Surgery For Vitiligo

  • Best Results4-12 months
  • Treatment Recovery6 days
  • Procedure Time30-120 minutes
  • Skin SpecialistDermatologist
  • Duration of ResultsVariable
  • AnaestheticLocal
  • Back to Work5 days
  • Cost$$$-$$$$$

Surgery For Vitiligo

Surgical options include transplanting pigment cells known as melanocytes from normal skin to areas of vitiligo. Surgery is last line treatment. It can be considered if vitiligo is stable & patients fail to respond to topical creams & phototherapy.

FactsFacts on Surgery for Vitiligo

  • Surgery is last line treatment
  • Patterns including segmental vitiligo can be considered for transplantation
  • Vitiligo must be stable for more than 18 months before surgery is contemplated
  • ReCell is autologous melanocyte transplantation
  • Limited surface areas can be treated; about 100 square centimetres
  • Methods include punch, blister, split grafting & micrografts
  • Follicular unit transfer can repopulate vitiligo areas with pigmented hairs
  • Micrografting gives the most natural results

When is surgery advisable or considered?

Surgical intervention is carefully considered when-

  • Vitiligo is stable for a minimum of 18 months.
  • When patients fail phototherapy & topicals.
  • In small areas of de-pigmentation
  • In cases of segmental vitiligo

Surgical procedures have a limited area of coverage. Small lesions on the hands & face do best. Following surgical procedures, you will still require phototherapy for best outcomes.

What types of surgical procedures for vitiligo are available?

The aim of any surgical procedure is to repurpose or transfer pigment producing cells called melanocytes from normal skin to vitiligo affected skin. There are three approaches to surgical intervention:

  1. Grafting of tissue. This includes punch grafting, mini-punch grafts, micrografting, split thickness & suction blister grafting.
  2. Cellular grafting involves spraying of donor melanocytes to affected areas. This is called autologous transplantation. The two main companies are ReCell & Regenera. See below.
  3. Follicular unit transfer is another option. This is a novel treatment. I manually transfer pigmented hairs into the bed of vitiligo. This takes the most amount of time. The logic behind this treatment is to harvest melanocytes from hair follicles. These then populate & migrate into the areas of vitiligo.

What should you try before contemplating surgery?

Everything. Surgical procedures are the last line. You should exhaust all other treatments including microneedling, phototherapy, alternative medicine & supplementation.

What are micrografting for vitiligo?

Micrografts are the most natural way of melanocyte transfer. This relatively new treatment repurposes pigment cells from a donor site & transfers them to the recipient – vitiligo involved sites. Re-pigmentation can be seen as early as 4 weeks. Maximal depigmentation is seen at 6 to 12 months.

Candidates for this procedure include segmental vitiligo, stable vitiligo (greater than 12 months) as well as smaller areas (less than 150 square centimetres in total).

How is micrografting done?

The first step is harvesting of the donor site with a blade, don’t worry, it is painless as numbing creams & anaesthetic is used prior to harvest. The usual donor site is the thigh, inner arm or buttock.

The vitiligo site is then prepared using an erbium laser. This is also painless. The donor site epidermis is cut up into small donor skin dots, it is then placed in the recipient site & occluded for one week. Pigment will start to form at week 3-5, & over the next 6 months cover up vitiligo areas. Micrografting gives the most natural results & is successful in 78-85% of cases. Phototherapy post vitiligo micrografts can accelerate pigment production.

Davin’s Viewpoint on Surgery for Vitiligo

Surgery should be viewed as last line treatment of vitiligo; the exception are small patches of segmental vitiligo. In some cases, I perform a test patch, prior to full transplantation. Though not 100%, it will give both myself & the patient an idea of how the graft takes, as well as other factors such as scarring.

I employ various methods including punch grafting, suction blister grafts, split thickness grafting, micrografts, as well as FUE transplantation. Autologous melanocyte transfer, namely ReCell is a novel technique. Despite reports in the literature, the success rate remains low. I prefer the micrografting technique as it gives the highest rate of re-pigmentation.

Over the next two decades we will develop better methods to multiple patient’s own melanocytes in petri dishes. This will markedly increase the numbers of cells that can be transplanted. The rate limiting factor is graft survival post-transplant. I suspect the answer will lie in moderately strong topical immunosuppressive agents.

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