Milia are common, small, white or yellowish bumps that frequently appear on the face, particularly around the eyes, nose, and cheeks. Often mistaken for whiteheads, these bumps are actually tiny cysts filled with keratin, a protein naturally found in skin, hair, and nails. While generally harmless, they can be a cosmetic concern, leading many people to seek professional removal. The primary concern is whether these lesions will return after treatment.
What Exactly Are Milia?
Milia form when dead skin cells, which contain the protein keratin, fail to shed normally and instead become trapped beneath the skin’s surface. This creates a hard, firm, dome-shaped cyst that lacks an opening, meaning they cannot be extracted like a typical pimple or whitehead. Unlike acne, milia are not related to clogged hair follicles or excess oil production.
Milia are classified into two main categories based on their origin. Primary milia form spontaneously and are often seen in newborns, though they can occur in adults. Secondary milia, also known as traumatic milia, develop following skin trauma such as burns, blistering rashes, aggressive treatments, or excessive sun damage.
Secondary milia develop when the skin heals over a duct, trapping the keratin. Certain long-term uses of steroid creams or heavy, occlusive skincare products can also contribute to their formation. Understanding the type of milia is helpful because it suggests the underlying cause, which can influence the likelihood of future recurrences.
Professional Removal Procedures
When milia do not resolve naturally, professional removal is the most effective way to eliminate them. The most common procedure is extraction, often referred to as de-roofing. This involves a dermatologist or licensed professional using a fine, sterile needle or a micro-lance to create a tiny opening in the skin overlying the cyst.
Once the cyst is “de-roofed,” a comedone extractor is used to gently remove the hard keratin plug. This precise, lesion-by-lesion approach minimizes damage to the surrounding skin and prevents scarring that can result from attempting removal at home. Other methods for stubborn or numerous milia include cryotherapy, which uses liquid nitrogen to freeze the cyst, or laser ablation.
For superficial cases, a professional might apply a chemical peel containing alpha hydroxy acids (AHAs) or beta hydroxy acids (BHAs) to encourage exfoliation. These treatments focus on removing the trapped keratin. However, physical extraction remains the most direct way to safely clear the individual milium.
Understanding Recurrence and Triggers
The most direct answer to whether milia return is that the exact cyst that was removed will not reappear. Once the keratin plug is extracted, that specific lesion is permanently gone. However, the underlying skin tendency or the environmental factors that caused the milia often remain, meaning new milia can develop in the same general area over time.
Recurrence is tied to the skin’s natural process of keratinization and cell turnover. If dead skin cells continue to get trapped beneath new layers of skin, new cysts will form. For adults, this tendency is often linked to external triggers that interfere with the skin’s natural exfoliation process.
One common trigger is sun damage, which thickens the outer layer of the skin, making it harder for dead cells to shed. Using heavy, occlusive creams, oils, or thick sunscreens can also trap dead cells, leading to new milia formation. Managing recurrence requires addressing these contributing factors.
Strategies for Long-Term Prevention
Preventing the formation of new milia focuses on optimizing the skin’s natural exfoliation and protecting it from damage. A primary step is to audit your skincare routine and switch to products labeled as non-comedogenic or oil-free, particularly for moisturizers and sunscreens. Avoiding heavy, thick formulations, especially around the delicate eye area, reduces the risk of trapping dead skin cells.
Routine chemical exfoliation is an effective preventative strategy. Ingredients like Alpha Hydroxy Acids (AHAs), such as glycolic or mandelic acid, and Beta Hydroxy Acids (BHAs), like salicylic acid, help dissolve the bonds holding dead skin cells together. Incorporating these acids a few times a week can regulate cell turnover and prevent keratin from becoming impacted.
Topical retinoids, which are derivatives of Vitamin A, are also important in long-term prevention. Retinoids, such as retinol or prescription tretinoin, accelerate the rate at which skin cells are produced and shed. This action helps to keep the ducts clear and promotes a normalized keratinization process.
Daily use of broad-spectrum sunscreen is necessary to protect the skin from UV-induced damage that can lead to secondary milia.