Vitiligo Or White Patch Removal Surgery

An Introduction

Vitiligo (white patch or SAFED DAAG) is a skin condition in which there is a loss of brown color (pigment) from areas of skin, resulting in irregular white patches that feel like normal skin. Vitiligo appears to occur when immune cells destroy the cells that produce brown pigment (melanocytes). This destruction is thought to be due to an autoimmune problem, but the actual cause is unknown. Though vitiligo does not cause any problem to health, but its appearance is a taboo or stigma for our society.

Vitiligo may appear at any age. There is an increased rate of the condition in some families. Vitiligo most often affects the face, elbows and knees, hands and feet, and genitals. It affects both sides of the body equally. Vitiligo is more noticeable in darker-skinned people because of the contrast of white patches against dark skin. No other skin changes occur.


Vitiligo is often difficult to treat. Early treatment options include the following:

Phototherapy, a medical procedure in which your skin is carefully exposed to controlled ultraviolet light. Phototherapy may be given alone, or after you take a drug that makes your skin sensitive to light. A dermatologist performs this treatment.

Skin may be grafted from normally pigmented areas and placed onto areas where there is pigment loss. The white portion of skin is rubbed off or peeled off very superficially and a very thin skin graft contacting only the top most layer of skin with melanin pigment is applied over that. This is the most satisfactory method of treatment of vitiligo and considered as GOLD STANDARD treatment for vitiligo. But vitiligo must be stabled for at least 1-years for any surgical treatment to be useful or effective. Small vitiligo can be directly excised and closed using very fine stitches to make it almost invisible. Remember, after skin grafting or excision of the vitiligo, the final result may take 6-12 months, so plan your surgery well in advance to any social event or ceremony.

Several cover-up makeups (waterproof skin colors) can mask vitiligo.

In extreme cases when most of the body is affected, the remaining skin that still has pigment may be de-pigmented to provide a uniform color to the skin. This is a permanent change that is used as a last resort.

It is important to remember that skin without pigment is at greater risk for sun damage. Be sure to apply a broad-spectrum (UVA and UVB), high-SPF sunscreen or sunblock and use appropriate safeguards against sun exposure.


 Ques. What is the right time to perform surgery on vitiligo spots?

Ans. Once the white spots become stable (neither increasing nor decreasing) for at least one year, this is the right time to under go for plastic surgery. Small patches can be directly excised & repaired, while large spots need removal of white layers & its replacement by normal coloured skin.


Surgical Correction of Mole or Nevi

An Introduction

Moles or Nevi are the local raised or flat collection of skin pigment (melanin) under the skin. It may be hairy or non-hairy. Some people are born with moles, other moles appear over time. Many families have a type of mole known as dysplastic (atypical) moles, which can be associated with a higher frequency of melanoma or skin cancer. These are due to familial tendency to forming moles and may keep on coming in crops or increasing in size due to excessive exposure to sun rays. Sun exposure seems to play a role in the development of moles and may even play a role in the development of atypical or dysplastic moles. Many people refer to a mole as any dark spot or irregularity in the skin, like any birthmark, abnormal collection of blood vessels (hemangiomas) or keratosis (benign or precancerous spots, which appear after about age 30 years).

Moles or Nevi are frequently removed for a variety of reasons, like their odd-looking appearance or risk of developing skin cancer, which can be very dangerous. But only the very large nevi (giant nevi has a tendency to develop skin cancer).

They can be removed by three surgical methods
  • Excision (cutting) in natural skin crease line followed by very fine stitches, so that after few weeks of surgery they are almost invisible. Even the bigger moles can be treated by this method may provide excellent result & almost invisible scar lines.
  • Round Excision with a punch or blade. This method is useful for very tiny moles that are less that 1-mm in size
  • The lump is much bigger than the original scar — it may began as an insect bite or scratch
  • Larger nevi (giant nevi) may need tissue expansion for its complete removal
  • Although laser removal has been tried for the moles, it is not usually the method of choice for most deep moles because the laser light doesn’t penetrate deeply enough to be effective.

  Scarring Left After Application Of Chuna over the Moles are very difficult to remove.


Common warts are local dome shaped irregular ferny type of growths in the skin that are caused by human papilloma virus (HPV) infection. Although they are considered to be contagious, it is very common for just one family member to have them. In addition, they often affect just one part of the body (such as the hands or the feet, finger and nails, face and neck) without spreading over time to other areas. It is more common in those people who are going to barber’s shop for shaving due to cross infection of HPV Virus from other people.

Treatment for Common Warts

Keloid scars having familial tendency and are more common is dark skinned people. Keloid scars are very difficult to treat, if not impossible.

Hypertrophic Raised Scars

Common warts can be annoying to anyone. The best, easiest & most effective treatment of wart is fine-feathered low voltage electro-fulguration using low voltage high frequency diathermy. The fine controlled local heat prevents recurrence of warts in future. The use of electro fulguration in an experienced hand is the best treatment available for the warts and may lead to almost none or negligible scarring, with no chance of recurrence.

Application of Salicylic-acid preparations (available as drops, gels, pads, and plasters) to warts may also lead to dissolution of protein keratin (which makes up most of both the wart and the thick layer of dead skin that often tops it) and cure from the warts.


Scar Removal Surgery

An Introduction

Scars are the result of skin repair following wounds, which may be related to accidents, burns, disease or surgery. The more the skin is damaged, the longer it will take to heal and the greater will be the risk of a noticeable scar. Scars appear red and thick initially, and then gradually fade. Scars that seem unsightly at three months may heal nicely by six months or one year. But one thing should be clearly noted that once the scar developed from full thickness damage to the skin, it could never be removed completely. The only possibility after a good management is to make it almost invisible or very thin & less visible, so that it can fade with surrounding skin crease or geometry of face.

There are many types of scars, many locations for scars and many causes for scars. Each scar has to be individually evaluated when treatment is being planned. The length of time scar has been present, the location of the scar, the appearance and whether it is causing irritation determine the treatment plan for individual scars.


ACNE Scars

ACNE scarring is the result of abnormal healing of the skin as a result of ACNE. This is the most common scar problem that presents to our practice in young population. The scars often cause the patient to be self-conscious and may impact on their self-esteem. The scars may be of different types from very deep to shallow. They may involve small or large areas of the face. The treatment depends on many factors and is highly individualized. Treatment of ACNE scars by Dermabrasion or Microdermabrasion will result in reduction in the number of visible scars, a reduction in the depth of the scars and a greater uniformity of colour of the affected area. A 50% improvement in appearance of the scars is considered to be a good result.

Keloid Scars

Not all raised scars are keloid scars. The features that make it a keloid scars are:

  • It has been present for a long time — more than one year
  • It is hard
  • The lump is much bigger than the original scar — it may began as an insect bite or scratch
  • It is itchy and irritating

Keloid scars having familial tendency and are more common is dark skinned people. Keloid scars are very difficult to treat, if not impossible.

Hypertrophic Raised Scars

Not all raised scars are keloid scars. In most of the cases, the raised hypertrophic scars are due to ill management from the beginning, due to burn & contractures or excessive tension on suture line. This is more common in dark skinned person. These types of scars can be avoided by proper management of wound or burn from the beginning by an experienced plastic surgeon. Once developed, this type of scar can be managed to a great extent to make it less visible.

What treatment options are available for scars?



Surgical scar revision can improve the appearance of scars to a great extent, however, no scar can ever be completely removed. Surgical scar revision results in a less obvious mark or hidden in crease. Each scar is different and each will require a different approach.

Silicone-containing products

Available as gels, creams and bandages through pharmacies. They are helpful in reducing scar thickness and pain.

Steroid Injections

Using a very fine needle, steroid is injected directly into the keloid or hypertrophic scar. Used with raised scars causing them to shrink and flatten.

Micro-dermabrasion or Full Dermabrasion

Dermabrasion is a method that uses an electrical machine to remove the top layers of the skin to give a more even and smooth contour to the surface of the skin. It can result in improvement of certain scars like ACNE Scar or scars due to childhood smallpox or chicken pox. However, it cannot get rid of the scar entirely.

Resurfacing lasers

Also referred to as peeling lasers, are an excellent method of improving acne scars and chicken pox scars. High-energy lasers are used to remove tissue, which is making the scars more visible. Patients can return to work usually within two weeks. The skin may remain pink for several weeks or months. This treatment is used in the treatment of wrinkles and sun-damaged skin. (Dark skin of Indian population is not very suitable for resurfacing laser, as they can lead to hyper pigmentation or dark discoloration of skin even after trivial exposure to sun rays or U.V. rays)
Non-resurfacing lasers

These lasers are very useful for reducing scar redness. They may flatten raised scars and can also improve itching and burning sensations. Acne scars can be improved with this type of therapy without any need for time off work.


There are a number of these injectable materials that are particularly helpful with depressed scars. They are injected under scars to lift them up and decrease their appearance. Fillers are also used in the treatment of wrinkles.

Some specific techniques are used for the treatment of ACNE scarring are :

    • Subcision

This technique is used in depressed ACNE scars. A needle is inserted under the scar to lift the scar up.

    • Needling

This technique can be used in all ACNE scars. Needles are used to break the superficial skin layers, to stimulate a healing reaction resulting in a smoother appearance.

    • Fusiform Excisions

Deep small ACNE scars can be removed by cutting them out. Stitches are left in place for one week.

    • Punch Grafting

Punch grafts are small pieces of normal skin used to replace scarred skin. Small knives called punches are used to remove the scars. The area is then filled in with a matching piece of unscarred skin, usually taken from the skin behind the ear. The “plugs” are taped into place for five to seven days. Laser resurfacing one month later to achieve the smoothest result can follow a Punch grafting.


Hair Transplantation

An Introduction

Hair Grafting is a surgical technique that involves moving individual hair follicles from one part of the body (the donor site) to bald or balding parts (the recipient site). It is primarily used to treat male pattern baldness, whereby grafts containing hair follicles that are genetically resistant to balding are transplanted to bald scalp. However, it is also used to restore eyelashes, eyebrows, beard hair, chest hair, and pubic hair and to fill in scars caused by accidents or surgery such as face-lifts and previous hair transplants.

Since hair naturally grows in follicles that contain groupings of 1 to 4 hairs, today’s most advanced techniques transplant these naturally occurring 1–4 hair “follicular units” in their natural groupings. Thus modern hair transplantation can achieve a natural appearance by mimicking natural hair for hair. This hair transplant procedure is called Follicular Unit Transplantation (FUT) or Follicular Unit Hair Transplantation (FUHT).

Donor hair can be harvested in two very different ways :

1. Strip Harvesting

A strip of scalp is removed under local anesthesia, the wound is then sutured back together and this piece of scalp tissue is then cut into small pieces, from which individual follicle is separated under magnification called “Follicles” or Grafts. These follicles or grafts are then transplanted back into the bald area of the patient’s head (recipient area). This method will leave a linear scar in the donor area, which is usually covered by the patient’s hair (if long) and almost invisible. The recovery period is around 2-weeks and will require the stitches to be removed by medical personnel.

2. Follicular Unit Extraction or FUE Harvesting

Individual follicles of hair are removed under local anesthesia; this removal uses tiny punches of between 0.6mm and 1.25mm in diameter. Each follicle is then reinserted back in to the scalp in the bald area using a micro blade. Because individual follicles are removed, only tiny, punctate scars formation occurs, which is practically remain invisible. No suture removal is required.

Preparing for the Surgery

At an initial consultation, the surgeon analyzes the patient’s scalp, discusses his preferences and expectations, and advises him on the best approach (e.g. single vs. multiple sessions) and what results might reasonably be expected.

For several days prior to surgery the patient refrains from using any medicines, which might result in intraoperative bleeding and resultant poor “take” of the grafts. Alcohol and smoking can contribute to poor graft survival. Postoperative antibiotics are commonly prescribed to prevent wound or graft infections.

The Procedure (view the procedure in 3-D animation)

Hair transplant operations are performed on an outpatient basis, with mild sedation (optional) and injected local anesthesia, which typically last about six hours. The scalp is shampooed and then treated with an antibacterial agent prior to the donor scalp being harvested.

In the usual follicular unit strip procedure, the surgeon harvests a strip of skin from the posterior scalp, in an area of good hair growth. The excised strip is about 1–1.5 x 15–30 cm in size. Working with binocular stereomicroscopes or magnification loupe, follicles are carefully removed from excess fibrous and fatty tissue while trying to avoid damage to the follicular cells that will be used for grafting. The latest method of closure is called ”Trichophytic closure’ which results in much finer scars at the donor area.

FUE harvesting negates the need for large areas of scalp tissue to be harvested and can give very natural results with little or no scarring.

The surgeon then uses very small micro blades or fine needles to puncture the sites for receiving the grafts, placing them in a predetermined density and pattern, and angling the wounds in a consistent fashion to promote a realistic hair pattern by inserting the individual grafts in natural angle & place.

Your Recovery

Advances in wound care allow for semi-permeable dressings, which allow seepage of blood and tissue fluid. The vulnerable recipient area must be shielded from the sun, and shampooing is started a week after the surgery. During the first 10-20 days, virtually all of the transplanted hairs, inevitably traumatized by their relocation, will fall out (“shock loss”). After two to three months new hair will begin to grow from the moved follicles. Then the patient’s hair will grow normally, and continue to thicken through the next six to nine months. So the final result of hair grafting is visible after 8-12 months after surgery. Any subsequent hair loss is likely to be only from untreated areas. Some patients elect to use medications to retard such loss, while others plan a subsequent transplant procedure to deal with this eventuality.

Clearing controversy of Modern techniques

There are several different techniques available for the harvesting of hair follicles, each with their own advantages and disadvantages. Regardless of which donor harvesting technique is employed, proper extraction of the hair follicle is paramount to ensure the viability of the transplanted hair and avoid transection, the cutting of the hair shaft from the hair follicle. Hair follicles grow at a slight angle to the skin’s surface, which means that regardless of technique transplant tissue must be removed with a corresponding angle and not perpendicular to the surface.

There are two main ways in which donor grafts are extracted today: strip excision harvesting and follicular unit extraction. Strip harvesting is the most common technique for removing hair and follicles from a donor site, most commonly the area at the back and sides of the scalp. Each incision is planned so that intact hair follicles are removed. Once removed, the strip is dissected into follicular units, which are small, naturally formed groupings of hair follicles.

Follicular Unit Extraction (FUE) takes place in a single long session or multiple small sessions. FUE is considered to be more time consuming, depending on the operator’s skill, and there are restrictions on patient candidacy. The advantages of this technique over the conventional strip harvest are that it does not leave a linear scar, and the procedure produces lesser postoperative pain and discomfort. There are some disadvantages such as increased surgical times, a little higher chance of damage to the follicles in the hand of new surgeon and higher cost to the patient.


Ques. Which technique is more advisable among the various available options of hair grafting?

Ans. Determining which hair transplant technique is right for you is a matter of personal choice based on factors such as procedure time, cost, time that you are willing to wait for result and number of procedures required. Beware of that a variety of over-the-counter and herbal remedies claim to slow hair loss or grow back hair, they not only affect your pocket but also have many side-effects causing severe consequences like disturbing normal hair growth, and even contribute to speed up hair loss.