Several years ago, I noticed a couple of small bumps on my forehead that were obviously not pimples. They were hard, impossible to pop and never went away. Luckily, they were easily hidden by my hair so I did not give it much consideration. However, a couple of bumps multiplied to at least 25 – 30 small ones over the last few years.
During my monthly facial, I asked my aesthetician what these bumps were and how we could treat them. She told me the bumps were milia – hard, white keratin-filled cysts that form under the skin. They typically occur when dead skin becomes trapped just under its surface and are often found on/around the eyes, cheek or nose. Milia does go away eventually but are stubborn and it would take a long, long time to break down naturally.
My esthetician gave me some at-home tips on how to encourage my skin’s natural exfoliation process to break down and prevent more milia from forming. She also warned me not to squeeze, scrape, poke them as they are under the skin’s surface and could damage surrounding skin.
Over the next 6 months, I tried various different exfoliating products including salicylic acid (BHA), retinol and peels with no avail. After a lengthy discussion with my esthetician, we both knew it was time to see a dermatologist for other options.
Some of The Options
- Carbon Dioxide (CO2) laser treatment: The laser vaporizes water and tissue within the milia with pin-point precision, removing it while leaving the surrounding tissue unaffected. Recovery is approximately one week and includes careful cleaning of the scabs (which fall off naturally) and extra sun protection.
- Electrocauterization – the cautery touches the surface of the milia which will “burn” the covering skin and allow the contents of the milia to pop out. The treatment is precise with no pain and a quick recovery.
“Despite having many different laser and energy-based devices in my office over the years, I still rely on a very traditional dermatology method to treat milia, which I was taught as a dermatology resident over 25 years ago. I still find the most effective way of dealing with this very common problem is to treat them with electrocautery. What this means is that a fine heated needle destroys the overlying skin allowing the small white “seed pearl” to exfoliate off several days later. The precision of this procedure means that there is very little side effect to the surrounding skin, no matter what the skin type involved.” – Dr. Jang.
My dermatologist patiently answered all my questions on why they formed, which treatment would be the easiest most painless way to get rid of them and if they would return. She suggested the Electrocautery option as the best course of action and we did the procedure right away. After applying a numbing cream, my dermatologist diligently cauterized each milia. The device looked like a long thin needle and felt like a small pin prick at each spot. Healing and recovery were very easy. Each bump developed a small crust, which naturally fell off in a week. I went back for a follow-up visit in 2 weeks where my forehead was 90% clear.
I knew there was a chance it would not eliminate all my milia but was happy with the results. I still exfoliate daily to prevent any new bumps and go back to get the last few zapped. The question is, why did I not get this done it earlier?