Milia: why they appear and how to remove them properly

What milia actually are

Milia are small, firm, pearl-white bumps that typically appear around the eyes, cheeks, nose, and forehead. Each one is a tiny cyst containing keratin, a protein that normally sheds naturally from the skin's surface. In milia, this keratin becomes trapped beneath the outer layer of skin (the stratum corneum), forming a compact, hard bump that feels like a small grain of sand under the skin.

They are benign, cause no pain, and pose no health risk. However, they can be cosmetically bothersome, especially when clustered around the delicate eye area. The key point: milia have an intact roof of skin above them. This is why squeezing them rarely works. The pressure forces the cyst sideways into surrounding tissue, causing microscopic scarring and often leading to the same milia reappearing in the same spot weeks or months later.

Why milia form: primary versus secondary

Milia fall into two categories. Primary milia appear seemingly on their own, often around the eyes, and are thought to arise from a buildup of keratin over time. They are very common and can affect anyone, regardless of skin type.

Secondary milia develop after skin trauma or stress. This includes burns, laser treatments, aggressive exfoliation, or prolonged use of heavy, occlusive skincare products. In my clinic, the most common trigger I see is the use of rich eye creams containing petrolatum, oils, or thick butters applied around the delicate periocular area. These products block the natural shedding of skin cells and sweat gland ducts, creating an ideal environment for keratin to become trapped. Even well-intentioned moisturisers can become problematic if they are too occlusive for the thinner, more sensitive skin around the eyes.

Understanding which type you have matters. If your milia appeared after using a heavy eye cream for months, switching to a lighter formula will be part of preventing recurrence after professional removal.

Why exfoliation and skincare don't work on existing milia

It is a common misconception that keratolytic agents like salicylic acid or glycolic acid can dissolve milia. These products can help prevent new milia by promoting skin cell turnover and keeping pores clear. However, once milia have formed, the keratin is too deeply trapped and too densely packed for topical exfoliants to penetrate and dislodge.

Retinoids are useful as a preventive measure and for reducing recurrence, but they cannot dissolve established milia. No moisturiser, cleanser, or at-home treatment will remove them. This is why so many people become frustrated: they apply expensive serums and creams for months with no result. The milia simply do not respond to what sits on top of the skin.

Professional removal: CryoPen and sterile extraction

There are two main professional methods for milia removal. The first is sterile lance-and-extract: a qualified practitioner pierces the intact skin covering the milia with a sterile scalpel or fine needle, then carefully removes the keratin using a comedone extractor. This is precise and works well for larger milia or those on areas of the face away from the eye itself.

The second method is cryotherapy, using a CryoPen to freeze each milium. Cryotherapy is particularly valuable for milia very close to the eye, where lancing carries a higher risk of damage to the delicate periocular skin. It is also gentler and carries minimal scarring risk. The cold causes the keratin-filled cyst to crystallise and separate from surrounding tissue over the following weeks, after which the body naturally sheds it. At Visage Aesthetics, we often recommend CryoPen for milia around the eyes, as it is non-invasive and highly effective.

Both methods should only be performed by a qualified, trained practitioner in a clinical setting. Attempting to extract milia at home with a comedone extractor or any other device, particularly around the eyes, risks infection, scarring, and permanent damage. The skin around the eye is only 0.5mm thick in places and has virtually no underlying cushioning. Even a small mistake can result in lasting harm.

What to expect during CryoPen treatment

CryoPen treatment is quick and well-tolerated. Your practitioner will apply a brief burst of extreme cold directly to each milia, freezing it. You may feel a sharp, icy sensation for a few seconds per spot, but it is not painful. There is no numbing needed, and most people find the discomfort minimal compared to the relief of finally having a solution.

After treatment, the area may be slightly red or feel tender for a short while. The treated milia will initially appear darker as the keratin begins to separate. Over the following weeks, the body's natural healing response pushes out the dead tissue, and the milia flake away or absorb. It is important not to pick or squeeze the treated area, even though the temptation may be strong.

For more detail on what to expect from CryoPen treatment, our CryoPen treatment page covers the full appointment process.

Breaking the cycle: how to prevent recurrence

Milia can return, particularly if the underlying cause is not addressed. If you were using a heavy eye cream when your milia formed, continuing to use it after removal almost guarantees recurrence. The same trigger will create the same problem.

To prevent secondary milia, swap heavy occlusives for lighter formulations. Look for moisturisers containing humectants like glycerin or hyaluronic acid, paired with a light occlusive such as dimethicone. These hydrate without suffocating the delicate eye area. Avoid petrolatum, coconut oil, shea butter, or other thick occlusive agents around the eyes, even if they are marketed as "nourishing" or "luxurious".

A maintenance retinoid applied two to three nights per week is one of the most effective preventive measures. Retinoids normalise skin cell turnover and prevent keratin from accumulating. Start with a low strength and build gradually, as retinoids can be irritating on the delicate periocular skin.

Gentle sun protection is also important. Sun damage thickens the stratum corneum and disrupts natural skin shedding, creating conditions favourable to milia formation. Use a broad-spectrum SPF daily, particularly around the eyes.

• · Switch to a lightweight eye moisturiser with humectants and light occlusives
• · Use a retinoid two to three nights per week to normalise cell turnover
• · Avoid petrolatum, oils, butters, and other heavy occlusives around the eyes
• · Apply broad-spectrum SPF daily to protect the periocular skin
• · Do not pick, squeeze, or attempt home extraction after professional treatment

A short safety note

Milia are benign, but any new bump on or near the eye should be assessed by a qualified practitioner before treatment. Very occasionally, other conditions such as closed comedones or small benign skin growths can mimic milia. A proper consultation ensures correct diagnosis and safe treatment.

Professional removal is safe when performed by a trained, qualified practitioner using sterile equipment in a clinical environment. Home extraction and DIY CryoPen devices carry real risks of infection, scarring, and damage to the sensitive periocular skin. It is always worth the small investment in professional care to avoid lasting complications.