Milia are tiny cysts that form on the skin when dead skin cells get trapped under the skin’s surface, appearing as pearly-white or flesh-colored bumps on the face. Milia develops most often on the cheeks, eyelids, and nose. While milia are not dangerous, some people may want to remove these cysts from their skin. A dermatologist (a doctor who specializes in conditions affecting the skin, hair, and nails) can safely and effectively remove milia.
Milia are not harmful and do not require treatment. Though milia often go away on their own, some people prefer to remove milia for cosmetic reasons. If you don’t like how they look, talk to a healthcare provider about milia removal. Getting a professional milia removal from a licensed healthcare professional is important, as attempting to pick, scratch, or pop milia can lead to scarring, bruising, or infection.
Types of Milia Removal
There are several effective methods for removing milia. The milia removal procedure your healthcare provider recommends may depend on the size, location, and number of milia on your skin.
Manual Extraction
Manual extraction is the most effective way to remove milia. Your healthcare provider will make a tiny incision (cut) on the skin overlying each millium by using a scalpel or needle. They will then gently extract the cyst using a tool such as a comedone extractor, tongue blade, or small surgical forceps.
Dermatologists perform manual milia extraction, though some estheticians (skin care specialists who provide treatments to improve the skin’s appearance) offer the procedure. In some states, estheticians cannot pierce the skin, so not all estheticians can provide this service.
Cryotherapy
Cryotherapy is a milia treatment that involves using liquid nitrogen at extremely cold temperatures to freeze and destroy the milia. Dermatologists apply liquid nitrogen to the milia using a cotton swab or spray device. Eventually, the milia sloughs off, revealing healthy, smooth skin underneath.
Laser Ablation
Laser ablation is a precise technique that applies a focused laser beam to the milia to remove the cysts without affecting or damaging the surrounding skin. The laser gently breaks down the outer layer of the cysts and vaporizes the contents to safely remove the milia.
Chemical Peels
Chemical peels work by applying a solution to the skin. The solution usually contains ingredients with exfoliating properties, such as salicylic and glycolic acids. These chemicals promote the shedding of the top layer of skin, including dead skin cells that make up milia. Exfoliation of the dead skin continues for several days as new, healthy skin forms.
Milia removal techniques are generally safe when a dermatologist or other trained and licensed skincare professional is performing them. These procedures can effectively remove milia in most cases. But in some cases, it's possible to experience short-term side effects and long-term changes to the skin.
Manual Extraction
Manual extraction is generally safe and comes with very few risks when the procedure is performed carefully by a trained healthcare provider. After the procedure, you may experience short-term side effects, such as:
- Redness
- Swelling
- Tenderness
- Bruising
Cryotherapy
Cryotherapy causes redness, swelling, and blister formation on the treated areas of the skin. Scabs form within 14 days and eventually fall off, revealing healthy and healed skin within four to six weeks. Cryotherapy does not cause scarring, but there is a small risk of long-term complications, such as:
- Hypopigmentation (loss of color) on the treated area
- Hyperpigmentation (darker color) on the surrounding skin
Laser Ablation
Laser ablation has a relatively low risk of side effects compared to other removal methods and reduces the risk of scarring. You may feel some discomfort and notice slight redness and swelling on the treated skin. Most short-term symptoms resolve within five to nine days.
The risk of long-term complications is low but can include:
- Hypopigmentation
- Hyperpigmentation
- Some scarring
Chemical Peels
Your skin may appear slightly red after a chemical peel. Mild skin peeling or flaking is expected for seven to 10 days after your procedure. But, it's possible that your skin feels dry and flaky for several weeks following the procedure. Eventually, the outer skin layer will shed entirely, leading to smooth skin.
Your healthcare provider may recommend avoiding prolonged sun exposure and skincare products with harsh ingredients for several days to prevent long-term complications, which may include:
- Hyperpigmentation
- Hypopigmentation
- Scarring
How to Prepare for Milia Removal
Milia removal is straightforward—regardless of what procedure you're getting. Before your appointment, your healthcare provider should give you instructions on how to best prepare for the procedure. Here are a few tips to keep in mind:
- Wear comfortable clothing that allows your provider easy access to the milia. Depending on the location of the milia, you may need to change into a medical gown for the procedure.
- Avoid wearing jewelry, makeup, creams, or lotions on the area that is receiving treatment.
- Stop using skincare products containing harsh ingredients for two to four weeks before the procedure.
- Talk to your healthcare provider if you are prone to developing cold sores. Skin irritation is a common trigger for a cold sore outbreak. As such, your provider may prescribe an antiviral medication prior to the procedure to reduce your risk of cold sores.
You may be able to bring a friend or family member to provide emotional support during and after the procedure. Depending on the facility’s policy, your support person may be asked to wait in a designated area during removal.
It's worth noting that milia removal is considered a cosmetic procedure, meaning it may not be covered by your insurance. Check with your insurance provider beforehand to determine whether your plan provides coverage for your procedure and what you can expect to pay out-of-pocket.
Immediately following milia removal, your skin should look and feel smoother. Depending on the removal procedure, you may have slight redness, swelling, and tenderness in the treated area for several days or weeks while your skin heals.
Milia does not always return, but recurrence is possible. You can lower the risk of milia recurrence by maintaining a consistent skincare routine that includes:
- Washing your face with warm water and mild soap twice daily
- Exfoliating your skin 2-3 times weekly
- Applying sunscreen to your skin before spending time outdoors
A Quick Review
Milia are harmless and usually go away on their own within a few weeks or months, but some people may want to remove them for cosmetic reasons.Dermatologists, or doctors who specialize in treating skin concerns, can use several different methods for milia removal.
Depending on the type, location, and amount of milia, your healthcare provider may recommend removing milia by manual extraction, laser ablation, chemical peels, or cryotherapy. Most procedures cause mild side effects (like redness and swelling) for several days following the procedure. However, your skin will be smoother and milia-free once fully healed.
While milia removal is often permanent, new milia can develop in the same or new areas. A daily skincare routine, including cleansing, moisturizing, and exfoliating, can help prevent milia from returning.
