What can a doctor do for blackheads, whiteheads and milia?

Besides prescribing a retinoid medication, a dermatologist can consider putting a patient on Accutane if a comedonal acne problem is extreme. Another effective remedy is a 20% or 30% TCA chemical peel, followed a week later by microdermabrasion to slough off the dead, peeling skin. After this process doctors manually extract any comedones that are left over. Usually three peels a year can keep the condition under control. Fractionated laser works well too, by literally drilling microscopic holes into the surface of the skin and into the cysts to release the trapped keratin. Microdermabrasion alone is in credibly effective for treating comedones and milia. Generally, people have microdermabrasion once a week for two or three months.

If retinoic acid and exfoliation are not working to control milia, a dermatologist can extract them. First the area is numbed with a topical anesthetic; then the doctor pierces the top of the cyst with a needle and extracts the keratin with a comedone extractor, a tiny bowl with a hole in the bottom. The doctor presses the convex side of the surface over the comedone, and the keratin is released. Another option is burning the top using electrocautery, then extracting larger cysts and letting the smaller milia slough off by themselves. If there are multiple milia to extract (which is often the case), a chemical peel will strip off the top layer of skin and get rid of them in one fell swoop. (Because a peel is not as deep as laser resurfacing, it usually won't end up generating more milia as the skin renews itself.) All of these methods are fairly painful and require four to eight days of recovery time; even more unfortunately, milia will slowly accumulate again. Regular exfoliation should impede that process.