Using the formulation of 1:80, it means in theory that the largest area treated can be eighty times the size of the donor area. For example, if I harvest 2 square centimetres, in theory I can populate 160 square centimetres of vitiligo. Theory does not equal practice & real-world results. A realistic figure is 1: 25-30, which is better than my usual 1: 10 ratio for SSG manual micrografting. More on that is the summary below.

The bed of vitiligo skin requires preparation. This enables perfusion of the area, meaning the greatest chance of survival for transplanted melanocytes. This is done via an erbium laser (as it has minimal collateral damage compared to CO2 laser resurfacing). On occasion I also use dermabrasion.

The recipient area (vitiligo areas) takes 7 to 12 days to heal. Facial skin heals up quickly, acral (hands & feet) requires 12-14 days. Dressings are left intact for this timeframe.

The donor site heals up in 14 to 23 days. Skin colour will improve in this area over 12 to 24 months.

The real clinical efficacy of processed melanocyte transfer using kits such as ReCell, & Regenera are highly exaggerated. Published studies are often a case series (or even n=1), follow ups are short, & treated areas small. Success rates range from 50- 80+%.

I prefer manual micrografting over kits. This way my team & I have complete control over the harvesting, processing & transfer of pigment. Manual melanocyte transfer, in my hands, is consistently successful in over 87% of patients.

In the context of hypopigmentation & vitiligo, I do believe that manual split thickness grafting gives far better results than kits such as Regenera & ReCell.

Manual grafting allows me to control the thickness of skin, the density of melanocytes & processing of the door skin. Micrografting is not only more effective than ReCell, but also one third the price of ReCell. 

With any surgical transfer procedure including autologous & cultured melanocytes, vitiligo specialists will want to ensure your chances of success are highest. ReCell is only suitable for-

• Stable vitiligo, this means patches have not increased in surface area for 12 months.
• Small areas, namely the size of 1.5 hand size at most.
• Non-Koebner vitiligo, meaning your condition does not get worse with trauma.
• Adult vitiligo. Diseases in children/teenage years are not treated with surgical methods, except for segmental vitiligo.

You may notice changes within the first 6 weeks; however it can take up to 12 months or longer before the full clinical improvement is seen. In the context of vitiligo, I prefer micrografting over ReCell as the former has faster repigmentation (usually 4 times as quick compared to ReCell).

In cases of stable vitiligo, melanocyte transfer can be permanent. This includes ReCell, Regenera, & micrografting. The big unknown is if your vitiligo will re-activate in the future. If this happens, you may lose pigment in treated areas, or develop new patches.

Reactivation of vitiligo can be due to stress, infection, genetics, & many other factors that are unknown & unpredictable.

For all melanocyte transfer procedures including split grafts, punch grafting, ReCell & Regenera, the use of pigment stimulatory creams & medically prescribed phototherapy can accelerate pigmentation production.

Creams include prostaglandin analogues & calcineurin inhibitors. In some cases, I add an anti-inflammatory topical on a rotational basis.  Phototherapy is a natural way of stimulating pigmentation. 2-4 sessions are recommended over a period of 3-6 months. This treatment is covered under Medicare.

As ReCell is a surgical treatment, the risks of surgery pertain to this vitiligo treatment method. They include-

• Infection: Less than 4%, usually at the donor site of the graft.
• Scarring: Less than 3%, usually at the donor site.
• Risk of failure: Varies between 30-60%. Higher rates in progressive vitiligo.
• Mottled pigmentation: Common. Seen in 60%, usually fades within 12 months
• Risk of vitiligo progression.

Renenera is another kit for repurposing pigment cells & skin cells. It is marketed as a stem cell therapy for conditions such as hair loss, burns, vitiligo, scars & anti-aging.

Unlike ReCell the recipient area does not require preparation. The donor cells are derived from a small punch biopsy.  Regenera injects stems under the skin, hence healing up times are much quicker. Free hand micrografts gives more predictable results compared to Regenera.

In a minority of cases, diet & vitamin supplements can improve vitiligo, even if they are placebo. Given the safety & low costs associated with these treatments, I do encourage patients to ‘give it a go.’ A summary is as follows-

• Vitamins: include B12, B complex, folate. Ginkgo biloba as supplementation.
• Diet: Low in acidic foods such as citrus fruits & tomatoes, high in antioxidants such as fish oil, leafy green vegetables, nuts & legumes.

Here is the summary checklist to see if your vitiligo is suitable for surgical intervention, including ReCell.

• Have you tried conventional treatment? Creams & phototherapy are the first line.
• Is your condition stable? This means body surface area involvement is the same (or decreasing) over the past 12 months.
• Are you committed to phototherapy post treatment?
• Do you have a basic understanding of the principles of surgical therapy for vitiligo? This includes all options, not just ReCell.

A referral from a GP is required. This will legally allow you to claim a rebate for any surgical work that I may perform. Medicare also subsidises phototherapy sessions, hence a referral will give you the ability to have no out of pocket expenses.