How do I treat milia on the face?

Treatment of Milia on the Face

The most effective treatment for milia on the face is surgical extraction with a sterile needle or blade, which provides immediate resolution with minimal scarring risk.

Understanding Milia

• Milia are small, benign, white keratinous cysts measuring 1-4 mm that appear on the skin surface 1
• They can occur spontaneously (primary milia) or secondary to trauma, skin conditions, or treatments 1
• Milia are cosmetically troublesome but medically harmless 1

Treatment Options

First-Line Treatment: Surgical Extraction

• Simple extraction using a sterile needle or small blade to create a tiny opening, followed by gentle expression of the keratin content 2, 3
• This technique:
  • Provides immediate resolution
  • Has minimal risk of scarring when performed properly
  • Is suitable for isolated or few milia 3

Second-Line Treatments for Multiple or Recurrent Milia

1. Dermabrasion

   • Effective for multiple milia or milia en plaque (milia within an erythematous base) 2
   • Complete regression can be achieved with proper technique 2
   • Requires healing time and temporary redness

2. CO₂ Laser Vaporization

   • Highly effective for multiple milia variants 3
   • Typically performed in superpulsed and focused mode at 2 W/cm² 3
   • Provides good cosmetic results with minimal side effects 3
   • Suitable for both adults and children 3

3. Topical Retinoids

   • Can help prevent new milia formation by promoting cell turnover 3
   • Requires consistent application over weeks to months
   • May cause temporary skin irritation

Treatment Algorithm

1. For isolated or few milia:

   • Proceed with gentle extraction using a sterile needle or blade 2, 3
   • Clean the area before and after extraction

2. For multiple or widespread milia:

   • Consider dermabrasion or CO₂ laser vaporization 2, 3
   • Multiple sessions may be required for complete clearance

3. For prevention of recurrence:

   • Consider topical retinoids for maintenance 3
   • Maintain good skin hygiene

Important Considerations

• Milia extraction should be performed by a trained professional to minimize scarring risk 3
• Self-extraction carries risks of infection and scarring 1
• Some variants like milia en plaque may require more aggressive approaches like dermabrasion 2
• Follow-up is recommended to monitor for recurrence, which can happen in some cases 3
• Different anatomical locations may require different approaches (facial milia treatment differs from genital milia) 4

Common Pitfalls to Avoid

• Attempting aggressive self-extraction, which can lead to scarring or infection 1
• Confusing milia with other white facial lesions (like closed comedones or sebaceous hyperplasia) 5
• Using harsh exfoliants that may irritate the skin without effectively treating milia 3
• Neglecting post-procedure care, which can lead to complications 2