Micrografting- Acne Scars

Asian Skin Rejuvenation at a glance

  • Best ResultsAt 3-6 months
  • Treatment Recovery7-14 days
  • Procedure Time40 to 120 minutes
  • Skin SpecialistDavin Lim
  • Duration of ResultsCan be permanent
  • AnaestheticNumbing & blocks
  • Back to Work4-6 days
  • Cost$$ Medicare

Micrografting- Acne Scars

Micrografting is a surgical procedure that transfers skin cells, including pigment cells to areas of the skin devoid of pigmentation. This procedure can treat hypopigmented acne, traumatic, chicken pox, & cutting scars. Micrografting is also useful to treat stable vitiligo.

FactsFacts on surgical micrografting

  • This procedure transfers pigment producing melanocytes 
  • It is the treatment of choice for hypopigmented scars
  • The donor skin is your own, located on the thigh or arm
  • The recipient site is prepared with a laser or mechanical dermabrasion
  • Cells are transferred to the affected areas
  • Dressings are left in place for 6-8 days
  • Repigmentation can be seen at 2 to 6 months after the procedure

What is surgical micrografting?

This procedure transfers or repurposes keratinocytes (skin cells) as well as melanocytes (pigment cells) with a small amount of collagen & fibroblast from a donor site to area of pathology; usually a scar or area of absent pigment (vitiligo).

It works on the same principles as split skin grafting, with key differences outlined below.

What conditions are treated with micrografting?

I primarily use surgical micrografting to treat areas of skin with less pigment compared to the surrounding areas. This includes –

  • Hypopigmented acne scars
  • Hypopigmented chicken pox scars
  • White scars from picking
  • Stable vitiligo
  • Cutting or self harm scars
  • Hypopigmented burn scars

What is the aim of micrografting?

Micrografting is best for changes in skin colour, namely hypo or depigmentation. Pale scars that have a similar contour compared to the surrounding skin are examples. This type of grafting is not suitable for depressed or hypertrophic scars. Depressed scars are best treated with subcision & or dermal grafting. Raised scars are treated with steroid injections & lasers.

How successful is micrografting?

The success of this surgical procedure depends on two main factors-

  1. The condition I am treating. Example: Hypopigmented acne scars are easier to repigment compared to cutting or self-harm scars. Smaller areas of stable vitiligo can be markedly improved in 80% of the time.
  2. Your immune system’s ability to generate pigment, once the graft has taken place. For re-pigmentation, we rely on your pigment cells, known as melanocytes, to re-establish the scar and produce pigment. Some people are efficient at this process, some are not.

Davin’s Viewpoint on Surgical Micrografting

Google micrografting & you will see lots of fruit trees & plants. Cutaneous surgical micro grafting is a similar concept of transferring cells from one area to another. Much like plants & stems, a healing period is required for the graft to take.

I believe this technique gives the highest repigmentation rate for hypopigmented or completely depigmented scars. In this context I use micrografting to treat acne scars, usually post picking (acne excoriee), as well as severe hypopigmented chicken pox scars. The ice or methamphetamine epidemic has seen a tremendous increase in previous users present with hypopigmented scars, secondary to picking. This type of scarring is usually more severe than acne scars because scars are gouged out, meaning in many cases there are elements of dermal atrophy. Additionally, the surface area of hypopigmentation is greater. In complex cases, I perform melanocyte micrografting transfer as well as fibroblast & collagen dermal grafting. Donor sites include the back of the ear & front of the thigh.

I enjoy performing micrografting because it is fiddly, it takes a tremendous amount of patience. The donor area requires preparation (the laser bit is easy), the harvesting is quicker, but preparation of micrografts is the most time consuming. Repurposing to the recipient bed is done by hand, followed by meticulous dressings.

Each step is critical for a good result. If the donor graft is too thick, it won’t take, if the pieces are too large, it won’t take, if the recipient bed is too deep, a depressed scar can result, if too shallow it won’t take. If an area receives too many grafts or too little the results are not optimal. If everything goes perfectly as planned and the dressings are not secure, it won’t take. This procedure has so many critical variables along each & every step- from harvesting through to dressings & post-operative recovery. Therefore only a select few plastics & dermatologists perform micrografting. The reward for me and my team is when everything aligns & scars are gone. Hypopigmentation remains as one of the Holy Grails of cutaneous surgery.

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