Milia are one of the more stubborn and misunderstood skin concerns. They look similar to whiteheads, they appear on the face particularly around the eye area, and the instinct to squeeze them is nearly universal. But they are not whiteheads, they cannot be popped in the usual way, and attempting to do so risks causing the inflammation and scarring they themselves do not cause. Understanding what they are determines how to deal with them effectively.
What milia actually are
Milia (singular: milium) are small keratin cysts. They form when keratin, the protein that makes up skin cells and hair, becomes trapped just below the skin surface in tiny pockets of epithelial tissue. They appear as white or yellowish domed bumps, typically 1-2mm in diameter, firm to the touch, and without any visible pore opening on the surface.
This is why they cannot be popped: there is no pore opening through which the contents can exit. The keratin is entirely enclosed by epithelial tissue. Pressing on them moves them slightly under the skin but does not extract them. Attempting to force them causes trauma to the surrounding skin without removing the milium.
Milia are not inflammatory. They are not infected. They are not contagious. They are simply small keratin deposits trapped in the wrong place.
Types and causes
Primary milia arise spontaneously from follicles or sweat gland ducts without a clear precipitating cause. They are common in newborns (neonatal milia), where they resolve spontaneously within the first weeks of life without treatment. In adults, primary milia appear most often around the eye area, on the nose, and on the cheeks, and they may persist indefinitely without treatment.
Secondary milia arise in response to a specific trigger. Skin trauma is the most common cause: blistering from an allergic reaction, a burn, dermabrasion, laser treatment, or another procedure that damages the skin surface can lead to milia forming during the healing process. When keratinocytes that would normally cycle to the surface through a follicle are disrupted by trauma, they can become trapped and form a milium during repair.
Topical skincare products are a frequently overlooked cause. Heavy occlusive products, particularly those with high-molecular-weight silicones, some mineral oils, and certain waxes, applied around the eye area can contribute to milia formation by creating conditions that trap keratin beneath the surface. The eye area’s thin, delicate skin is particularly susceptible.
Genetics plays a role: some people are significantly more prone to milia than others regardless of what they apply to their skin.
What removes them
Professional extraction is the most reliable method. A dermatologist or experienced aesthetician makes a tiny incision with a sterile lancet, creating a small pore opening, and then uses gentle pressure to express the keratin contents. Done correctly, this removes the milium with minimal trauma. Done incorrectly or attempted at home with inadequate tools, it causes inflammation and the risk of scarring or infection.
This is not a treatment to attempt at home. The tools available domestically are not suitable, and the eye area in particular has a low tolerance for poorly executed extractions.
Retinoids are the most effective topical approach for milia prevention and gradual reduction. Retinoids increase cell turnover and promote the exfoliation of dead cells, reducing the accumulation of keratin that forms milia. Applied consistently to milia-prone areas over several weeks, they can help existing milia reach the surface naturally and reduce the formation of new ones.
This is best applied under the supervision of a dermatologist for the eye area, where the thin skin requires particular caution with retinoid strength and frequency.
Chemical exfoliation with AHAs supports the same mechanism of improving cell turnover and reducing surface keratin accumulation. Glycolic acid or lactic acid applied regularly in the milia-prone areas of the face prevents buildup that contributes to new milia forming.
Salicylic acid may help for milia associated with follicular blockage, though milia are technically not a follicular condition, so its effectiveness is more variable than for comedonal acne.
What does not work
Attempting to pop milia at home is the most common mistake. The keratin is enclosed in a cyst with no pore opening. Squeezing produces nothing except trauma to the surrounding skin, potential bruising, broken capillaries in the thin eye area skin, and occasionally infection of the manipulated area. It does not remove the milium.
Spot treatments designed for acne (benzoyl peroxide, tea tree spot treatments) are not appropriate for milia. They treat bacterial infection and inflammation, which are not part of the milium’s pathology.
Scrubbing the area physically does not access the trapped keratin beneath the surface. Physical exfoliation works at the skin surface; the milium is under it.
Prevention for milia-prone skin
Product choice is the most controllable prevention factor. Avoid applying heavy occlusive products around the eye area, including rich eye creams with significant wax or silicone content. For people prone to milia around the eyes, a lighter, less occlusive product delivers hydration without the pore-blocking effect that contributes to milia formation.
Regular gentle exfoliation (AHA-based) maintains the skin surface in a state that is less likely to trap keratin. This preventive exfoliation is more straightforward and less risky than treating established milia.
Retinoids as a regular part of the routine (not just around the eyes, where they need particular care) support the cell turnover that prevents keratin accumulation broadly across the face.
When to see a dermatologist
If you have multiple persistent milia that are aesthetically bothersome, a dermatologist can extract them safely and efficiently. This is a relatively simple in-office procedure that takes a few minutes and, when done properly, leaves no marks. It is far preferable to months of home extraction attempts that damage the skin without removing the milia.
For milia that appear after skin trauma or procedures, a dermatologist can also determine whether any underlying issue requires attention. Secondary milia after burns or laser treatments are expected and usually resolve, but professional assessment is appropriate if they are numerous or persistent.