No. For small wounds less than 2 mm, a suture is not required. The recipient site heals up within 5-10 days, whilst the donor site heals up in 7-12 days.

Pigment is visible immediately after the transplant, however maximal pigmentation takes12 months or longer. Melanocyte migration takes 6 months or longer to move 0.2 to 0.4 mm. The speed of pigmentation depends on the density & size of grafting as well as location, the use of pigment migrators, UVB stimulation & many other factors.

A punch is sometimes used to test for vitiligo stability & the probability of pigment production. I prefer to punch graft test spots as it only takes 2 seconds to harvest the donor site & about 10 seconds to plant the donor tissue. Most importantly, the donor site heals up within 6 days, compared to spit grafting healing of 2 weeks or more (technically I can do a SSG micrograft free hand).

In summary I perform a test spot if vitiligo is possibly unstable, or if I suspect you have trauma induced (Koebner) vitiligo.

I have replaced punch grafting with micrografting as the surgical treatment of choice for vitiligo. Micrografting has the following advantages-

• Quicker results almost 50 times quicker
• More pigmentation in any given area
• More even pigmentation
• Less cobble stoning & scarring
• Faster operation times

Yes, this is where punch grafts excel. Follicular Unit Extraction is the treatment of choice for patches of poliosis or white hairs. The downside about this procedure is the time taken to remove & replace each strand of hair. Another option is to SSG the whole area & rely on melanocyte migration to re-pigment hair. 

I consider factors such as area, site, stability, donor hair density & many other factors before deciding what type of pigment transfer is best for vitiligo patients.

The mainstay of vitiligo treatment is the use of topical anti-inflammatory creams & pigment stimulators. These are prescribed in a pulsed rotation manner. I also use narrowband phototherapy to stimulate melanocytes in patches of vitiligo. Ancillary treatments include vitamins, herbs & diet. 

There are many different surgical treatments including split thickness skin grafts, either whole, meshed, stretched, or hybrid. Melanocytes can also be harvested & cultured in a medium. This takes 3-5 weeks to grow pigment cells, which are then transferred to vitiligo patches.

There are numerous novel transfer kits available to harvest, process then transfer skin cells. These kits are complex & invariably require trypsin enzymes to break down skin before transferring to the recipient site. They include ReCell & Renova. I have been using these kits over the past decade. The success rate is very low. If you really want me to use this because your own research says so, I can do it- at your expense.

Yes and no. Grafts can cure segmental vitiligo & achromic nevus. They can potentially place stable vitiligo into long term remission. For stable, non-trauma induced vitiligo, surgical grafting can give good long-term results in over 90% of patients.

It depends on the surface area. Test spots are taken from the front or back of the ear. Traditionally, areas of true harvesting include the upper thigh, abdominal area, posterior ear & inner arm.

Lots. The main problems with this type of grafting are cobble stoning or raised grafts. Other side effects include scarring at the donor & recipient site, graft failure, as well as irregular pigmentation. The usual side effects of surgery apply to punch grafts, including infections, dyspigmentation, tri-colour changes, etc…

Your dermatologist or plastic surgeon has their own way of grafting. Side effects can be minimised by-

1. Harvesting thin grafts, namely in a donor site that matches dermal thickness.
2. Trimming the fat from the graft
3. Using small punches that are less than 1.2 mm wide
4. The use of super sharp punches that reduce tissue trauma
5. The use of punches smaller than the recipient site defect
6. Post op care & appropriate dressings

I use 2 methods to speed up re-pigmentation post-transplant. Firstly, the use of pigment cell migrators, including prostaglandin analogues & calcineurin inhibitors. These are initiated at 14 to 28 days post grafting.

I also use narrowband phototherapy to stimulate the pigment cells within the patches of vitiligo to produce melanin. This procedure is conducted 2-3 times a week & is bulk billed (under Medicare in Australia).

Yes. There are papers that encourage dietary changes & supplements. These treatments are banal, with poor evidence. Given the low cost & the fact that placebo can help patients mentally & emotionally, I recommend-

• Vitamins including B12, iron & folate
• Vitamin D supplementation
• Ginkgo biloba herbs
• Diet high in fish oil & antioxidants
• Diet low in acidic foods including citrus fruits & tomatoes

Most children are not surgical candidates, except for segmental (stable) vitiligo, or achromic/nevus depigmentosus. Childhood vitiligo can be progressive. I do not recommend surgical procedures until 17 years of age.

If you have a child with vitiligo, medical treatments including phototherapy & topical creams are first line. 

A thorough history & examination is required prior to surgery. My checklist is as follows-

• Have you tried medical therapy? UVB & topicals?
• Is your vitiligo stable for over a year?
• Is there absence of trauma induced vitiligo?
• Are you older than 17?
• Have you got insight as to the course of vitiligo?
• Are the areas small enough to graft?

Cost depends on the extent of vitiligo, and the graft technique. As a guide, smaller areas cost $1490 upwards. This includes theatre costs, nursing & post-operative care.

Any phototherapy sessions are bulk billed if you have Medicare. This saves approximately $7500 per annum.