Best way to cure Milia in Tear Trough, medicinally or surgically? (photo)

There is no medical treatment for them.  The benefit of removing them needs to be weighed against the damage that removing will cause.  Milia are small inclusions, trapped skin element that makes a small keratin pearl.  A syrigoma is a skin structure that is visible in the thin eyelid skin.  They can't be "extracted."  In my opinion, you are probably wise to learn to ignore them.  You got a bad filler service.  Under eye filler is highly fussy.  You need an injector who is willing to fuss to make a good service.  Enzyme can be used to smooth the old service.

but I don't appreciate any on your lower lid.  My suggestion is simply wait and let your filler resorb and then figure out what you really want to do to help your areas of concern.  And you should be seeing a board certified oculoplastic or plastic surgeon and not those spas that give fillers too.

Thank you for your photo. If you feel you still have overfilled tear troughs due to Restylane, the remainder can be dissolved with hyaluronidase, which is an enzyme which degrades only the filler. It is safest to treat your tear troughs one step at a time due to your sensitivity. Once the Restylane and any residual inflammation or swelling is gone, some of the milia may resolve on its own. Any remaining tiny milia can be treated topically with Vitamin A-based creams. Larger more cystic milia may have to be directly to remove the keratin material trapped under the skin. It is best to have an-office examination to determine what exactly is the cause of your skin changes so the right treatment plan can be formulated. Performing the wrong or overly agressive treatment may agitate your sensitive eyelid skin even further. Hope this helps!Johnson C. Lee, MD Plastic Surgery