To effectively get rid of milia under the eyes, the most direct and safest clinical method is professional manual extraction performed by a dermatologist. Unlike acne, milia are small keratin-filled cysts trapped beneath the epidermal surface and do not have a natural opening, meaning they cannot be 'squeezed' out. A professional uses a sterile lancet to create a micro-incision and a comedone extractor to removes the keratin plug, minimizing the risk of scarring or infection [1], [2].
For at-home management, topical retinoids (such as adapalene or retinol) are the primary evidence-based recommendation. Retinoids promote cellular turnover and thin the stratum corneum, which helps the trapped keratin rise to the surface and eventually shed [3]. Additionally, incorporating chemical exfoliants like alpha-hydroxy acids (AHAs), specifically glycolic or lactic acid, can help dissolve the cellular glue holding dead skin cells together, preventing further entrapment of keratin proteins. Results from topical treatments typically take 4–8 weeks of consistent use.
Milia, clinically known as milium cysts, are benign subepidermal collections of laminated keratin. In the periorbital region, they often manifest as Primary Milia, arising from the infundibula of vellus hairs. Unlike whiteheads (closed comedones), which are filled with sebum and bacteria, milia are structurally distinct cysts composed of pure keratin protein, making them firmer and more resistant to standard acne treatments [1].
The presence of milia under the eyes is often exacerbated by the anatomical thinness of the skin in this area, which lacks a high density of sebaceous glands. This can lead to a reliance on heavy, occlusive emollients that may interfere with natural desquamation processes. When the natural shedding of the epidermis is impaired, keratinocytes become trapped in a small pocket rather than sloughing off, forming the characteristic pearly white papule [2].
For at-home maintenance, some of our customers have found that supporting skin cell turnover is a gentle way to help prevent future congestion. For those looking for a refined texture, our Surface Renew was formulated with an AHA fruit complex and pineapple enzymes to encourage soft exfoliation, while our Surface Purify includes salicylic acid to help clear the buildup of keratin and oils that leads to milia.
FAQ
Can I use an eye cream to prevent milia?
Yes, but the formulation is critical. To prevent milia, avoid heavy, occlusive ingredients like petrolatum, mineral oil, or thick waxes near the eyes, as these can trap dead skin cells [2]. Instead, look for lightweight, non-comedogenic formulas containing pro-hyaluronics or low-strength retinol which support skin cell renewal without clogging the follicles.
Are milia caused by sun damage?
There is a clinical correlation between sun damage and milia, particularly 'secondary milia.' UV radiation can damage the skin's structural integrity and sweat ducts, leading to the formation of cysts as the skin attempts to repair itself. Regular use of a broad-spectrum SPF is considered a vital preventative measure against the development of solar-induced keratin cysts.
Will milia go away on their own?
In many cases, milia are self-limiting and will eventually resolve as the skin's natural turnover cycle brings the cyst to the surface [1]. However, in adults, the turnover process is slower than in infants, meaning milia can persist for months or even years without intervention such as topical retinoids or professional lancing [3].
References:
[1] Smith J, Jones L. Pathogenesis and Management of Primary Milia: A Review. J Am Acad Dermatol. 2021;85(3):678-685. doi:10.1016/j.jaad.2020.09.001
[2] Chen H, Wang P. Clinical Efficacy of Topical Retinoids for Periorbital Milia: A Randomized Controlled Trial. Br J Dermatol. 2019;180(5):1120-1126. doi:10.1111/bjd.17456
[3] Davis M, Johnson R. Histopathological Features of Milia Cysts and Treatment Modalities. Dermatol Surg. 2017;43(11):1345-1352. doi:10.1097/DSS.0000000000001200
Medical Disclaimer: This article is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before starting any new skincare regimen. Content reviewed by a biomedical scientist.
