Milia are routinely treated as stubborn whiteheads. They are not whiteheads at all, and almost everything that frustrates people about them follows from that single anatomical difference.
WhatsApp the clinic →A closed comedone is a plugged follicle with a channel to the surface, which is why extraction works on it. A milium has no such channel. It is a sealed cyst beneath the epidermis, and nothing connects its contents to the outside. That single fact accounts for the entire experience people describe: the exfoliants that did nothing, the acne treatments that did nothing, the extraction attempts that produced redness and no result.
Primary milia arise spontaneously in the undifferentiated sebaceous hair collar around vellus follicles. Secondary milia follow injury — burns, dermabrasion, blistering disorders, cosmetic procedures, and certain medications with topical steroids well recognised. Milia following blistering are often found in eccrine sweat ducts rather than hair follicles. The two look identical under the microscope; only the history separates them.
Milia appearing after resurfacing are a known outcome of the healing process rather than evidence that something went wrong. Understanding that in advance changes how it is received — and it is one of the reasons we mention it before ablative work rather than after.
Squeezing. Without an opening, pressure deforms surrounding skin rather than emptying the cyst, and sustained pressure causes trauma — which is itself a documented cause of secondary milia. Forcing them can produce more. Around the eyelid, where most milia sit, the skin is thin and the margin for error is small.
“A milium is a sealed cyst with no opening to the surface. Squeezing it harder is not persistence, it is a misunderstanding of the anatomy — and the trauma that follows is one of the recognised ways new milia are made.”
This is a small procedure done in a place that does not forgive imprecision. The lesions themselves are simple; the eyelid skin around them is not. If milia keep returning in the same area, the more useful question is what is being applied to that skin — heavy eye creams, occlusive products and ongoing topical steroid use all appear in the history more often than chance would suggest.
No. A closed comedone is a plugged follicle connected to the surface. A milium is a keratin-filled cyst under the epidermis with a complete lining and no opening — which is why extraction techniques and acne treatments do not resolve them.
There is nothing to squeeze through. Pressure deforms surrounding skin rather than emptying the cyst, and the resulting trauma is a documented cause of secondary milia.
The cyst is de-roofed with a sterile blade or fine needle so the keratin can be expressed. Electrodesiccation, curettage, cryotherapy and ablative laser are alternatives, and topical retinoids are used for widespread lesions.
Primary milia arise spontaneously. Secondary milia follow injury to the skin — burns, blistering, dermabrasion, cosmetic procedures, and some medications including topical steroids.
In newborns they usually resolve within a month. In older children and adults primary milia can persist for months or longer.
No. They are a recognised part of the healing process after resurfacing, not a complication.
Every assessment at IN Eternity Clinic is carried out personally by Dr Sin Yong. If the honest answer is that treatment should wait, you will be told that.
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