"A white grain-like thing has formed under my eye — is it okay to squeeze this?"
"I thought it was a pimple and squeezed it, but it wouldn't come out. What's the difference?"
This is the question people most often bring to mind when a small grain forms around the eyes.
Hello, I'm Director Kwon Si-jin at DA Clinic Myeongdong ^^
We're getting ready to open our doors in Myeongdong soon, and since so many people have been asking about milia ahead of our opening, we wanted to put together this overview for your information first.
Quite a few people come in after the grains around their eyes flared up from squeezing them carelessly.
Milia are different in nature from acne, so squeezing doesn't get them out and instead easily leaves a mark — let me show you exactly where the two part ways.
Milia Aren't Acne — They're 'Trapped Pockets'
Milia refers to small white cysts that form when waste like sebum or keratin gets trapped in the form of a tiny pocket in a shallow layer of the skin.
Let me first lay out what milia are.
With acne, the flow is that a pore gets blocked and spreads into inflammation, but milia are closer to a 'closed pocket' itself than to inflammation.
That's why they often stand out as white grains 1-2mm in size on areas with thin skin, like around the eyes or on the cheeks.
Why Do They Tend to Form Around the Eyes of All Places
There's a reason milia are often seen around the eyes.
The area around the eyes is a spot where the skin is especially thin and delicate, so even a bit of trapped waste shows through the surface right away.
They can form in the process of a tiny wound healing, and they can also form constitutionally with no particular trigger.
There are also cases where they seem to increase when oily cosmetics or heavy eye creams don't agree with you, so it's a good idea to review the products you usually use.
There's a Clear Reason Not to Squeeze Them at Home
Squeezing milia yourself is hard to recommend.
Milia are closed pockets with no outlet on the surface, so they don't come out well even when pressed, unlike acne.
If you force it with pressure, you can leave a wound on the thin skin around the eyes, or add irritation that spreads into inflammation.
Especially if you touch it with a fingernail or needle, the mark can be left as a scar, so the more visible the area, the more careful it's best to be.
When Tidying Them Up, the Method Empties the Whole Pocket
When we tidy them up at the clinic, we proceed by opening the closed pocket and emptying out the contents inside.
The CO2 laser works on the principle of using the heat generated as light energy is absorbed by water to microscopically open just a very shallow surface, creating a passage to draw out the trapped keratin.
A method of making a tiny incision to open an entrance and clearing out the contents is sometimes used together too.
If they're small in size and few in number, they're usually tidied up in one go, but depending on heavy sebum production or constitution, they can form again in a different spot over time.(the response and course vary by individual)
What the CO2 laser does
The CO2 laser is what's most used for lesions. Knowing the principle makes the recovery make sense.
It's described as working by being absorbed by water in the tissue and vaporising it. Closer to boiling water off than to burning.
Two things follow from that.One is that the depth can be controlled finely; the other is that the treated site is left with a wound that goes through a healing process.That's where the scab forming and coming away comes from.
At our Myeongdong clinic we have Hestia in the CO2 family.
Recovery runs in this order
- Day 1 to 3a scab forms at the treated site. Best to avoid water contact and rubbing
- 1 to 2 weeksthe scab comes away naturally. Picking it off makes a mark likely
- The months afternew skin looks red, then gradually fades
Many people think it's over once the scab falls off, but whether pigment remains is decided in the months that follow. Red skin makes pigment easily, so taking sun on it then can leave a brown mark.
So there are three things to attend to during recovery: moisturising, keeping it covered, and sun protection.For ointments and dressings, following the instructions from where you had it done is safest.
People in These Situations Should Take a Closer Look First
Tidying up milia isn't a treatment casually recommended for every situation.
If it's at the very edge of the eye or a spot very close to the mucous membrane, it may be sensitive to irritation, so it's safer to first check the condition and then decide whether to proceed.
If you have a constitution where wounds don't heal well or a keloid tendency, or if there's inflammation or a herpes outbreak at the treatment area, it's good to first look into the state of the skin.
Also, since even something that looks like milia could be a different skin lesion, it's more accurate to have it checked in person rather than deciding by eye alone.
Confusing them with acne sends the response off course
Some people treat milia as acne and reach for acne products, but they're different in nature.
Acne is oil and inflammation entangled, so the approach addresses oil and bacteria together.Milia are closer to a sac of trapped keratin, and reducing oil doesn't bring out what's inside.
So exfoliating hard or layering on acne medication doesn't change much, and on thin skin such as around the eyes it only accumulates irritation.
The approach diverges even where they look alike, so it's better to have it checked before changing method on your own judgement.
- It is not acne you squeeze out
- The trapped sac is emptied from the surface
- Around the eyes it is handled even more shallowly
FAQ
Q. Do they all disappear in one go?
A. Milia that are small in size and not many in number are tidied up in one go in many cases.That said, since it's closer to emptying out a closed pocket, if you have a constitution with heavy sebum production or as time passes, new milia can form in a different spot. Rather than the spot you already tidied up recurring identically, it's closer to a flow of showing up again in a new location.So it'll be easier on your mind to view it as a concept of managing it when needed rather than one-and-done for life. Since the number of sessions needed and the course vary with the number, location, and state of the skin, it helps to keep in mind that there are individual differences.
Q. Won't a scar be left?
A. Milia are small lesions sitting close to the surface, so they're tidied up shallowly, but the skin around the eyes is so thin that for a few days right after tidying up, a small scab or redness can remain. It's usually a flow that naturally settles down over time, but the recovery pace and the degree to which the mark fades vary by individual.Tidying it up shallowly in a controlled environment is a direction that reduces the mark burden compared with a wound made from squeezing it yourself, but it's hard to declare that there will be no scar at all. Reducing irritation after the treatment and being mindful of UV protection help recovery.
Q. How do I tell milia apart from grain-like acne?
A. On the surface, both look like white grains, so telling them apart isn't easy. Milia are closed pockets with no opening on the surface, so they don't come out well even when pressed, and they're felt as firm, smooth grains. Grain-like acne, on the other hand, is connected to a pore, so it can spread into inflammation or release contents when squeezed. That said, the two are handled differently, and if you try to tell them apart yourself and irritate one wrongly, a mark can be left. For an accurate distinction, having the state of the skin checked in person is safer than judging by eye alone.
Q. Will changing my skincare stop them forming?
A. Heavy, oil-rich products are said to play a part, so not layering rich products around the eyes may help.Skincare alone won't remove what has already formed, though.
Q. Can several be cleared at once?
A. It depends on the number and location.The eye area is particularly thin, so handling many at once can raise the recovery burden, and it's sometimes approached across sessions.
Q. Do they come back?
A. Cleared sites generally don't recur, but new ones can appear elsewhere. It varies with your skin type and condition.
Emptying, not squeezing
This is where the story we've followed ends.
Milia aren't acne you squeeze out — they're a lesion you manage by shallowly emptying out the trapped pocket.
That first curiosity of yours — I hope you've found its answer here.
If the small grains around your eyes have been on your mind, it's fine to view it in the direction of having the condition checked rather than touching them with your hands. Just please keep in mind that the number of sessions and the result vary by individual.
DA Clinic Myeongdong is set to open soon.We'll share news of our opening and treatment information first on our blog and Instagram ^^
Thank you for reading this long piece.This was Director Kwon Si-jin at DA Clinic Myeongdong.
This column is an informational article meant to provide general medical information, and the effects and side effects of treatments may vary by individual. DA Clinic Myeongdong is set to open soon. (Medical Service Act Art. 56)