Using laser treatment to remove a milia?

Although they pose no risk, milium cysts are considered unsightly by some who wish to remove them. Several solutions exist, such as laser treatment. Indeed, lasers are regularly used in aesthetic dermatology, including the CO2 laser. It is so named because it uses CO2 as its "medium". An electric current passes through a tube filled with gas, the ends of which are mirrors. When electricity flows through the tube, carbon dioxide (CO2) is triggered to emit photons, which will produce light. This light acts in a specific way to precisely target areas. It is this laser that is used to eliminate milium cysts.

Initially, it is prudent to schedule an appointment with a dermatologist who will assess the appearance of the milia and establish a diagnosis. Following this analysis, they will decide on the appropriate treatment method based on the nature, location, and number of milium grains. They may then recommend the use of a CO2 laser. It is advisable to avoid exposure to UV rays prior to the procedure in order to limit skin fragility. Anaesthesia can be either local or general, depending on the patient's comfort. The implementation of eye protection is essential.

During the session, the doctor guides the laser using a handheld device that fractionates the light into pulses onto the milia. These beams reach the surface of the milia, where they are absorbed by the water present in the cells. The epidermis and superficial dermis are photo-vaporised, which will destroy the milium. Subsequently, this superficial layer will restore and smooth itself through the formation of collagen fibres triggered in the deep dermis: this is photo-coagulation. Finally, the remnants of the cysts are manually removed. The procedure lasts 15 minutes to an hour depending on the size of the area to be treated.

This is a technique that has proven to be effective. Indeed, Beatriz FERNÁNDEZ-JORGE and her team observed the results of a CO2 laser session with two passes on each lesion. This session allowed all milia in patients to disappear. Furthermore, they noted that 12 to 36 months after the treatment, the patients did not experience any recurrence, nor did they have any scars, making the CO2 laser an interesting method to employ.

Only one session is necessary to eliminate all milia, in most cases. This technique is swift, as it allows for the treatment of multiple lesions in a minimal amount of time. Moreover, it is often possible to leave on the same day. The procedure can be performed on the entire body, with areas such as the face, décolletage, and neck being more commonly affected.

A potential issue could arise from the fact that the dermis is exposed at the end of the session, which significantly weakens it and can lead to bleeding. The healing process can last approximately two weeks. During this time, local skin care treatments using emollients or dressings will be applied until complete healing is achieved.

Following the healing process, the skin may also be dry, red, and potentially swollen for weeks, or even months. Care may then be prescribed, such as anti-inflammatory treatments and possibly suitable makeup to conceal erythema after the tenth day. Due to the extreme fragility of the skin post-treatment, it is strongly advised against sun exposure. It is also recommended to wear a sun protection with a minimum SPF 50 for six months.

Furthermore, complications, although rare, can occur. These may include, among other things, viral infections such as herpes, outbreaks of acne or rosacea, milia, hypopigmentation or hyperpigmentation, persistent pain and redness, and allergies to products used to disinfect the skin before the operation. Once again, these reactions remain extremely rare.

• Traitement abrasif du visage par laser CO2 ultra pulsé ou scanné. Société Française de Dermatologie (2003).

• FERNÁNDEZ-JORGE B. & al. Variants of milia successfully treated with CO2 laser vaporization. Journal of Cosmetic and Laser Therapy (2010).

• Abrasion du visage par laser. Société Française de Chirurgie Plastique Reconstructrice et Esthétique (2011).

• OMI T. & al. The role of the CO2 laser and fractional CO2 laser in dermatology. Laser Therapy (2014).