How Do You Solve a Problem Like Milia?

Darling, Wonderful, Fabulous Amy –
I have milia on my cheeks. I asked my doctor about them, and he told me to use Clearasil. It doesn’t help – my aesthetician laughed when she heard that advice. I had a (painful!!) facial and the aesthetician removed most of them, but they keep coming back. I can’t afford to get facials every month, so I need a long-term solution for these pesky things.
Thankfully mine aren’t very swollen, so they don’t look too bad and are easily covered up. On the other hand, the fact that they’re deep in the skin makes them really hard to remove. In spite of what the ‘net says, I have done it myself, particularly when they get close to the surface, by sticking a needle in my skin and squeezing. I’m getting better at it, but I worry that I’m going to get scars. Plus, I can only get at one or two at a time, which means that I always have healing spots on my face, and new ones that are becoming visible.
I don’t use a lot of crap on my face. I don’t wear make up every day. I don’t have a lot of sun damage (I’m fair and I burn easily, so I stay out of the sun and use sunscreen pretty religiously). I do, however, use St. Ives Medicated Apricot Scrub on my face almost everyday.
Here are my questions – 1) Could the scrub be causing the milia? 2) Do you know of any way to prevent them? If I could get a facial and then start using some magic potion, could I keep them away for more than a few weeks? Is there anything in my diet I could change? 3) Am I spelling aesthetician right?
Thanks, in advance, oh brilliant one!!
Another Amy
Let’s cut to the chase and get to your questions, right in order.
1) Yes. YES. YESSSSSSSSSSSSSSSSS. Lord have mercy, yes.
2) Yes. I think. Probably. We’ll see.
3) No, but you’re close. Esthetician.
Milia are not acne — I’d laugh at your doctor’s Clearasil recommendation too, because WHAT? — they’re cysts. Tiny little benign cysts filled with dead bits of skin and fluid. They are caused by sloughed-off skin getting trapped around a hair follicle or sweat gland and forming a teensy little pocket of whitehead-like joy. Very common in newborns who are prone to all kinds of skin-shedding weirdness, but pretty much anyone can get them at any time.
As they are NOT whiteheads or any type of acne, zit creams aren’t the answer. Removal by an esthetician is usually the only way to get rid of them, as otherwise they just sort of sit and stay there — not really getting bigger or worse, but not getting better without a loooooong wait. (I’m not gonna touch the spearing-them-at-home topic, because we all gotta do what our wallets allow us to do but OMG OWWWWW.) But as you’ve seen, you can get them removed over and over again until the end of time unless you figure out and correct the cause.
The main causes of adult milia are as follows: sun damage (including just one very bad burn), harsh facial scrubs, heavy comedogenic lotions and sunscreens, and overly hot showers.
So it sounds like it is DEFINITELY time for you to reassess your products. Good and proper exfoliation IS key to preventing milia, so your scrub isn’t bad simply because it’s a scrub — but I think the “medicated” (read: 2% Salicylic Acid) is too much for you. (The St. Ives also contains fake fragrance, my old skincare nemesis.) You don’t mention any other problems with blackheads and zits, and since milia ISN’T going to clear up with acne medication, I would really, really HIGHLY recommend finding a different, gentler face wash.
Personally, I’d go get that facial and extraction one last time, and switch to a wash for normal skin — something non-soap-based, non-scrubby, non-perfumed — for my regular twice-daily use, and then use a top-quality GENTLE exfoliating product on an as-needed basis. Every other day to start, and then use less if it seems like it’s doing the trick. Anything with “microdermabrasion” on the label is something worth considering — although they ARE expensive, I will warn you right up front. However, if the alternative is going in for $100 facials every few weeks, spending $75 on a cream or a peel that should last you many, many more months might not be so bad of a trade-off. Check out DERMAdoctor Physical Chemistry, Philosophy’s Microdelivery Peel, Dr. Brandt Microdermabrasion Exfoliating Cream, just to name a couple options. I’m pretty sure Olay Regenerist makes something similar, but I honestly haven’t been overly impressed with the Regenerist line in general. (Heavy on the cosmetic surgery buzzwords, light on the actual results.)
If you just plain like your daily scrubs, you can try downgrading to the regular ol’ non-medicated Apricot Scrub, although PERSONALLY, I found that Philosophy’s Microdelivery Wash to be the most gentle on my skin, while still packing a nice exfoliating punch. I like it in the summer especially, when my sweat glands are working overtime, though I only used it a few times a week, alternating with the Purity Wash. The key for you is to find yourself some BALANCE. Yes, you need to help your skin exfoliate properly but you don’t want to overdo it. So no daily scrubs PLUS a deep exfoliating treatment, particularly if your skin already tends to be oily and blemish-prone. Either find a gentler scrub and leave it at that, or do the normal-skin wash plus deep treatment routine. (Again, personally I’d recommend going with the latter, if you can.)
Annnnd it doesn’t stop with the scrub. You didn’t specify what type of sunscreen or moisturizer you use on your face. It should be something oil-free and non-comedogenic. If you aren’t sure, ditch it and switch to something that clearly makes these promises. Avoid exposing your face to very hot water, either in the sink or shower.
Hopefully — hope, hope, hopefully — a few changes in your skincare lineup will make a huge difference. I think your chances are good, since it doesn’t sound like the milia has been a life-long problem for you. (Some folks just get the short end of the genetics stick and will get the cysts no matter what they do.) If you continue to get them and remove them at home, just PROMISE ME you’re sterilizing your tools really well, and disinfect your skin afterward to prevent infection (which would be the biggest cause of any scarring). (And for anyone else reading this with non-cheek milia: do not remove your own milia from your eyelids. DO NOT. NO. BAAAD READER, STOP.) (BTW– we’re not going to berate anyone, but we can’t endorse at-home milia removal either.)