Got Milia? Me Too. Here's What I Did About It
I woke up one morning last winter with tiny bumps all over one eyelid. At first, I thought the smattering was just crumbly, pilling eye-shadow I’d neglected to remove the night before. But no, the bumps were definitely attached to me. And as I peered at them in the bathroom mirror, I suddenly realized what they were. Ugh: milia.
If you’ve ever had milia, you know why I felt dread. Unlike a pimple, a milium cyst is not a clogged pore that eventually breaks up and disappears (or that can be squeezed out…not that I do that. I just have a ‘friend’ who does.) Milia forms when a buildup of dead skin cells get trapped in a “pocket” in the top layer of your skin. Newborns sometimes get milia and, because their skin cells turn over so quickly (one benefit of being young), they are typically, eventually, sloughed off. Adults over 40, though? Usually not so lucky.
Milia, at this point in our lives, may form because skin cells are not shedding like they did when we were newborns (or twenty-somethings)...thus the buildup. These tiny, cyst-like bumps also frequently show up around the eyes, an area that is difficult to exfoliate without causing irritation. And, after 40, years of sun exposure starts to show up on our faces in the form of rougher, tougher skin—and thick skin would be more apt to entrap dead cells.
Note: If you have rosacea, seborrheic dermatitis (a.k.a. facial dandruff) or you're just super sensitive, you also have a greater propensity to develop milia. A complexion that's chronically irritated or inflamed doesn't act as efficiently as healthy skin, falling down on jobs like dead-cell shedding. This can also lead to buildup and milia formation.
So how do you get rid of the bumps once they’re there? After my unhappy discovery, the first dermatologist I visited told me my milia would eventually go away, and I just needed to be "patient." (It is worth noting that this M.D. is not yet 40, and I suspect not many of her patients are either.) Frustrated by her response, I decided to take matters into my own hands and began to alternate applying two different exfoliating eye creams to my under-eyes and lids before bed, one with glycolic acid, Beauty Rx Gentle Exfoliating Eye Cream ($60; beautyrx.com), and one with retinol, Glow by Dr. Brandt Revitalizing Retinol Eye Cream ($55; sephora.com). After about a month, no additional milia had appeared, but the eyelid bumps were still, stubbornly, there.
Fortunately, I was headed to New York for a few days, so I made an appointment with Neal Schultz, MD, a dermatologist I’ve trusted with my face countless times. It's also worth nothing that he, like me, is no longer in his thirties.
Dr. Schultz took one look at my lid and said I could live to be 100, and those milia might outlast me. Bumps on the eyelid rarely resolve themselves because the skin there is especially slow to shed the dead. So, with a steady hand and a stomach of steel, Dr. Schultz numbed my lid skin, then proceeded to lance and squeeze out at least twenty cysts. I know. Gross. In case you’re curious (and not eating right now), the reason the milia are usually squeezable (once lanced) is that the dead skin cells often mix with a little sebum, forming a puss-like consistency.
For twenty-four hours afterward, I looked like I’d been popped in the eye, but the lanced areas did heal surprisingly quickly. Within four days, you couldn’t even tell I’d had twenty (twenty!) milia removed.
To prevent those pesky bumps from returning (I'm now nine-months-bump-free), I have continued to be diligent with the aforementioned exfoliating eye creams. I also switched to using a micellar water, rather than an oily makeup remover, to take off every trace of my eye makeup before bed. While I realize that oil does not cause milia (I repeat, they are not pimples), I am convinced that oily residue on the lid can help dead cells stick together and become entrapped—and I'm taking no chances. My two favorite formulas are: Bioderma Hydrabio H2O Micelle Solution for Sensitive Skin ($12; beautylish.com) and Simple Micellar Water Wipes ($8; ulta.com).
Finally, I visited esthetician Gillian Rogers here in Ann Arbor last August for a facial. When I mentioned to her that I’d struggled with milia around my eyes, she asked if I wore glasses or sunglasses regularly. I said yes (I’ve become diligent about wearing sunglasses now that I know sun-damaged skin around the eye can up milia risk). Then she asked if I washed them regularly. This stumped me. Obviously I wiped the lenses all the time so I can see. But I didn’t regularly sanitize the frames or nose piece. Maybe I'm alone in this negligence, but when Gillian told me she believes the oily buildup on your frames may play a role in milia formation (as I noted above, I believe skin sebum may glue dead cells together), I started washing them daily. It's super easy: hand soap plus a quick splash under the faucet.
Final note: If you cannot tolerate glycolic acid or retinol near your eyes, gentle, manual exfoliation may help with milia-prevention too. Try a clean, damp washcloth or a cleansing brush like the Clarisonic with the gentle Delicate brush attachment..