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Vitiligo

When is vitiligo surgery possible? The right time to consider surgery

Jung Min Bae Jung Min Bae Dermatologist · Heal House Gangnam Branch

"Can I get rid of it with surgery too? When should I do it?" This is a common question when treatment is not going well. Vitiligo can also be treated with surgery. However, it is not done 'at any time.' There are appropriate candidates and timing. Today, we will go over those criteria.

Can Vitiligo Be Treated with Surgery?

Yes, it is possible. It is a method of transferring pigment cells to the white areas. However, not all vitiligo cases are candidates.

Surgery is a treatment that transplants healthy pigment cells from another area to the area where pigment cells have disappeared. This can restore color to that area. Currently, representative methods used in Korea include suction blister grafting, which transfers blisters created by applying negative pressure to normal skin; minipunch grafting, which harvests and transfers normal skin using a small punch of 0.5 to 0.8 mm; and non-cultured epidermal cell suspension transplantation, which separates pigment cells from normal skin and transplants them in liquid form to larger areas.

However, surgery is a treatment that is done 'when conditions are right.' We will look at what conditions are suitable below.

When Is Vitiligo Surgery Performed?

The principle is to do it during the 'stable phase' when spreading has stopped. And usually, it is considered after other treatments have been tried sufficiently.

In order, it goes like this. First, you try to restore pigment with topical medications or light and laser therapy. If there are still lesions that do not respond, and those lesions are stable and no longer spreading, surgery is considered. Generally, a stable state with no new lesions for at least the past 12 months is considered one criterion. In other words, surgery is usually close to a 'card to consider last after trying enough.'

Which Vitiligo Cases Are Suitable for Surgery?

Lesions that have stopped spreading and are stable, and that have not responded to other treatments, are suitable.

Cases where surgery can be consideredCases where surgery is still too early
Spreading has stopped and the condition is stableStill spreading currently
Lesions that have not responded to other treatmentsMedication or light therapy has not been tried yet
The area is localizedActively spreading in multiple areas

The key is 'stability.' If it is currently spreading, the first step is to stop the progression. Also, surgery can be expected to have better results in children or in segmental vitiligo, and it tends to show better responses on the face and neck than on the hands and feet. In fact, if the lesion has been stable for more than a year, relatively high success rates have been reported regardless of the method, but results vary by individual depending on the area and condition.

Why Is the 'Stable Phase' Important Before Surgery?

Because if you have surgery while it is spreading, the transplanted area may turn white again. So, stability is checked first.

Vitiligo can also appear in areas where the skin has been irritated (Koebner phenomenon), and surgery itself is a form of skin irritation. So, if surgery is done during an actively spreading phase, there is a risk that the transplanted pigment may disappear again. Conversely, doing it during the stable phase helps maintain results better.

Also, after surgery, it is important to combine light therapy or laser treatment so that the transplanted pigment cells settle and spread well. Whether the condition is stable and what additional care to add after surgery will be confirmed and decided together during a consultation.

Jung Min Bae

Dermatologist · Gangnam Branch

With sincere care and continuous research, I will be a reliable companion for vitiligo patients.