Milia extraction is typically performed when milia are persistent, cosmetically bothersome, or located in areas where they frequently recur. Milia extraction is generally not performed on skin that is actively infected or significantly inflamed. If a bump resembles milia but has atypical features (rapid growth, bleeding, crusting, or irregular pigmentation), evaluation is performed first to confirm the diagnosis and determine the safest plan.

Milia extraction is an in-office procedure performed with careful technique and sterile tools. The process can vary based on the location and depth of the milia, but a typical visit includes the following steps:

1. Cleansing and preparation – The treatment area is cleansed to reduce surface bacteria and remove oils or makeup. In some cases, a warm compress or gentle softening step is used to make the lesion easier to remove.
2. Precise opening of the surface – A very small, controlled opening is created at the surface of the milia using a sterile lancet or fine needle. This step is targeted and designed to minimize trauma to surrounding skin.
3. Extraction of the keratin plug – The trapped keratin is gently expressed using a comedone extractor or sterile instrument. Proper technique helps remove the contents with minimal pressure, which reduces the risk of bruising, irritation, or scarring.
4. Hemostasis and soothing care – Mild pinpoint bleeding can occur, especially with deeper milia. The area is treated with gentle pressure and appropriate topical care. A protective ointment or post-procedure product may be applied to support healing.
5. Treatment planning for recurrence prevention – When milia occur repeatedly, the clinician may recommend adjustments to skin care, avoidance of heavy occlusive products in the affected area, and, when appropriate, medical-grade topical options that help normalize skin turnover.

Milia near the eyelids require particular care due to the delicate skin and proximity to the eye. For periocular milia, the procedure is performed with added attention to comfort and safety.

Healing after milia extraction is usually straightforward and relatively quick. Most people experience mild redness and slight swelling at the treatment site that improves within 24–48 hours. Depending on the depth of the milia and individual skin sensitivity, the following may occur:

• A small superficial scab or pinpoint crust at the opening site for a few days
• Mild tenderness in the treated area
• Temporary post-inflammatory color change (pinkness in lighter skin tones or mild darkening in deeper skin tones), especially if there is friction or sun exposure during healing

To support smooth healing, post-procedure guidance often includes:

• Keeping the area clean and moisturized with a gentle ointment or recommended product
• Avoiding picking or rubbing, which increases scarring and pigment change risk
• Limiting strong exfoliants or irritating actives for a short period, as advised by the clinician
• Using daily sunscreen to reduce the risk of lingering discoloration, particularly on the face

Signs that warrant prompt medical review include increasing redness, warmth, significant swelling, worsening pain, pus-like drainage, or fever, as these may indicate infection or an unexpected reaction.