Milia are tiny, hard white bumps filled with a protein called keratin that get trapped just beneath the skin’s surface. They don’t pop like pimples, and squeezing them at home usually leads to irritation, bruising, or scarring. The most reliable way to remove milia is a quick in-office procedure called de-roofing, where a dermatologist makes a tiny opening in the skin and extracts the contents. But depending on how many you have and where they are, other options range from topical products to light chemical peels.
What Milia Actually Are
Each milium (the singular of milia) is a small cyst sitting just under the outermost layer of skin. Unlike a whitehead, which forms inside a pore clogged with oil, milia form when dead skin cells get trapped in a tiny pocket and harden into a pearl-like ball of keratin. That’s why they feel firm to the touch and won’t release when you press on them the way a pimple would.
Milia can show up at any age. In newborns, they’re extremely common and typically disappear on their own within a few weeks without any treatment. In adults, they tend to stick around indefinitely unless physically removed or treated. They appear most often around the eyes, on the cheeks, and along the nose, though they can form anywhere on the body, including the forearms and chest.
Professional Extraction (De-Roofing)
The gold-standard removal method is manual extraction, sometimes called de-roofing. A dermatologist or trained aesthetician uses a sterile needle or lancet to create a tiny superficial opening in the skin directly over the milium. Then, using a comedone extractor or even just two cotton-tipped applicators, they apply gentle vertical pressure to express the hardened keratin ball through the opening. The whole process takes seconds per bump.
The procedure is virtually painless for most people since milia sit so close to the surface. There’s no need for numbing in most cases, and the tiny openings heal quickly without stitches. One published case described a dermatologist removing 15 milia from a patient’s forearms in a single session using a 30-gauge blood glucose lancet and a sterilized paper clip loop as a makeshift comedone extractor. The tools matter less than the sterile technique and the practitioner’s precision.
If you have just a few milia, one visit is usually enough. For people with dozens of bumps spread across a larger area, a second session may be needed after the skin heals from the first.
Why You Shouldn’t Try It at Home
It’s tempting to grab a needle and do this yourself, especially since the procedure looks simple. But the risks are real. Picking, scratching, or trying to pop milia without proper technique and sterile instruments can cause scarring, bruising, or infection. The skin around the eyes, where milia commonly appear, is especially thin and prone to damage. Even small scars in that area tend to be noticeable.
The other issue is accuracy. Milia can look similar to other skin conditions. Syringomas, for example, are small sweat gland growths that form in clusters and look like yellowish or skin-toned bumps, often in the same places milia appear. A dermatologist can tell the difference on sight and, if needed, confirm with a biopsy. Attempting to extract a syringoma as though it were a milium won’t work and could cause unnecessary injury.
Topical Treatments That Help
For mild or widespread milia, topical products can gradually encourage the skin to shed the trapped keratin on its own. The most effective options work by speeding up cell turnover or dissolving the outer layer of dead skin cells. Over-the-counter choices include:
- Glycolic acid products: An alpha hydroxy acid that loosens the bonds between dead skin cells, helping them shed more efficiently. Look for leave-on serums or pads rather than wash-off cleansers, which don’t stay on the skin long enough to have much effect.
- Salicylic acid products: A beta hydroxy acid that penetrates into pores and helps clear buildup. It’s particularly useful when milia appear alongside congested or acne-prone skin.
- Adapalene (Differin): A retinoid available without a prescription that accelerates skin cell turnover. By pushing new cells to the surface faster, it helps prevent keratin from getting trapped in the first place.
These products work slowly. Expect weeks to months of consistent use before milia noticeably shrink or resolve. They’re more effective at preventing new milia from forming than at clearing existing ones, which is why many people combine topical treatment with professional extraction for a faster result.
Chemical Peels and In-Office Treatments
When milia are numerous or keep recurring, a dermatologist may recommend professional-strength chemical peels using higher concentrations of glycolic or salicylic acid than what’s available over the counter. These peels remove a controlled layer of surface skin, which can release superficial milia and reduce the likelihood of new ones forming.
Some practitioners also use electrodesiccation, a technique that applies a small electrical current to destroy the cyst, or cryotherapy, which freezes individual milia. These approaches are less common than simple extraction but may be offered when milia are particularly stubborn or located in tricky areas.
What Causes Milia in Adults
Understanding why milia form can help you prevent them from coming back. Primary milia appear spontaneously when keratin simply gets trapped during the skin’s normal renewal process. They’re more common in people who use heavy, occlusive moisturizers or sunscreens that may slow natural exfoliation, particularly around the eyes.
Secondary milia develop after some kind of skin trauma or damage. Burns, blistering injuries, dermabrasion, and even prolonged use of strong topical steroid creams can disrupt the skin’s normal structure enough that keratin gets trapped as the skin heals. These secondary milia can appear at any age and in any location where the skin was injured.
Preventing New Milia
Once your milia are removed, a few habits can reduce your chances of developing new ones. Regular use of a gentle exfoliating product containing glycolic acid, salicylic acid, or a retinoid keeps dead skin cells from accumulating. If you’re prone to milia around the eyes, switch to a lightweight, non-occlusive eye cream, and avoid applying heavy facial products too close to your lash line.
Sun protection also plays a role. UV damage thickens the outer layer of skin over time, making it harder for dead cells to shed normally. A lightweight, non-comedogenic sunscreen applied daily helps maintain healthy cell turnover. If you’ve had milia removed professionally, keeping up with a basic exfoliation routine is the most practical step to avoid another round of extraction down the line.