Keratin Cysts · Extraction · CityLink Mall
A milium is a sealed cyst containing a pearl of keratin, sitting in a pocket with no opening to the surface. It cannot be squeezed out and it should not be burned off — the contents have to be released through a small controlled incision, which is why the technique differs entirely from removing a skin tag.
A milium is a cyst, and that single fact explains every frustration patients have with them. Keratin becomes trapped within a small pocket lined by epithelium, sitting just beneath the epidermis. The pocket has no opening to the surface — no pore, no follicular ostium, no channel. What accumulates inside compacts into a firm white pearl, and because the lining continues to produce keratin, the lesion persists indefinitely rather than resolving.
This is why they do not respond to the things people try. Squeezing raises pressure inside a sealed cyst and produces nothing but bruising and, occasionally, rupture into the surrounding dermis with inflammation afterwards. Exfoliating acids act on the skin surface and cannot reach a lesion lying beneath intact epidermis. Cleansing has no relevance at all — milia are not caused by dirt or by inadequate washing, and they occur in scrupulously clean skin as readily as in any other.
They divide into two groups. Primary milia arise spontaneously, most often around the eyes, on the cheeks and across the forehead, and are extremely common in otherwise normal skin. Secondary milia develop where the skin has been injured or where a follicular structure has been disrupted — after burns, blistering conditions, dermabrasion, laser resurfacing, or prolonged use of heavy occlusive products. Secondary milia in a resurfaced field are a known and expected part of healing rather than a complication, and they are extracted in the same way.
The removal follows directly from the anatomy. If the problem is a sealed pocket, the answer is to open it. A sterile fine needle or micro-blade lifts the epidermis over the lesion in a tiny incision, and gentle pressure with a comedone extractor delivers the keratin pearl intact. The whole event takes seconds per lesion and is almost bloodless. What is removed is the contents; the small collapsed lining is then cleared by the skin itself.
Differential
Small pale bumps on the face are a common presentation and milia are only one of the possibilities. The distinction is made by examination, and it matters because the treatment for each is different and attempting extraction on the wrong lesion produces nothing but a mark.
Milia are not blocked pores and they are not a hygiene problem. They are sealed cysts, and a sealed cyst has to be opened, not squeezed.
Recurrence
An extracted milium does not refill — the contents are gone and the small lining collapses. What returns is new lesions, in the same regions, because whatever predisposed the skin to form them has not changed. Patients with a tendency to primary milia around the eyes will generally form more, and periodic clearance is a more sensible arrangement than expecting a permanent end after one session. That is a nuisance rather than a treatment failure, and it should be described honestly in advance.
Some contributing factors can be influenced. Heavy occlusive eye creams and thick balms used nightly over periorbital skin are a recognised aggravator, and changing to a lighter preparation reduces the rate at which new lesions appear in some patients. A retinoid used appropriately can improve epidermal turnover and reduce formation, though it does nothing to established cysts and is a preventive measure rather than a treatment. Sun damage thickens the epidermis over time and is associated with milia in weathered skin, which is another reason photoprotection is worth being serious about in Singapore.
Where milia appear in skin that has recently been resurfaced, they are part of healing rather than a sign that something went wrong, and they are extracted once the field has settled. Where they are numerous, extraction is staged across visits rather than attempted all at once — clearing forty lesions in a single sitting leaves a face that looks worse for a week than the lesions did. Where the bumps prove to be something else on examination, the plan changes accordingly, which is the reason the assessment happens first.
Continue
Atelier Aesthetics · Owned by AYA
1 Raffles Link, #B1-28, CityLink Mall, Singapore 039393 · +65 8023 7170
Book a Consultation