Spots and Milia (White Cysts) after Laser and Peels

What are milia after laser and peels?

Milia are small, pinhead-sized, firm, white cysts located close to the surface of the skin. Inside them, a protein called keratin, produced by skin cells, builds up. Milia that form as the skin heals after an injury or a procedure are called secondary milia. They can be seen after procedures that resurface the skin, such as ablative and fractional lasers, medium and deep peels and dermabrasion.

Milia do not cause pain, do not sit on a red base and do not swell like an inflamed spot. They are usually not dangerous; some may disappear on their own within weeks or months. However, if their appearance bothers you or they do not go away for a long time, your physician can empty them under suitable conditions.

Why do spots appear after a procedure?

Acne-like breakouts that appear after a procedure are called acneiform eruptions. The heavy, occlusive ointments and creams recommended to protect the skin during the healing period can block pores. The newly formed skin surface is also temporarily more sensitive. This flare-up is more common in people who already had a tendency to acne.

In studies, these breakouts are among the most frequently reported temporary problems, and they usually recede with a suitable change in care and, if necessary, treatment. How often they occur varies greatly with the type and depth of the procedure, the skincare products used and the person’s skin. For procedures done while you have active acne, see our article “Medical Aesthetics for Active Acne”.

After which procedures are they seen, and when do they start?

Milia and acne flare-ups have been reported most often after ablative lasers, fractional lasers and chemical peels. Similar breakouts can also be seen after microneedling and intense pulsed light (IPL), especially when heavy skincare products are used; however, the data for these procedures are more limited. For information about the procedures themselves, see our articles “Fractional Laser”, “Chemical Peels” and “Microneedling”.

Symptoms usually appear in the first weeks after the procedure, as the skin closes and a new surface forms. Inflammation of the hair follicles (folliculitis) after laser hair removal is a separate topic and is covered in our article “Problems after Laser Hair Removal”.

Spots, infection or a cold sore? How can you tell them apart?

Skin that is healing after a procedure is more open to bacteria, viruses and fungi settling on it; so not every acne-like breakout is a simple acne flare-up. Increasing pain, warmth, swelling, honey-coloured crusts, discharge, spreading redness and fever suggest a bacterial infection.

Small blisters filled with clear fluid arranged in clusters, or painful sores that start with a burning or stinging feeling, suggest reactivation of the cold sore virus; this can also happen in people who have never had a cold sore before. Itchy, small pinpoint spots on a red base or a white coating that develop under covered or heavy skincare products may be a sign of a fungal (candida) infection. These symptoms need the area to be seen by a physician. For general information, see our article “Infection after Aesthetic Treatments”.

How can it be confused with an allergy (contact dermatitis)?

Skin irritation or an allergic reaction can develop to the skincare products used after a procedure. In this case, instead of individual spots, there is more widespread redness, intense itching, burning and sometimes a raised rash whose edges match the area where the product was applied. If these symptoms start after trying a new product, stop the product and consult your physician. For details, see our article “Allergic Reactions in Aesthetic Treatments”.

What should you do at home if spots or milia appear?

1. If you have any of the warning signs, call the physician who performed the procedure the same day; take a photo of the area and say which procedure was done, when, and which products you use.
2. If there are no warning signs, report the milia and spots at your check-up or by calling your physician; ask whether your care routine needs to be changed.
3. Clean the area gently, without rubbing, as your physician recommends.
4. Apply the occlusive ointment or cream only as much as your physician tells you and in a thin layer; ask when you can switch to a lighter moisturiser.
5. If your physician has started a treatment, use it for the period you were told even if the symptoms ease; consult your physician before stopping it.
6. Keep protecting yourself from the sun; inflamed spots on healing skin are more likely to leave dark marks.

What should you not do?

• Do not squeeze or scrape spots or white cysts; the risk of infection, dark spots and scarring increases.
• Do not try to open milia at home with a needle, a pin or a sharp tool.
• Do not start strong acid products, retinoids, exfoliating mitts or peeling products before the skin has fully healed and without your physician’s advice.
• Do not stop or change the treatment your physician started on your own.
• Do not use prescription antibiotic, steroid or cold sore creams unless a physician recommends them.
• Do not use home remedies such as toothpaste, lemon, vinegar, cologne or plant oils; heavy oils can make spots worse.
• Do not try to cover the breakout with heavy make-up; ask your physician when you can wear make-up.

What can a physician do?

The physician first determines whether the breakout is milia, an acne flare-up, an infection, a cold sore, a fungal infection or an allergy; if necessary, a sample is taken. For an acne flare-up, skincare products can be made lighter, and acne treatments applied to the skin and, in some cases, short-term oral treatment can be planned. If an infection, a cold sore or a fungal infection is suspected, appropriate medication is started.

Milia that do not go away can be emptied under sterile conditions by a physician or by healthcare staff under a physician’s supervision, by making a small opening. For widespread milia, some treatments applied to the skin can also be considered. Which treatment suits you is decided by your physician after an examination. For marks left after spots, see our article “Acne Scars”.

What can be done to reduce the risk?

• Before the procedure, tell your physician about your history of acne, whether you often get spots and the acne treatments you use.
• If you have a history of cold sores, be sure to mention it; if your physician considers it necessary, preventive treatment can be planned.
• After the procedure, use the occlusive ointment only for the period and in the amount you were told, in a thin layer.
• When your physician allows it, switch to a lighter moisturiser that does not block pores.
• Do not try new products during the healing period; consult your physician before changing products.
• Ask your physician when you can restart retinoid and acid products. For general information, see our article “Retinoid Guide”.

For other problems after a peel, such as dark spots, prolonged redness and scarring, see our article “Problems after a Chemical Peel”; for the general steps to follow when any problem occurs, see our article “What Should You Do If a Complication Occurs after an Aesthetic Treatment”.

Limits of the evidence: most of the information on how often milia and spots occur after laser and peels is based on single-centre retrospective studies, case series and reviews; how often they occur varies greatly with the type and depth of the procedure, the skincare products and the skin type. The data for microneedling and IPL are even more limited. For this reason, you cannot be given a personal risk figure. This page is for general information and does not replace an examination.