My usual practice is free hand split harvesting of pigment cells. Occasionally I use a surgical dermatome. I take the upper layer of skin known as the epidermis (that contains melanocytes) & a very thin layer of dermis. The bottom layer allows the cells to survive the transfer & repopulate.

The donor area is numbered with topical anaesthesia for one hour before the surgery. I harvest between 10-400 square centimetres, depending on the extent of vitiligo.

The recipient site (areas of vitiligo) needs to be prepared. I use a laser or mechanical dermabrasion. This allows the pigment cells to have a nutrient rich bed to survive. This procedure is painless as we use both numbing cream & local aesthetic.

You will see changes within the first 3-5 weeks after melanocyte transfer, however the best results can take up to, & beyond 6 months. Faster pigmentation is seen on the face & neck, whilst larger areas on the trunk may take longer. Re-pigmentation is accelerated with phototherapy. 

This will depend on your skin type. Red & somewhat even pigmentation is seen if you have fair skin, Caucasians are examples.

If you have dark skin expect a mix of colours including hyperpigmentation (darker) coupled with a halo of white & red. This is not a side effect, but part of the healing process. It will take more than 6 months to even out. This is normal. 

Healing depends on factors such as your age, health, the donor site area & location. As a guide-

• Vitiligo areas: takes 1-2 weeks to heal.
• Donor site: takes 2-4 weeks to heal. Longer healing times on the legs compared to the arms.

Everything. Surgical micrografting is one of the last line treatments for vitiligo. You should attempt less invasive non-surgical modalities, including narrowband phototherapy & topical creams. In Australia, Medicare reimburses phototherapy treatment for vitiligo.

Yes & no. In most patients with stable vitiligo, melanocyte transfer will give a permanent solution. I cannot predict how your immune system will be in the months to years following micrografting. Surgery only addresses the skin; it does not change your DNA or immune response.

If you have recent onset vitiligo (less than 18 months), you are unsuitable for this procedure. The reason is that I cannot predict if your condition will get worse or has stabilised. I do not perform surgery if you have a history of trauma exacerbated vitiligo, known as Koebner. Google this to understand.

I do not perform micrografting on genital or flexural vitiligo. If you exercise a lot & cannot limit your activities for one week, do not consider this procedure. This procedure is not indicated for childhood vitiligo as this is classed as unstable.

17. I do not perform vitiligo surgery on young children & young teenagers. Post-surgical care of the operation sites are imperative for good results. I do not like sedating children for this procedure. Narrowband phototherapy & topicals are far better solutions for kids.

International consensus is that vitiligo in children can be progressive & is classified as unstable (exception is segmental vitiligo).

Disclaimer: I do not see vitiligo in children under the age of 7. Cutis Clinic has a few paediatric dermatologists.

Phototherapy is a medical procedure designed to wake up pigment cells called melanocytes. After surgical transfer, light therapy stimulates re-pigmentation of vitiligo at a faster rate than without light.

This treatment uses band specific UVB, delivered by a medical device at Clinic Cutis. Treatments take between 30 to 240 seconds to perform. It is painless and bulk billed through Medicare, saving patients over $200 per week.

Yes, but eyelid vitiligo treated with surgery means I suture your upper eyelid closed for one week. This enables the graft to survive.

Lip vitiligo can be treated with ablation & grafting. Healing time of approximately 7 days.

Success in these areas ranges from 60-70% on the hands to 20-30% on fingers-toes-feet. Lack of follicular units in these areas means I cannot prepare the graft bed as well. These areas are less perfused (circulation) compared to face-neck.

These areas are more prone to graft scarring compared to facial areas. If I do perform surgery on these areas, you will require a splint for 5-9 days.

It is important to understand that the success of surgical micrografting depends on many factors, including things that I can control & factors that I cannot. Every step of the transfer process is vitally important for pigment cell take up. This includes-

• Patient selection & type of vitiligo
• Harvesting of the graft
• Preparation of micrografting
• Preparation of the recipient site
• Graft transfer
• Correct application of dressings
• Dressing duration
• Post procedure care
• Post grafting stimulation of pigment
• Immune response & other factors

Follow the instructions given by my team. Do not remove your dressings or you will dislodge the graft, meaning your pigment cells would fail to survive.

My nursing staff will give you specific instructions on how to look after the donor & recipient sites. Bathing & exercise restrictions apply, be guided by them.

Dietary supplementation does no harm. A literature review has shown that the following foods & vitamins can help (even if it is placebo).

Vitamins to take include Vitamin B12, folic acid, iron & vitamin D. Vitamin D has the most amount of evidence, & I do prescribe this to most patients as part of a trial when vitiligo stabilises. Another supplement that I add is ginkgo biloba. 

Dietary supplementation with antioxidant rich foods such as leafy green vegetables, legumes, seed & fish can improve health, & in rare cases, vitiligo.

This procedure is classified as skin surgery. It carries the benefits of re-pigmentation at a rate that far exceeds normal creams & phototherapy. It also carries the risks of surgery including-

• Infection at the recipient site or donor site: 2-4% of cases
• Prolonged recovery at both sites: 5-7%
• Failure of graft uptake: less than 5%
• Hypertrophic scar donor site: 5-7%
• Skin colour changes at donor site lasting more than 8 months: 8%
• Scarring at recipient site: less than 3%, higher for areas off the face
• Non-response: variable, higher in Koebner & unstable vitiligo

Micrografting is infinitely smaller than punch & suction blister grafting. Traditionally dermatologists have used dermal punches that transfer full thickness dermis with the overlying epidermis. This gives a cobblestone appearance that looks unnatural.

Suction blister grafting was popular in the 80s’ & 90’s, however, like dermal grafting it gives an unnatural result with patchy pigmentation. Micrografting on the other hand consists of thousands of mini-grafts, hence integration is better.

Book an appointment with me at Clinic Cutis. I do need to examine your vitiligo & take a full history to see if you are a suitable candidate. I cannot do this online, & I do not do e-consults.

A referral from your GP is required, as I am a specialist dermatologist. Reception can guide you through this process.

Not much in the scheme of things. Australia’s Medicare subsidies most treatments.  Surgical procedures start at $1290 to $4390, depending on complexity & surface area.

Phototherapy is bulk billed, saving approximately $7500 per year.