Milia Under Eyes: Why They Form and How to Prevent Them

I'm Dr. Hongseok Kim, a board-certified Korean dermatologist with 21 years of practice and the medical director of VOS Dermatology Clinic in Gangnam, Seoul, in front of Dosan Park. At VOS I see every patient myself, from the consultation to the treatment.

Milia under eyes are one of the first things people ask me about when I say I'm a dermatologist, and the question is usually the same: "How do I stop getting them?" Because good habits really can prevent many of them, I made a video on where milia come from and how to deal with them. This page is based on that YouTube video from February 2024; I rewrote it for readers abroad. The video above can be watched with translated captions.

What milia are, and how they differ from other bumps

Milia are small, round, white bumps of trapped keratin, and they are among the most common benign skin growths (in the video at 00:22).

A paper published in 1956 described milia as the most common benign growth of the skin. They can be tiny or fairly large, and they can appear as a single bump or in a cluster. They form when dead skin that should shed normally gets stuck instead, and the material collects in a small pocket deep under the surface (in the video at 00:55). Two things are sometimes confused with milia: syringomas and flat warts. Both are close to your normal skin colour, while milia are distinctly white, so a dermatologist can usually tell them apart at a glance (in the video at 01:13). The under-eye area is simply where many people notice them first; the causes below apply to milia anywhere on the face.

Cause 1: dead skin that does not shed properly

If one or two milia appear for no obvious reason, the likely cause is that dead skin is not turning over well (in the video at 01:27).

Milia that have already formed are hard to fix at home and generally need to be removed with a procedure such as a laser. For people who keep getting new ones, though, two habits help. Using an exfoliating product with AHA or BHA once or twice a week supports normal shedding (in the video at 01:49). Retinoids, both cosmetic retinol or retinal and prescription retinoids, speed up skin turnover, so steady use can help prevent milia to a certain extent (in the video at 01:58). If you are not sure which exfoliant suits your skin, my video note on AHA vs BHA and how to choose an exfoliant goes through the differences, and how to use retinol covers starting a retinoid without irritation.

Causes 2 and 3: dressings, petroleum jelly and heavy make-up

Anything that seals the skin for long periods can stop dead skin from shedding and lead to milia (in the video at 02:22).

When a child falls and scrapes their face, many parents cover the wound with a hydrocolloid dressing and leave it for two or three weeks, changing it but never giving the skin a break. Because these dressings stick so well, the shedding skin gets trapped, and I quite often see one or two milia around the old wound. Keep the dressing on during the day, when you need protection, but at night after washing, leave the area open for about 30 minutes to an hour or two before covering it again for sleep (in the video at 03:16).

The same logic applies to petroleum jelly. It is a useful moisturiser, but I always say to spread it thinly: applied thickly every day for a long time, it can interfere with shedding (in the video at 03:45). Make-up is similar. A primer plus a thick foundation, layered again on top, can block pores, especially if residue is left after washing (in the video at 04:13). One day of heavy make-up will not cause milia; the risk rises when it happens daily and the skin is not cleansed properly.

Cause 4: long-term topical steroid use

Using a steroid cream for a long time can thin the skin and encourage milia (in the video at 04:51).

Steroid creams calm inflammation quickly, which is why some people keep using them for months. Long-term use can cause skin atrophy and visible blood vessels, and milia can form in between. I see this less often now that more people know long-term steroid use is not a good idea. Still, if you are applying a steroid out of habit because of frequent flare-ups and have not seen a doctor, it is important to stop and get the underlying problem checked (in the video at 05:30).

How milia are removed, and whether they go away on their own

Don't pick milia with a needle; a dermatologist can remove each one with a laser in about a minute (in the video at 05:54).

Many people sterilise a needle and try to squeeze milia out, but it usually doesn't work. Milia sit deeper than they look, and forcing them can leave a wound and later pigmentation. With a laser, the procedure is simple and takes less than a minute (in the video at 06:10). On the VOS price list, milia are among the lesions treated with the CO₂ spot laser, listed at KRW 10,000 to 50,000 with 10% VAT added; see the VOS price list for the current figures. A similar laser is used for moles, which I explain in my guide to mole removal in Korea.

Will they disappear if you wait? Milia in newborns usually do, because the oil glands were not fully developed at birth (in the video at 06:31). In adults, a milium you can clearly see is already firmly trapped and generally does not go away by itself (in the video at 06:47). Very small ones may come out naturally as dead skin sheds, especially with the exfoliation and retinoid habits above, but larger, raised ones usually need removal (in the video at 06:59).

Do milia spread?

No. Milia are not an infection, so one bump does not spread to the skin beside it (in the video at 07:58).

When several appear close together, it is because the whole area sheds poorly, not because one milium "caught" the next (in the video at 07:28). Each forms independently for the same environmental reasons. That is why prevention means changing the conditions: help dead skin shed, avoid sealing the skin for long periods, keep heavy products thin, and cleanse well at night. You can see how visitors combined clinic visits with their routines in our creator experiences at VOS.

Results vary from person to person, and whether a bump is milia and how to treat it is decided at an in-person consultation.

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Results, swelling and recovery vary from person to person. This page is general information from VOS Dermatology Clinic based on Dr. Kim's video and does not replace an in-person consultation.