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-
- 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.
- 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.
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How soon will I see the results of micrografting?
Pigment cells start to wake up around 4 weeks after the graft. It can take 4-6 months or longer for results. Scars achieve their full remodelling potential 12 months after the procedure. Results are assessed by objective photography taken prior to, & after the procedure in defined time intervals of 4 weeks, 3, 6 & 12 months.
Where do I harvest the skin from?
In most cases the donor site is the front upper thigh. In some cases, the inner arm. The surface area depends on what I am treating. In most cases the width is 4-8 cm & the length ranges from 4 to 10 cm. This graft is called an ultra-thin split thickness graft; the depth ranges between 0.2 to 0.3 mm.
The donor site takes 12-21 days to heal. Normal pigmentation is expected at one year.
What is the difference between a split thickness graft & micrografts?
Lots. SSG or split thickness grafts are primarily used in skin cancer surgery. This graft is three to four times thicker than ultra-thin micrografting. I harvest micrografts by free hand, compared to a mechanical dermatome as the later goes too deep.
Micrografting takes 10 times longer to perform than SSG. Traditional grafts can either be glued on or sutured in place, whilst micrografting requires meticulous preparation of the donor skin with superfine scissors. The end result of micrografting is more natural compared to sticking on SSGs.
How long does it take the donor site to heal?
2-3 weeks. In most cases the donor site (leg or arm) takes longer to heal compared to the recipient site. The colour of the donor site takes another 6-14 months to get back to normal. Redness, & eczema like changes can be seen for a few months or so after harvesting.
How do I prepare the recipient site?
I normally use an ablative erbium laser as this allows me to plane 1/100 of a millimetre with each pass. This has much less collateral damage compared to a CO2 laser. In some cases, I use mechanical dermabrasion. This is very different from microdermabrasion which uses gentle suction devices.
How long is the dressing left on for?
6-9 days, depending on site, surface area & depth. Under no circumstances are the dressings to be removed. This will dislodge the grafts. If you have any questions, please contact my nursing team for directions. We will check the dressings at specific time intervals.
The donor site dressing (usually thigh or behind your ear) is less important as this heals with secondary intention. This site can take up to 3 weeks to heal. Redness, eczema changes & itch are common symptoms.
Is there anything you can do to speed up healing?
Turn up to your appointments after the procedure. My nursing staff will check your dressings & progress. Eating a well-balanced diet will help. Smoking depletes your graft of nutrients & blood flow.
You are required to limit strenuous exercise for a period of 8-14 days, this gives your graft a higher chance of survival. If you have any questions that are not covered in this site, please contact your designated nurse.
Can creams & lasers speed up repigmentation?
Yes. In some cases I will prescribe you creams to stimulate pigmentation. They include tacrolimus & or PG analogues. These compounds stimulate melanocyte migration & or melanin pigment. Not all cases require topicals post-treatment. I will guide you accordingly.
I may also prescribe you a course of narrowband UVB. This stimulates pigmentation using a specific wavelength of light.
How does micrografting compare to ReCell & other commercially available kits?
I have had 8 years of experience in the context of ReCell, Regenera Activa & Rigenera other types of commercial kits. In the context of what I use micrografting for (re-establishing pigmentation in areas devoid of pigment cells- melanocytes), this procedure has a much higher success rate compared to kits.
For some kits, we ask your immune system to generate many steps before the end cell is produced. For example, in stem cell transplantation, an adipocyte stem cell is required to differentiate into a melanocyte. This melanocyte then needs to produce pigment. By directly transferring melanocytes with as little collateral damage as possible, we can repigment areas more efficiently.
What are the risks of micrografting?
I will go through the risks pertaining to your skin condition. Remember, micrografting is surgical & not a fuzzy cosmetic procedure. It is important to differentiate expected outcomes & timelines compared to unexpected side effects, which include-
- Colour changes – persistent.
- Poor or delayed wound healing
What should you consider before contemplating micrografting?
Micrografting is not a spa procedure, it is not like micro needling or a simple laser. Micrografting requires a dedicated team of specialists including an experienced operator & nurses & is conducted in an operating theatre. It carries all the risks associated with surgery, as well as the benefits. Consider the following-
- Time taken for actual surgery is around 2-4 hours
- Dressings; recipient site 6-7 days. Donor site 10-18 days
- Healing time as discussed
- Re-pigmentation time of months
- Costs vary depending on the extent. Medicare rebates apply.
- In some cases, such as vitiligo, need for narrowband UVB 2-3 times a week
What other laser procedures are commonly done with micrografting?
Pigmented scars are easy to understand. To achieve a better blend, you can either change the colour of the scar, or the surrounding skin. For hypopigmented scars I want to increase the pigment in this scar, hence micrograting. If you have photodamage or pigmentation surrounding the scars, I often use a blend laser to reduce this contrast. In some cases, I use erbium, other cases I prefer CO2, Pico, BBL or Thulium lasers.
What is narrowband phototherapy for pigmentation?
Think of narrowband UVB as water for your pigment cells, and chemicals such as tacrolimus & prostaglandin analogues (bimatoprost) as fertiliser.
Narrowband UVB is a medical procedure under Medicare. It uses special lights in one spectrum 311nm to stimulate pigment cells to produce melanin. The focused wavelength of light minimises the harmful UV spectrum of normal sunlight. A typical course of UVB ranges from 2-3 times per week, for a period of 10-20 weeks after micrografting.
Who are not suitable candidates for surgical micrografting?
Micrografting is a surgical procedure that carries benefits & risks. My job is to provide the best possible outcome & mitigate risks, hence patient selection is critical.
Patients with unstable disease are not suitable for micrografting. This includes active acne, skin picking, active & progressive vitiligo. These patients require medical therapy prior to procedures. I will refer you to my colleagues for management. If you smoke more than 4 durries a day, I won’t micrograft you.
I do not employ micrografting to treat patients with body dysmorphic disorder. If I, or others find it hard to find or understand your scars from an objective POV, you may have BDD.
Is this treatment covered under Medicare or Health Insurance?
A partial rebate applies as of the time of writing. This is a surgical procedure that uses split thickness skin grafts. I employ this technique to treat objectively severe hypopigmentation that can be demonstrated with normal examination & lighting.
I do not treat mild forms of scarring with this procedure, namely body dysmorphic disorder patients. If I or others need to look closely at your problem, to understand what you see, this procedure is not for you.
Why are self-harm or cutting scars difficult to treat?
Self-harm scars are hard to treat because I do not know the level of the cut until I resurface the skin. It is like the iceberg effect. I can only see what is on the surface. Generally, scars that are greater than 2.5 to 2.75 mm require excision.
Shallow scars that can be resurfaced & are not raised can be treated with surgical micrografting. These scars take 12 months to mature.
What other conditions can micrografing treat?
Micrografting can also be used for treating surgical, traumatic scars & larger burn scars. For larger areas exceeding 100 cm2, micrografting should ideally be conducted in a tertiary hospital.
Hypopigmented birthmarks can, in theory, be treated with micrografting. This includes conditions like stage 4 Incontinentia pigmenti, hypopigmented macules, & cutaneous mosaicism. A test patch is required to ascertain melanocyte take up & survival. Nevus anaemicus ccannot be treated with this procedure as the primary abnormality is vascular sensitivity, & not melanocytic.
Can tiny white dots on the arms & legs be treated?
They can, but I don’t like doing these. They are most likely called idiopathic guttate hypomelanosis. This is a form of white spots secondary to sun damage. The histology resembles that of a seborrheic wart, with no pigment. The reason I don’t treat these are-
- There is no Medicare rebate, as this is cosmetic, not the result of pathology. Your out-of-pocket gap is around $6000 per limb.
- More will come in other areas. It is genetic & age related. I do not have an answer for both.
- Healing times on the lower limb are long; like 2 weeks or rest. I cannot treat extensive areas as these dots are scattered, hence partial areas are treated.
You are best seen by a cosmetic doctor or a general dermatologist who will guide you regarding prevention etc…
How do I get assessed for micrografting?
This procedure requires careful thought. It is surgical. Wound care is super important. I perform micrografting with assistance from my nurses. You do require real time assessment prior.
If you live Interstate or Internationally, you can ask a plastic surgeon for an opinion. There are not many dermatologists or plastic surgeons that perform this procedure. To book an appointment with myself, contact firstname.lastname@example.org or Cutis Clinic.
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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