- Best Results6-12 months
- Treatment Recovery6-12 days
- Procedure Time90-120 minutes
- Skin SpecialistDr Davin Lim
- Duration of ResultsLong-term
- Back to Work4-10 days
ReCell is an Australian invention. It was used initially to repopulate open burn wounds. This is a form of autologous non-cultured cellular grafting. This treatment is novel; however it has been used to treat vitiligo for over 15 years. The theory behind ReCell is sound, however in my hands I get much better results with free hand cellular grafting. Read this page to find out more on ReCell.
FactsFacts on ReCell treatment for Vitiligo
- This is a technique of transferring pigment from skin to areas that has vitiligo
- The cell type is known as a melanocyte. This produces pigment known as melanin
- ReCell than process skin to repigment up to 80 times the area of the donor site
- Your normal pigmented skin acts as a donor for these pigment producing cells
- ReCell involves breaking down the donor site with enzymes
- The cell suspension is then placed on the prepared bed of vitiligo
- Pigmentation takes 6-12 months before maximal results are achieved
What is ReCell?
ReCell is a patented kit for transferring cells from one area (known as the donor site) to another called the recipient site. In the context of vitiligo, the recipient site is the vitiligo involved area. The donor site is an area of skin that has pigment, most commonly the front of the leg.
How is ReCell performed?
Read below to understand the terms donor and recipient sites for more detail. Donor skin is broken down using an enzyme called trypsin. This helps separate the epidermis (where pigment cells reside) from the underlying dermal layer. This kit uses a compound called sodium lactate. This facilitates the appropriate dilutions for the cell suspension that is then transferred to the areas of vitiligo.
The entire procedure takes between 90 to 120 minutes to perform. It is done under local anaesthesia in an operating room. I have a team of nurses & technicians to assist in processing the cellular grafts. My role is to harvest the donor sites & prepare the vitiligo skin for the melanocyte suspension.
How is this different from other cellular grafts?
The major difference between the ReCell technique and conventional cellular transplantation techniques is the use of a patented sodium lactate as cell delivery system and for dilution of the cell suspension, which gives a donor ⁄ recipient ratio of about 1:80. It is thought that this medium plays an important role in both survival & multiplication of pigment cells.
What is the donor site & how do I harvest the melanocytes?
My usual donor site is the front of the thigh, or the inner upper arm. I harvest the skin using either a free blade or a dermatome.
For vitiligo, I am only interested in the upper layer of skin, namely the epidermis. Hence the thickness of harvested skin is only 0.15 to 0.2 mm. I remove between one to three square centimetres; about the size of 1-2 postage stamps.
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What is the biggest area of vitiligo that can be treated with ReCell?
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.
How do I prepare the vitiligo areas for ReCell?
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.
How long does it take for wounds to heal following ReCell?
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.
How effective is ReCell for vitiligo?
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.
What treatments are better than ReCell for vitiligo?
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.
What types of vitiligo are suitable for ReCell or melanocyte transfer?
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.
When will you see the results from ReCell?
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).
Is vitiligo ReCell treatment permanent?
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.
How do you improve the chances of re-pigmentation following ReCell treatment?
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.
What are the potential side effects of ReCell therapy?
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.
What is the difference between Renenera AMT vs ReCell therapy for vitiligo?
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.
Can diet & supplementation make a difference in vitiligo?
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.
What is the ReCell checklist- what should you consider?
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.
How do you get an appointment with me?
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.
Davin’s Viewpoint on ReCell for Vitiligo
Invented by Australian innovation, ReCell has been a novel treatment over the past two decades. I have personally employed ReCell to treat hypopigmented scars, burns, dermal scarring, as well as cases of vitiligo. I suspect that this treatment is best used to increase the number of keratinocytes, as compared to the number of melanocytes.
In the context of vitiligo & hypopigmented skin conditions, my success rate is less than 30 percent. Let us compare the logic and efficacy of three different methods of regenerating or transposition melanocytes. This page has discussed ReCell, namely enzymatic separation of dermis & epidermis, followed by a cell suspension in sodium lactate solution. The advantage of ReCell is that it requires very little in the way of clinical skills, that is why a dermatologist who has a paucity of skill sets can be a key opinion leader in this field. Harvesting skin is easier than filleting a fish. One to two postage stamps. Thickness is not that important as trypsin breaks down the layers. Preparation of the bed is easy; it is less complex than sanding a floor board. Press a button on a laser, stop when you get pinpoint bleeding. Place solution on the area, cook for 7 days.
The new competitor in this field of ‘skin kits’ is of course Regenera. This device is even easier. Take 3 punch biopsies with a 3 mm device, this takes approximately 4 seconds to harvest (no kidding). Place in a blender device that breaks up pieces of skin to 5/100 of a millimetre, add some dilution to the solution, then inject under the skin. The advantage of Regenera is that the skill required to harvest & to deliver is even less- to a point that it can even be performed by someone who has zero knowledge of skin surgery. The success of Regenera depends on the ability of stem cells to differentiate into melanocytes, & the ability to repopulate the epidermis at a density whereby re-pigmentation is clinically relevant. Many variables determine success- the rate limiting is your immune system.
I find that manual micrografting gives the most predictable results for treating stable vitiligo & hypopigmented scars. This is technique dependent. Everything from donor thickness to transfer & dressings is super important. The upside of micrografting is the much higher density of melanocytes in the transposed skin. My usual ratio is 1:3 to 12. This technique is not only better, but also about one third the price of ReCell, & is significantly cheaper than Regenera. If you really want me to use ReCell, I would be more than happy to do so.
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