If you notice tiny, firm white bumps that stay “forever” and don’t behave like acne, there’s a good chance you’re dealing with milia.

Although benign, they can be persistent and cosmetically frustrating. Milia are epidermal inclusion cysts that lack a true pore opening.  They are persistent so attempts at “DIY” extraction—squeezing, lancing, or using pimple patches—often injure the skin and may lead to scarring, especially in delicate areas.

Instead of fighting a losing at-home battle, talk with Dr. Elizabeth Briden about safe, effective care. At Advanced Dermatology & Cosmetic Institute, we take a two-pronged approach: using sterile surgical instruments to remove existing cysts and helping you establish a gentle, preventive routine that reduces the likelihood of new ones.

What Milia Are (and What They’re Not)

Milia are small, superficial cysts made of compact keratin that sit within the uppermost layer of the skin. 

Keratin is the tough, fibrous protein that forms the outermost skin cells, called corneocytes, as well as hair and nails. Typically, keratinized cells rise to the surface and shed away naturally, which is what we refer to as cell turnover. When you have milia, however, the corneocytes become trapped in a small pocket sealed just below the surface, in the epidermal lining. 

So, to clarify what makes milia different from acne, the bump is firm and pearly in appearance, full of dry, compacted keratin rather than oil and bacteria.

That sealed epidermal wall mentioned above also prevents the center from having an exit point, in the form of a pore, so there’s no way to force it out with pressure, and there’s no way for topical treatments to get in. Instead, you’ll need a dermatologist to create a small opening just large enough to remove the cyst without injuring the surrounding tissue. 

The Types of Milia

There are several different kinds and causes of milia:

  • Primary milia: The most common type in adults. They form de novo (Latin for “from the beginning”—arising on their own, not due to a prior rash or injury) when normal surface shedding slows and keratin gets sealed beneath thin, sun-exposed skin.
    • Years of UV exposure make the top layer a bit thicker and less flexible. Dead cells don’t shed as easily, so tiny pockets of keratin are more likely to get trapped near the surface.
    • The skin around the eyes is very thin and has fewer hair follicles and oil glands. With fewer “escape routes,” small plugs of keratin have nowhere to go and can become sealed in place
    • Removing waterproof eye makeup, tugging at concealer, or pressure from eyeglass frames causes tiny, repeated irritation. As that spot heals, a thin “roof” can form over a small bit of keratin, creating a milium
    • Using heavy or waxy products can leave a residue build-up that slows natural skin shedding, especially on the eyelids. 
    • Skin renewal slows down with age, so keratin has more opportunity to collect under the surface and form milia.
  • Secondary milia: Develop where skin is healing after injury or inflammation. During re-epithelialization, or the phase of healing when new epidermal cells migrate to the surface and multiply, the new epidermis can “wall off” tiny pockets of keratin, creating cysts.
  • Neonatal milia: Very common in newborns and completely harmless. They arise as the baby’s skin naturally matures and resolves within a few weeks. 
  • Multiple eruptive milia: Sudden groups of tiny cysts on the face or upper torso.
  • Milia en plaque: Densely clustered milia on a slightly raised, sometimes pink patch—often near the eyelids or ears.

Combining In-Office Removal and Preventative Maintenance to Keep Milia at Bay

Treating milia works best when you pair targeted, in-office removal with a preventive routine.

Removing Existing Milia Bumps

Dr. Elizabeth Briden will start with removing the milia by making a tiny opening in the skin with a scalpel and releasing the compact keratin without injuring surrounding tissue, which is especially important near the eyes.

The healing process is very quick, with the majority of patients leaving the office with nothing more than a pinprick mark lasting only a few days. You’ll need to keep the area clean and avoid rubbing the area for the next few days. By letting a dermatological expert handle these stubborn bumps, you’ll find that there’s minimal discomfort and a very low risk of scarring.

Keeping Milia Bumps From Coming Back

Because the source of milia is hampered skin cell turnover, you’ll need to adopt a skincare routine that focuses on helping your skin shed evenly while avoiding heavy, occlusive products in the delicate areas around your eyes.

Our typical recommended routine includes:

Retinoids

A retinoid a few nights a week—like NeoStrata Potent Retinol Complex and Revision Skincare Retinol Complete 1.0%—helps your skin shed more regularly. Start 2–3 nights per week and increase as tolerated. Use a pea-size amount for the whole face and only a rice-grain amount along the orbital bone while avoiding the eyelids. Layer with a lightweight moisturizer to help prevent irritation and dryness.

Chemical Exfoliation

Gentle chemical exfoliation with a mild leave-on acid—such as lactic or glycolic—removes the upper layer of dead cells without friction. PHAs add hydration while smoothing, so we often recommend NeoStrata Bionic Lotion PHA 15. You may also consider pairing it with NeoStrata 15% Vitamin C + PHA Serum to achieve a more radiant complexion.

If you’re prone to tiny bumps in thicker skin zones, you can also use an exfoliating AST 5% Glycolic / 2% Salicylic Pad a few times a week.

TLC in the Eye Area

When removing eye makeup, use a gentle oil followed by a mild cleanser to prevent residue from building up.

Massage the remover lightly, let it dissolve long-wear formulas, then rinse and cleanse—no tugging or scrubbing. Pat dry and avoid rubbing the upper cheeks and lash line where milia tend to form.

SPF

Always use broad-spectrum sunscreen to prevent sun damage, which slows natural shedding. Choose a daily SPF 30+ with a mineral formula. We have several options in-office, such as EltaMD UV Clear Broad-Spectrum SPF 46 and Colorescience Sunforgettable® Total Protection™ Brush-On Shield SPF 50. Avoid the eye area, and follow your facial sunscreen with a targeted treatment, like Colorescience Total Eye 3-in-1 Renewal Therapy.

Schedule a milia evaluation with Dr. Briden, and she’ll provide you with the intervention you need to banish those stubborn bumps. After gentle, safe extraction, she’ll give you personalized, clinical-grade product recommendations, so you’ll know exactly what to use, where, and how often.