area with a mild, non-foaming cleanser twice a day. Pat the skin dry with a clean towel; do not rub.

  • Avoid Harsh Products: For the first few days, avoid using any exfoliants, retinoids, or harsh toners on the treated area. Stick to a simple routine of a gentle cleanser and a non-comedogenic moisturizer.

  • Sun Protection is Non-Negotiable: The skin is more vulnerable after any procedure. Use a broad-spectrum sunscreen with an SPF of 30 or higher every day, even on cloudy days, to protect the healing skin and prevent hyperpigmentation.

  • Reintroduce Active Ingredients Slowly: Once the skin has healed (typically 5-7 days), you can gradually reintroduce your preventative skincare products like retinoids or AHAs, starting with 2-3 times a week.

When to See a Professional

While at-home prevention strategies can be helpful, you should see a dermatologist for:

  • Widespread or Persistent Milia: If you have numerous milia that don’t respond to at-home care.

  • Milia Near the Eyes: The skin around the eyes is extremely delicate, and any at-home attempts at removal are highly dangerous. This is a job for a professional.

  • Milia on a Baby or Child: Milia in infants are very common and almost always resolve on their own within a few weeks. They do not require treatment. Consult a pediatrician if you are concerned.

  • Milia that Appear After an Injury or Burn: These are secondary milia and may require a professional’s assessment to determine the best course of action.

Ultimately, milia are a common skin concern with a clear solution. By understanding the difference between milia and other blemishes, avoiding dangerous at-home picking, and implementing a smart, preventative skincare routine, you can significantly reduce their appearance. For existing milia, the safest, most effective, and fastest route to clear skin is through professional treatment. A dermatologist has the knowledge, tools, and sterile environment to remove milia safely and effectively, leaving you with the smooth, blemish-free skin you desire.