If dermatologists were genies and we all had one wish, I would wish away my milia forever. You see, bags are not the only thing I carry under my eyes. For years now I’ve been lugging around a seriously annoying case of milia: small, hard, dome-shaped bumps that ~conveniently~ look like whiteheads, mostly around my eyes and upper-cheek region. It wasn’t until recently that I learned of their name, and why it is they’ve overstayed their welcome.

Unlike pimples, milia don’t form within a pore and actually seal over within the skin, which makes DIY removal next to impossible. As a result, I’ve spent many hours of my life in front of the mirror trying to dig them out, hacking away at my poor face in the process. I was lucky enough to speak with New York-based acclaimed dermatological surgeon, Dr. Patricia Wexler, who is the ultimate skin guru for A-list celebs, designers, musicians and the like. She shed some light on the horrors that lie beneath, and how to banish them forever.

What causes milia? Is it genetic, lifestyle-induced, or a combination of the two?

Milia are small (but not to be underestimated) dome-shaped bumps, usually white or yellow. They are asymptomatic, meaning they’re not harmful or infectious. The most common type of milia is caused by keratin ‘plugs’ that get trapped beneath the surface of the skin, forming hard cysts. These cysts can be found around the eyelids, vermillion border of the lips, forehead, cheeks, upper torso, genitalia, and hands. They can last weeks or months, but should usually resolve as the skin exfoliates naturally. Less common forms of milia can occur as a result of genetic diseases that disrupt the auto-immune system, such as discoid lupus. Milia can also occur as a result of sun damage, which basically thickens the skin cells and decreases cellular turnover, which in turn delays the skin’s natural exfoliation process.


Outside of aesthetic concerns, are there any health concerns surrounding milia?

Milia are almost always asymptomatic, and of no bother outside of aesthetics. If the skin is traumatised after attempts to get rid of the milia, they may become inflamed or even infected, so be sure to see a professional. Milia will usually resolve on their own, but can last anywhere from a few weeks to several months, and will usually go away as normal exfoliation occurs with cellular turnover.


How do you treat milia? Are there any products on the market that will successfully remove or prevent it?

When it comes to preventing milia, it’s all about exfoliation, exfoliation, exfoliation! You want to maximise your cellular turnover, so things like chemical peels, topical retinoids, alpha hydroxy acids (AHAs), beta hydroxy acids (BHAs), charcoal, mud masks, micro abrasion and vitamin C are amongst the recommended. Adding a glycolic acid or retinol product to your routine will help, such as Peter Thomas Roth’s Glycolic Acid 10% Hydrating Gel or SkinMedica Retinol Complexe 1.0, both of which hydrate and advance cell renewal to increase cell turn-over. Pick a cleanser with cell-renewal properties, like DERMAdoctor’s Ain’t Misbehavin’ Medicated AHA BHA Acne Cleanser With Salicylic Acid.  Pore cleansing and tightening will help to prevent the keratin build up in the first place, so use regular treatments like Boscia’s Pore Purifying Black Strips, which help draw out impurities and tighten pores, or GlamGlow’s Supermud Clearing Treatment, which has activated X charcoal and K 17 clay, both of which lift away dirt and other skin congestions. The only way to successfully get rid of existing milia is to have them professionally extracted. Dermatologists can ‘de-roof’ the milia by means of a sterile instrument, laser ablation, desiccation and curettage, or cryotherapy.


Are there any products milia-prone people should avoid? We've heard there's a correlation between heavy face/eye creams and milia.

Avoid products that are particularly oily; hair products, sunscreens, moisturisers, makeup removers, and lip balms — anything that could be irritating or clog the pores. Lip balms are especially associated with milia along the vermillion border of the lip. Hair products with oils will not only affect the scalp, but will also affect the skin of the forehead, temples, and cheeks.


What is milia extraction, and what should we know about it before getting it?

Milia extraction is the use of a sharp sterile needle or instrument to open the keratin plug and remove the cyst in a sterile way without damaging the skin. You should know that the cyst is a very firm nodule, and these are very difficult to extract, as they often attach firmly to the underlying skin. Even with a sterile, sharp instrument, they are difficult to remove, and will require professional help to prevent scarring and inflammation. There is usually a short healing period.


Words, Cassandra Wait-Hughes. Model, Charlotte Gregg at IMG.