Milia
Those small white bumps that won't budge no matter what you try aren't whiteheads. They're milia, and they need a completely different approach.
Milia are tiny keratin-filled cysts that form just beneath the skin's surface. They're completely harmless, but they're also stubborn. Squeezing doesn't work, and most over-the-counter acne treatments don't touch them because milia don't have an opening at the surface the way a whitehead does. The good news is that professional extraction removes them cleanly in a single appointment, and there are steps you can take to prevent them from coming back.
About This Condition
What Are Milia and Why Do They Form?
Milia are small, firm, white or yellowish cysts that form when keratin (the protein that makes up skin, hair, and nails) becomes trapped beneath the skin's surface rather than shedding naturally. They appear most often around the eyes, on the cheeks, and across the nose, and range in size from 1 to 2 millimetres. They're not inflamed, they're not contagious, and they don't hurt.
The reason they don't respond to squeezing is structural. A whitehead has a pore opening at the surface that allows pressure to expel the contents. A milium cyst is encapsulated beneath the skin with no natural opening, so squeezing simply pushes it down rather than out.
There are two main types of milia:
Primary Milia
Form spontaneously when keratin becomes trapped in a hair follicle or sweat gland. Common around the eyes and cheeks, and can affect all ages, including newborns. In newborns, they resolve on their own within a few weeks. In adults, they tend to persist indefinitely without professional removal.
Secondary Milia
Develops as a result of skin trauma, injury, or prolonged use of heavy skincare products that block the skin's natural cell turnover process. It can appear after blistering conditions, burns, or cosmetic procedures. Also associated with long-term use of thick creams around the eye area.
Professional extraction is the fastest and safest way to remove milia. A sterile fine lancet is used to create a tiny opening in the skin above the cyst, and the keratin contents are then gently expressed. When done correctly by a trained esthetician under a dermatologist's oversight, it takes seconds per milium and leaves no lasting mark. The keyword is “correctly”. Rushing the process or working too aggressively can cause scarring or hyperpigmentation, which is why this isn't something to attempt at home.
Targeted Treatments
How We Treat and Prevent Milia
Surgical Excision and Mole Removal
Our estheticians use a sterile fine lancet to create a small opening above each milium cyst and gently remove the keratin contents. The extraction process is quick, relatively painless, and leaves no lasting mark when done correctly.
Chemical Peels
Regular chemical peels accelerate cell turnover and prevent the surface buildup that traps keratin. A good option for patients with recurring milia or those who want to maintain clear skin between extraction appointments.
Dermaplaning
Dermaplaning physically removes the outermost layer of dead skin cells, reducing the congestion that leads to the formation of milia. It's a gentle, effective option for anyone who wants consistent exfoliation without concerns about chemical sensitivity.
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Frequently Asked Questions About Milia
Can I remove Milia at home?
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We'd strongly advise against it. Because milia are encapsulated beneath the skin with no surface opening, attempting to squeeze or pick them tends to cause bruising, broken capillaries, or post-inflammatory marks rather than successfully removing the cyst. Some patients use a fine needle at home, but without proper technique and sterile conditions, this can lead to infection and scarring. Professional extraction takes only a few seconds per cyst and leaves no lasting mark when done correctly. It's genuinely worth coming in rather than risking a worse outcome at home.
Does extraction hurt?
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Most patients describe it as a brief, mild pinch, similar to a tiny prick from a fine needle. The discomfort lasts only a second or two per cyst and subsides immediately. No numbing is required for most patients. If you have a large number of milia or are having them removed from a sensitive area like directly under the eyes, we can discuss comfort options at your appointment.
Will milia go away on their own?
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In newborns, yes. Neonatal milia resolve on their own within a few weeks. In adults, primary milia can occasionally resolve spontaneously over several months, but many persist indefinitely without professional removal. Secondary milia are less likely to resolve on their own, especially if the underlying cause (heavy skincare products, skin trauma) hasn't been addressed. If you've had milia for more than a few months without any change, professional extraction is the most reliable option.
Is there anything I can use at home to prevent milia from coming back?
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Yes. A retinoid applied in the evening is one of the most effective preventative measures, as it speeds up cell turnover and reduces the likelihood of keratin becoming trapped. A gentle exfoliating toner with AHAs can help keep the skin's surface clear between professional appointments. Switching to a lighter eye moisturizer reduces the occlusive buildup that contributes to milia in that area. We can recommend specific products suited to your skin type at your appointment.