Many people are confused when they notice tiny white bumps under the eyes or on the cheekbones and try to squeeze or extract them as they would with comedonal acne or inflammatory acne. However, these bumps are hard and do not come out easily. They are milia, which, unlike ordinary acne, are not caused by bacteria or excess oil. Understanding how they actually develop can help us choose the safest and most appropriate milia treatment for facial skin.
Understanding Milia
Medically speaking, milia are not “acne” in the pathological sense. They are small cysts (Subepidermal Keratin Cysts) containing keratin, a type of protein found in the outer layer of the skin, hair, and nails.
How Milia Develop: More Than Just Blocked Pores
Studies have found that milia develop when dead skin cells do not shed as part of the natural cycle. Instead, they become trapped beneath the epidermis and form firm, round lumps under the skin. Research indicates that milia commonly arise around the pilosebaceous unit or eccrine sweat ducts. They are divided into two main categories:
- Primary Milia: Develop naturally due to abnormal skin-cell turnover.
- Secondary Milia: Develop after skin injury, such as blistering, prolonged use of steroid creams, or sun damage (Photoaging) that blocks the sweat ducts.
Comparison: Milia vs Comedones vs Sebaceous Hyperplasia
The following comparison can help you distinguish between these conditions before choosing a treatment.
| Feature | Milia | Comedone | Sebaceous Hyperplasia |
| Cause | Keratin trapped beneath the skin | Sebum and bacteria | Abnormal activity and enlargement of the sebaceous glands |
| Appearance | Firm, smooth, white or yellow bumps | White bumps (closed comedones) or black bumps (open comedones) | Creamy-yellow bumps, often with a central depression |
| Location | Under the eyes, cheekbones, and nose | Throughout the face, chest, and back | Forehead, cheeks, and nose (common in relatively oily skin) |
| Treatment | Laser treatment or extraction | Topical acne medication or comedone extraction | CO2 laser or electrocautery |
Common Types of Milia
To select the milia treatment most likely to produce clear results, it is first necessary to identify the type of milia you have. Different causes affect long-term treatment planning. In dermatology, milia are commonly classified according to age and triggering factors as follows:
1. Neonatal Milia
Neonatal milia occur in as many as 40–50% of newborns and commonly appear on the nose and eyelids. They result from sweat glands that are not yet fully developed at birth. This type is not considered a disease and usually disappears on its own within a few weeks without treatment.
2. Primary Milia
This is the most common type among adolescents and adults. It develops spontaneously without a preceding lesion or injury. Research indicates that it results from abnormal skin-cell shedding (Desquamation) around the sebaceous duct, causing keratin to accumulate in round lumps beneath the skin. It commonly appears on the cheeks, forehead, and around the eyes.
3. Secondary Milia / Traumatic Milia
This type results from damage to the skin’s structure (Skin Trauma), an issue that The Vanish Clinic considers particularly important because it reflects weakened skin health. Causes include:
- Skin injury: Such as blisters, abrasions, or procedures using excessive heat that damages the sweat ducts.
- Sun damage (Photoaging): Long-term cumulative UV damage causes the outer layer of the skin to thicken and obstructs the release of keratin.
- Use of certain topical medications: For example, prolonged use of topical steroids can thin the skin and disrupt its structural balance.
4. Milia en Plaque
This is a rare type that is often associated with other skin diseases, such as Discoid Lupus or Lichen Planus. Clusters of milia form a large plaque on a red, inflamed area of skin.
5. Multiple Eruptive Milia
This type involves numerous milia that rapidly erupt and spread over a short period, ranging from weeks to months. They commonly appear on the face, upper arms, and upper torso and may be associated with genetics or an immune-system response.
Medically Recognized Milia Treatments
You should not try to squeeze milia yourself because these cysts have no open head. Squeezing them can inflame the surrounding tissue and cause dark marks or scarring. Treatments commonly used today include:
- Topical Retinoids: These help accelerate cell turnover and are suitable for small milia, but require time and consistent use.
- Manual Extraction with a Sterile Needle: A physician uses a needle to make a small opening in the uppermost layer of skin, then extracts the keratin plug.
- Laser Treatment: This is the most precise method, particularly in delicate areas such as around the eyes.
Milia Treatment with Picoway Laser and Discovery Pico at The Vanish Clinic
At The Vanish Clinic, we prioritize treatments that not only remove milia but also minimize trauma to the skin. We therefore apply world-class Pico Laser technology to skin resurfacing and the effective treatment of related skin concerns.
- Picoway Laser: An innovative Picosecond-speed laser that focuses on delivering Photoacoustic energy, using pressure rather than heat. This helps renew the skin without causing burns. It is especially suitable for people with numerous milia who also want to restore a smoother skin texture.
- Discovery Pico: Its High Peak Power precisely targets problem areas, helps stimulate collagen production beneath the skin, and balances skin-cell turnover, reducing the chance of milia returning over the long term.
How to Help Prevent Milia from Returning
Even after treatment, milia can return if your skincare habits remain unchanged. The following are recommendations from specialists:
- Double Cleansing: Cleanse the face thoroughly to reduce the accumulation of dead skin cells.
- Avoid overly heavy, occlusive creams: This is particularly important under the eyes, as using an eye cream that is too oily can increase the likelihood of blockage.
- Apply sunscreen every day: Research confirms that UV radiation thickens the outer layer of the skin and disrupts natural skin-cell turnover.
- Exfoliate gently: Using AHA or BHA 1–2 times per week can help reduce keratin buildup beneath the skin.
Summary: Choosing a Targeted Milia Treatment
Whatever type of milia you have, it is important to use tools that are gentle on the skin. At The Vanish Clinic, we use Picoway Laser and Discovery Pico. These “King of Laser” systems include Picoway from the United States and Discovery Pico from Italy. Both are original technologies that meet globally recognized safety standards, including USFDA standards, and are supported by certificates issued directly by their importers. Patients can be confident that the clinic uses 100% authentic devices, each of which can be scanned to verify its history. These lasers deliver energy at Picosecond speed to help break the bonds within keratin plugs and stimulate the reorganization of skin cells (Skin Remodeling), without causing the scarring associated with traditional heat cauterization.
If your milia result from an imbalance in skin health (Secondary Milia), energy from Discovery Pico can help restore collagen and repair skin structures damaged by the sun, strengthening the skin and reducing the chance of new milia developing over the long term.
References (Research References)
- Bolognia, J. L., Schaffer, J. V., & Cerroni, L. (2018). Dermatology. Elsevier Health Sciences. (Chapter on Adnexal Cysts and Neoplasms).
- Berk, D. R., & Bayliss, S. J. (2008). Milia: A review and classification. Journal of the American Academy of Dermatology, 59(6), 1050-1063.
- American Academy of Dermatology (AAD). “Milia: Overview, Causes, and Management”.
- Journal of Cosmetic and Laser Therapy. “Effectiveness of Picosecond Lasers in Skin Resurfacing and Keratinization Disorders”.
