Background Information:

What are the other Names for the Procedure?

• Repigmentation Surgery for Vitiligo
• Skin Grafting for Vitiligo

What is Vitiligo Surgery procedure?

• Vitiligo Surgery is a procedure in which pigmented skin is transplanted into areas of skin in which the autoimmune inflammatory process of vitiligo has killed the original resident pigment cells (called melanocytes)
• Virtually all vitiligo patients have ample expanses of skin with residual pigmentation, to be able to donate into areas depigmented by vitiligo
• Vitiligo Surgery is done in conjunction with efforts to simultaneously slow the process of depigmentation, as well as stimulate repigmentation, for example with phototherapy
• The pigment cells moved into the vitiligo skin, once they are securely engrafted, are exposed to ultraviolet light to stimulate the melanocytes to proliferate and move into the surrounding pigmented skin

Vitiligo Surgery is not a mature science, and is variable in techniques used, with variable long term success rates.

What part of the Body does the Procedure involve?

The Vitiligo Surgery procedure involves transplanting superficial skin specimens from skin bearing pigment cells, into regions of skin that have become depigmented from the process of vitiligo.

Why is the Vitiligo Surgery procedure Performed?

Vitiligo Surgery is primarily performed for patients with significant depigmentation from vitiligo. For optimal results, their pigment loss should be stable. Otherwise, the surgical results might be reversed by the ongoing autoimmune disease.

What are some Alternative Choices for the Procedure?

Some of the alternative choices for Vitiligo Surgery include:

• Cover-up cosmetics to camouflage the depigmentation of vitiligo
• Use of topical or oral medications to halt or reverse the depigmentation process
• Ultraviolet light treatments, with and without photosensitizing topical or oral medications

Some individuals may use of tattoos to minimize pigment discrepancies.

What are the Recent Advances in the Procedure?

With emerging scientific and technical understanding of vitiligo, new insights are frequent. Consultation with an expert in the field of vitiligo is an excellent way to keep up with new advances.

What is the Cost of performing the Vitiligo Surgery procedure?

The cost of the Vitiligo Surgery procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

Note: Probably no US insurance companies will cover the cost of Vitiligo Surgery. When consulting about having such a surgery, a discussion of cost is important.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding the Vitiligo Surgery procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

https://dermnetnz.org/topics/surgical-treatment-of-stable-vitiligo/ (accessed on 05/16/2021)

https://www.nhs.uk/conditions/vitiligo/treatment/ (accessed on 05/16/2021)

Prior to Vitiligo Surgery procedure:

How is the Vitiligo Surgery procedure Performed?

The Vitiligo Surgery procedure is performed in the following manner:

• Some vitiligo surgeons transplant the pigment bearing skin as punch biopsies. Punch biopsies are then taken from the skin region affected by vitiligo; 2-3 mm punch grafts are harvested. The resultant small holes are then filled with the donor, pigmented grafts, and held in place until they heal into their new domain
• Some vitiligo surgeons use suction blister epidermal grafts. A small device with multiple small holes in a flat plexiglass surface is applied to the skin. It simultaneously heats (gently) the skin and applies suction.   This is put on an area of skin with an intact pigment expanse, unaffected by vitiligo
• The resulting blisters are the pigment cell donors. Shortly before forming these blisters, liquid nitrogen is used to freeze small areas of skin in the depigmented areas. The cryosurgical process lifts off only the epidermis (outermost skin layer)
• A fine forceps and scissors are used to remove the cryo-blisters from the recipient site, which are discarded. The same way, the pigmented blisters are removed and transferred to the fresh blister bases, and held in place with a clean firm bandage
• The thin epidermal grafts have a very high rate of surviving the transplantation process
• The multiple new areas of pigment can be stimulated with ultraviolet light to spread out and grow into the skin that was never transplanted
• Some Vitiligo Surgery experts use larger sheets of epidermal cells from pigmented cells, break them into a suspension with small individual aggregates of pigment and other skin cells, and transplants them as a suspension onto vitiligo skin
• In the highest level of technology, either just the melanocytes or a mix of melanocytes and epidermal cells, are grow in tissue culture in a laboratory. The original cells come from the patient and are biochemically treated to multiply many-fold. These are then induced to take a place of growth in skin affected by vitiligo

Where is the Procedure Performed?

The Vitiligo Surgery procedure is usually performed in an outpatient setting, the surgical suite of a vitiligo specialist.

Who Performs the Procedure?

A specialist in the entire spectrum of treatments for vitiligo usually performs the Vitiligo Surgery procedure.

How long will the Procedure take?

The Vitiligo Surgery is so variable that an estimate is generally not possible; it would almost inevitably be inaccurate.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the procedure and helps avoid complications.

• Provide a complete medical history
• Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• A complete history of the course of your vitiligo, activity of disease, any treatments currently or previously used

What Preparations are needed, prior to the Procedure?

The physician performing the procedure will evaluate the patient prior to the procedure and discuss the details with risks for complications and obtain his/her permission (termed informed consent).

As a truly optional surgical treatment, Vitiligo Surgery is only (typically) performed on healthy patients.

• A complete history and physical examination will be needed
• The surgeon will also take into account the significant emotional and cultural overlay that the depigmentation process of vitiligo brings

What is the Consent Process before the Procedure?

The physician will obtain permission for the Vitiligo Surgery procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is the approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

In case of minors and individuals unable to give informed consent, the parent or legal guardian or next of kin can sign the consent for the procedure.

What Tests are needed, before the Vitiligo Surgery procedure?

Generally, no specific tests are required for Vitiligo Surgery. The physician may suggest further tests depending on the health of the individual and their medical history.

What are some Questions for your Physician?

Some of the questions that you might ask your healthcare provider are as follows:

• What is a Vitiligo Surgery procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Vitiligo Surgery procedure:

What kind of Anesthesia is given, during the Procedure?

The procedure can be performed with anesthesia, which is typically decided by the specific vitiligo surgeon.

How much Blood will you lose, during the Procedure?

There is not much blood loss during an uncomplicated Vitiligo Surgery procedure.

What are the possible Risks and Complications during the Vitiligo Surgery procedure?

There are general factors that increase one’s risk of getting complications during the Vitiligo Surgery procedure. This may usually depend on the general health status of the patient.

Some of the possible risks and complications that may arise during a Vitiligo Surgery procedure include:

• Infection
• Bleeding
• Pain
• Discomfort

What Post-Operative Care is needed at the Healthcare Facility after the Vitiligo Surgery procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care.

After the Vitiligo Surgery procedure:

What are the possible Risks and Complications after the procedure?

The risks and complications that may arise after Vitiligo Surgery may include infection of the surgical wound.

What is the Prognosis after the procedure?

The recovery from a Vitiligo Surgery procedure is usually excellent. In a vast majority of cases, the patient is discharged after completion of the procedure.

When do you need to call your Physician?

Do contact your physician or call 911 (or your local emergency number) based on the seriousness of any of the following symptoms:

• Fever and chills
• Severe pain
• Shortness of breath
• Bleeding or fluid discharge from the surgical wound
• Nausea and vomiting
• Signs of infection
• Severe fatigue
• Dizziness

What Post-Operative Care is needed at Home after the Vitiligo Surgery procedure?

At home, follow the post-operative care recommended by your vitiligo surgeon, paying scrupulous attention to compliance.

How long does it normally take to fully recover, from the Procedure?

• The recovery time usually depends on the extensiveness of the surgery. Simple procedures have shorter recovery period
• An evaluation of the success of the procedure will take several months to a year. A multifactorial approach to therapy is to be expected

Additional Information:

What happens to tissue/samples (if any), taken during the Procedure?

The residual tissue is usually disposed as per the standard clinic/hospital protocol.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

A pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Vitiligo Surgery procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility or hospital
• The dermatologist
• An anesthesiologist (if anesthesia was administered)
• A laboratory if cells are grown in tissue culture

The patient is advised to inquire and confirm the type of billing before the Vitiligo Surgery is performed.