Vitiligo Surgery in Pune: Skin and Cell Grafting for Stable Vitiligo

What is vitiligo surgery?

Vitiligo is a long-term condition in which melanocytes, the skin cells that make pigment, stop working or are lost, leaving pale or white patches. It is not infectious and is not caused by diet. There are two main types: non-segmental vitiligo, the more common type, which tends to appear on both sides of the body; and segmental vitiligo, which affects one area or side and usually stops spreading after a period.

Medical treatment, such as creams and light therapy, works for many people. When patches have stopped changing but have not regained colour, surgery can move healthy melanocytes from normal skin into the patch. The transplanted cells then spread pigment across the white area over several months.

Who may benefit, and how is suitability assessed?

The most important requirement is stability: no new patches, no enlargement of existing ones and no new patches at sites of cuts or friction (called the Koebner response), usually for at least a year. Grafting into active vitiligo often fails, because the grafted cells can also be lost.

At consultation the doctor will:

1. Take a history of when patches appeared, how they have changed and what treatment you have had.
2. Examine the patches, often with a special lamp, and photograph them.
3. Confirm stability, sometimes with a small test graft before treating a larger area.
4. Check for thick scarring or keloids after past injuries, which affect the choice of method.
5. Discuss expectations: colour match and coverage vary, and more than one session may be needed.

What are the treatment options?

Method	How it works	Suits	Points to consider
Punch (mini-punch) grafting	Tiny cores of normal skin placed into small holes in the patch	Small, stable patches	Can leave a cobblestone texture
Suction blister grafting	The thin roof of a blister raised on normal skin is placed on the patch	Small to moderate areas	Takes time to raise blisters; good colour match
Thin split-thickness grafting	A very thin layer of skin covers the prepared patch	Larger areas	Edge lines or colour difference possible
Cell suspension grafting	Cells separated from a small skin sample are spread on the prepared patch	Larger areas from a small donor site	Laboratory step; more equipment
Medical treatment and light therapy	Creams and phototherapy	Active or widespread vitiligo	Usually tried first
Cosmetic camouflage	Matched cover creams	Any patch	Daily use; no repigmentation

Grafting uses the same principles as skin grafting surgery elsewhere on the body. Pale patches after burns or injuries are a different problem; see burn scar treatment.

How is vitiligo surgery performed?

1. Anaesthesia: local anaesthetic is injected into the donor area (often the thigh or buttock) and the patch.
2. Preparing the patch: the surface layer of the white skin is removed by abrasion, laser or small punches, depending on the method.
3. Harvest: tiny punches, blister roofs, a thin graft or a small skin sample for cell separation are taken from the donor area.
4. Grafting: the grafts or cell suspension are placed on the prepared patch.
5. Dressing: a dressing holds the grafts in place, usually for about a week.

How should you prepare, and what should you ask?

• Bring records of past treatment and photographs showing that patches have been stable.
• Tell the doctor about medicines, bleeding problems and any tendency to thick scars.
• Plan to rest the treated area for about a week; avoid friction and strenuous use of grafted hands or feet.

Questions to ask:

• Is my vitiligo stable enough for surgery?
• Which method suits my patches, and why?
• How much improvement is realistic, and will I need light therapy afterwards?
• What will the donor area look like?

What is recovery like?

Time	What to expect for most patients
Week 1	Dressing stays on; keep it dry; limit movement of the treated area
Weeks 1-2	Dressing removed; donor area heals
Weeks 2-8	Light therapy often starts; small dots of colour appear
Months 3-6 and beyond	Colour gradually spreads; final result may take longer

What are the risks of vitiligo surgery?

• Incomplete or no repigmentation, particularly in unstable vitiligo or difficult sites.
• Colour mismatch, darker or lighter than surrounding skin.
• Cobblestone or uneven texture after punch grafting.
• New patches at the donor site if vitiligo is not stable.
• Infection, scarring or milia (small white cysts).
• Graft loss if the dressing moves.

Contact the doctor if the dressing becomes wet or displaced, or if you develop increasing pain, spreading redness or fever.

What results can you expect?

Many people with stable vitiligo gain worthwhile colour in treated patches, but the evidence comes mostly from small studies of low or very low quality, and results vary widely. Segmental and small localised patches tend to respond better than widespread vitiligo. Repigmentation can take many months, and new patches may still appear elsewhere.

What affects the cost of vitiligo surgery in Pune?

• Number, size and site of patches.
• Technique: tissue grafting or cell suspension grafting.
• Number of sessions, including any test graft.
• Light therapy and follow-up visits after surgery.