What is milia? And the dark circles question…

I love getting reader questions because I always learn something new in pursuit of the answer. Yesterday, someone asked me about dark circle creams and somehow we got onto the topic of milia. I do have a current favorite eye cream (more on that soon), but keep in mind I don’t really have dark circles (before you hate me, I do have other skin rants, but that’s for a later post). In this case, I usually go by what people rave about from their own experience, or more likely, I’ll turn to the experts. Dr. Robert Schwarcz, a cosmetic and facial surgeon in NYC, came highly recommended to me. He was named the best doctor for eyes by W magazine, so I thought he’d be perfect to answer some of the eye-related questions that came up yesterday:

BATF: What exactly is milia?
Dr. Schwarcz: Milia are tiny hard white cysts that are filled with keratin (hard protein like substance produced by the skin) Milia are found on the skin of people of all ages.

BATF: What are some ways you can treat it? Any product recommendations?
Dr. Schwarcz: The best solutions for curing this include (1) having a professional pierce each milium with a sterile lancet (a cutting instrument) or scalpel followed by removal of the cyst material with a tool called a “comedone extractor”; (2) topical retinoid cream such as tretinoin, tazarotene, or adapalene; or (3) a series of acid peels or microdermabrasion procedures at the dermatologist’s office.

BATF: Can it only be removed by a derm?
Dr. Schwarcz: No, aestheticians can remove them as well. If the milia is close to the eyelid, the patient should seek help from an ophthalmologist. They are treated by manual extraction with a needle, so it is important to be careful when especially close to the eyes.

BATF: Will they come back once they’re removed?
Dr. Schwarcz: They will not come back if properly removed.

BATF: What are treatment/products he can recommend to reduce dark circles around the eyes?
Dr. Schwarcz: It depends what it is causing the circles. Dark circles are usually caused from the shadow effect which is solved by either fillers or surgery. I have a lot of patients that come to me with this issue and every recommended treatment really depends on the severity of the problem. If it is increased pigmentation, it can occasionally be treated with a bleaching cream, but the cause tends to be genetic and is usually impossible to treat with bleaching cream alone.

BATF: Do you have any favorite eye creams you can recommend?
Dr. Schwarcz: Products I really like include SkinCeuticals and RoC eye creams. It never hurts to have a consult with an oculoplastic surgeon just to understand your options as creams alone will not remove dark circles.

BATF: If you have milia, can you still use the same eye creams for fine lines and/or dark circles, or are there certain ingredients you want to stay away from?
Dr. Schwarcz: Creams have no bearing on milia. Stay away from very caustic ingredients that remove too much of the top layer of skin though.

Dr. Schwarcz does not recommend any products for milia aside from many the topical retinoids as they really do not work. For bleaching, prescription strength hydroquinone 4%.