Milia removal: how doctors extract milia

Milia are tiny, hard, white bumps made of trapped keratin, the tough protein in the top layer of skin. Removing one takes a small, careful procedure: a clinician opens the thin skin over the bump and lifts the keratin out. This guide explains when removal makes sense, how doctors do it, what other methods exist for many milia at once, and whether milia come back. For what milia are and why they form, start with the hub guide, what milia are.

Skinli gives general education and is not a doctor. Every method on this page is done by a trained clinician. If you are thinking of removing milia yourself, read can you pop milia first.

What a milium is, and why it does not squeeze out

StatPearls, a medical reference hosted by the U.S. National Library of Medicine, describes milia (one is called a milium) as "benign and transient subepidermal keratin cysts" that look like "small, firm, white papules." A papule is a small raised bump. The cyst has a wall, and the keratin inside is packed hard.

That structure explains how removal works. The AAD says a whitehead forms when oil and dead skin cells plug the opening of a pore. A milium is a small closed cyst just under the surface. That is why StatPearls describes making "a tiny incision" before applying pressure: the clinician makes an exit first, then presses. The difference is covered in full in milia vs whiteheads.

When removal is needed at all

For many people, no removal is needed. StatPearls says milia in newborns "do not require specific treatment, as they tend to resolve spontaneously." MedlinePlus says that in children "no treatment is needed."

Adults are different. StatPearls says the other forms of milia, both primary milia that appear on their own and secondary milia that follow skin damage, "may not resolve on their own." MedlinePlus says "Adults may have milia removed to improve their appearance." So for an adult, removal is a choice. Milia are harmless, and StatPearls says "No systemic complications have been documented." People choose removal when the bumps bother them, when they sit where makeup or glasses rub, or when they have lasted for months.

How a clinician extracts a milium

The medical sources describe a few ways to do the same basic job.

A tiny incision and pressure. StatPearls says milia that do not resolve "can be treated with simple surgical interventions such as evacuation with a tiny incision and tangential pressure applied with a comedone extractor or curette." Tangential pressure means pressing from the side, at an angle, instead of straight down. A comedone extractor is a small metal loop. A curette is a small tool with a rounded edge for scraping.

A needle that removes the top. The StatPearls chapter on eyelid bumps says milia "are often surgically removed with a 'deroofing' technique using a needle to remove the epidermis directly above the cyst." The epidermis is the top layer of skin. A 2002 report in the Journal of the American Academy of Dermatology described removing milia with a disposable hypodermic needle, the kind used for injections.

Fine forceps. A 2022 report in the journal Cutis, from dermatologists at the Mayo Clinic in Arizona, described using forceps, which are small tweezers, for milia extraction.

The AAD describes a related procedure for large pimples, incision and drainage, as "using a sterile needle or surgical blade to open the blemish and then removing what's inside." That page is about acne, and it makes the same point for any bump: the opening is made by a doctor with sterile tools.

A 2026 case report in the journal Cureus shows what this looks like in practice. A 17-year-old taking isotretinoin for acne developed 15 to 20 milia below his eyes. His doctors removed them by "manual extraction during follow-up visits," and the authors report that "No recurrence or development of new milia was observed after extraction."

Methods for many milia at once

Extracting milia one by one works for a few bumps. When there are dozens, or when they sit together on a red patch, doctors have other options.

• Topical retinoids. StatPearls lists "topical retinoids" among the options for multiple milia. These are vitamin A creams and gels, such as adapalene and tretinoin. The guide retinoids for milia covers what the evidence shows.
• Electrocautery and electrodesiccation. StatPearls also lists "electrodesiccation or electrocautery." Both use a small electric current to heat and destroy the tissue.
• CO2 laser. A CO2 laser is a medical laser used in skin clinics. A 2010 study in the Journal of Cosmetic and Laser Therapy treated four patients aged 12 to 50 with different types of milia. The authors report that "All patients showed marked improvement after a few sessions of CO(2) laser," with follow-up of 12 to 36 months, and "No-one had recurrence or noticeable side effects." Four patients is a small number, so treat this as an early report.
• Er:YAG laser. A 2020 report in Dermatologic Surgery described treating milia in people with brown and black skin (Fitzpatrick skin types IV to VI) with a short-pulse Er:YAG laser, another type of laser. If you have darker skin, ask the doctor about the risk of dark marks before any heat treatment.
• Cryotherapy, excision and others. A 2014 review of milia en plaque, a patch of many milia on a red base, lists "electrodessication, dermabrasion, cryotherapy, simple excision, surgical opening of the cysts, topical retinoids, oral minocycline, photodynamic therapy and CO 2 laser." A 2025 case report removed one such patch by surgical excision, cutting it out, with no return at two months.

One method can also cause the problem it treats. A 2014 report in Dermatology Online Journal describes milia that formed at a site treated with liquid nitrogen freezing. The authors say treatment options for those milia "include manual extraction, topical retinoids, or observation," and that the milia in their patient went away on their own.

Milia near the eyes

Milia often appear on the eyelids and under the eyes. StatPearls says milia that appear on their own in older children and adults "tend to occur on the eyelids, cheeks, forehead, and genitalia." The skin there is thin, and the eye is close.

Never pick, squeeze or cut milia near your eyes at home. The StatPearls chapter on eyelid lesions says, in its section on growths on the eyelid, that "The risk for scarring and a poor functional or cosmetic outcome is higher on the eyelids than elsewhere on the body," and recommends an oculoplastic specialist for those lesions. The adapalene label tells users to avoid contact with the eyes. The guide milia under the eyes covers this area in detail.

Will milia come back after removal?

A removed milium is gone, because its wall and contents are taken out. New milia can still form, and some types return more often than others.

• The 2026 Cureus case, a one-time eruption, reports no new milia after extraction.
• For milia en plaque, the 2014 review says all treatments offer cosmetic improvement "but recurrence can occur." The 2025 case report says "Simple extraction has often resulted in recurrence" for that type.
• A 2008 review in the Journal of the American Academy of Dermatology, "Milia: a review and classification," says milia are frequently seen in clinics and that "there are few studies on the origin of milia." Few studies means no one can give firm odds of return.

If milia keep appearing, the cause matters more than the removal. StatPearls says "persistent and widely distributed milia may require investigation for other causes." The guide what causes milia lists the causes the sources name.

Make sure it is a milium first

Many white or pale bumps look alike. StatPearls names sebaceous hyperplasia, acne whiteheads, flat warts and small calcium deposits as the main lookalikes. The AAD says basal cell carcinoma, the most common skin cancer, can appear as a "cluster of shiny bumps" or a "firm, round, and raised growth," and that "you cannot rule out or know whether you have this skin cancer by looking at pictures." A dermatologist looks at the bump before removing it. The guide white bumps that are not milia describes the lookalikes the sources describe.

Questions to ask at the visit

• Are these milia, or could they be something else?
• Which method do you suggest for the number and place of my bumps: extraction, a retinoid, electrocautery or a laser?
• How many visits will it take, and what does each visit cost?
• Is there a risk of dark marks on my skin tone, and how do you reduce it?
• What might be causing new milia, and can I change it?

For how clinics remove blackheads and whiteheads, a different problem with some of the same tools, see how a dermatologist removes blackheads and the guide to the comedone extractor.

When to see a doctor

See a dermatologist if milia bother you and have lasted for months, if many appear at once, or if they sit on your eyelids. See a doctor promptly for any bump that grows, bleeds, changes, spreads, or that you cannot tell apart from other bumps. Skinli's photo plan at /analyze is built for acne, so use it only if you have acne as well as milia.