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The Journal Of Dermatology
Japanese Dermatological Association

아래 내용은 SST를 이용한 흉터치료 관련해서 JDA에 게재 된 논문 내용입니다.

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Accepted: 24 March 2024
Successful repigmentation of hypopigmented scars with micropunch grafting with a skin-seeding technique

Dong Seok KIM 1,Jin Cheol Kim2 | Du Jin Baek2 | Hee Young Kang2
1Eureka Skin & Laser Clinic, Seoul, South Korea
2Department of Dermatology, Ajou University of Medicine, Suwon, South Korea
Hee Young Kang, Department of Dermatology, Ajou University Hospital, 164 World cup-ro, Yeongtong-gu, Suwon, 16499, South Korea.


Hypopigmented scars are challenging to treat, and the focus for successful treatment is to cause pigment cells to produce more melanin. In this study, we evaluated the re- pigmentation effects of 0.4 mm motorized-micropunch grafting with skin-seeding for hypopigmented scars. Twenty-one patients with hypopigmented scars on the face and neck that had been resistant to conventional treatment and who had finally undergone micropunch grafting with a skin-seeding technique (SST) were retrospectively reviewed. Repigmentation outcomes were evaluated with global assessment by a physician using a 4-point repigmentation scale. Adverse events were noted. The subjects were followed for a 2-year follow-up period post grafting. All 21 subjects exhibited excellent to complete repigmentation of more than 75% of the hypopigmented scars. More than 90% repig- mentation was observed in 17 patients. The mean duration for repigmentation that the subjects were satisfied with was 5.5 months. No adverse effects or recurrence instances were observed. Motorized micropunch grafting is an effective and promising alternative treatment for repigmentation of hypopigmented scars.

Key words: graft, hypopigmentation, melanocytes, micropunch, pigmentation, scar.


Hypopigmented scars are a significant clinical concern, extending beyond the mere physical concerns of cutaneous trauma or surgical procedures.1 The consequences of such scars are far-reaching, often giving rise to pronounced cosmetic and emotional distress and an overall impaired quality of life.2,3 A plethora of treatment options are commonly employed in the management of hypopigmented scars, ranging from topical medications to ablative laser therapies and surgical interventions such as microneedling. However, the efficacy of these approaches is frequently compromised by limitations and challenges such as incomplete scar repigmentation and undesirable pigment alterations such as hyperpigmentation, after treatment.2,4 Therefore, the focus of successful treatment of hypopigmented scars is, ideally, to stimulate pigment cells causing them to produce more melanin. In this study, we evaluated the repigmentation effects of motorized-micropunch grafting for hypopigmented scars on the face and neck.


2.1 | Study participants

This was a retrospective study to evaluate the treatment effects of micropunch grafting for hypopigmented scars. The study cohort consisted of 21 subjects with hypopigmented scars on the face and neck, selected through a thorough retrospective review of medi- cal records. Study participants included individuals who had not responded satisfactorily to conventional scar treatments such as topical medications, laser therapy, or surgical interventions, and who had finally undergone grafting for scar repigmentation. All cases in- cluded in this study were those who had not been diagnosed with vitiligo, either in the past or at the time of surgery (Table 1).
TABLE 1 Demographic and clinical characteristics of the study participants.
Number of participants 21
Sex, n (%)
Male 4 (19.0)
Female 17 (81.0)
Age distribution, n(%)
<30 9 (42.9)
30–50 10 (47.6)
>50 2 (9.5)
Diagnosis, n (%)
Wound suture scar 4 (19.0)
Burn scar 4 (19.0)
Acne scar 2 (9.5)
Laser scar 4 (19.0)
Plastic surgery scar 7 (33.5)
Fitzpatrick skin type, n (%)
III 14 (66.7)
IV 7(33.3)

2.2 | Data collection

The retrospective data collection process involved a meticulous review of subjects' medical records, encompassing preoperative evaluations, procedural details, postoperative outcomes, and fol- low-up assessments. Key variables of interest included the extent of hypopigmented scarring, subjects’ demographics, characteris- tics of the donor and recipient sites, and any documented adverse effects.

2.3 | Intervention: Motorized micropunch grafting with a skin-seeding technique

The skin-seeding technique involves transplantation of full-thickness skin, consisting of melanocytes and melanin pigment obtained from a pigmented donor area, to the hypopigmented scarring site. The surgical procedure was identical to that reported in a previous study.5,6 The donor and recipient sites were harvested using a mo- torized 0.4-mm micropunch (i-graft; Ilooda) and were grafted onto the hypopigmented scarring site (Figure 1).

2.4 | Outcome measures

The primary outcome measure was the degree of scar repig- mentation. The repigmentation rate was assessed through a photograph evaluation using a physician's 4-point repigmenta- tion global assessment a scale: mild, 0–25%; moderate, 26–50%; good, 51–75%, and excellent to complete, 76–100% repigmenta- tion.7,8 Secondary outcome measures included the occurrence of any adverse effects such as infection, bleeding, or other surgical complications.

2.5 | Ethical considerations

This study adhered to ethical guidelines and obtained approval from the institutional review board of Ajou University Hospital (IRB num- ber: AJOUIRB-DB-2023-610). Informed consent was obtained from all patients involved in the study.


3.1 | Patient demographics and clinical characteristics

The study cohort comprised individuals who exhibited hypopigmented scarring patches, predominantly as a consequence of plastic surgery (n = 7), specifically epicanthoplasty (Table 1). Others included those with a wound suture scar (n = 4), burn scarring (n = 4), acne scarring

FIGURE2 Representative photographs of micropunch grafting treatments for various hypopigmented scars. (a) Suture scar on the right forehead of a 23-year-old female, (b) acne scar on the nose of a 31-year-old female, (c) alar resection scar on the philtrum of a 31-year-old female, and (d) epicanthoplasty scar on the philtrum of a 29-year-old female.
(n = 2), and ablative laser scarring (n = 4). The distribution of hypopig- mented scars was consistently observed on the face or neck in all sub- jects. Participants had undergone prior treatments, encompassing a range of conventional modalities such as topical medications (n = 14), chemical peels (n = 2), laser therapy (n = 10), and micro-needling (n = 4).

3.2 | Repigmentation of hypopigmented scars

All 21 subjects exhibited excellent to complete repigmentation, of more than 75% repigmentation of the hypopigmented scars. Outcomes of more than 90% repigmentation were observed in 17 subjects (Figure 2). The mean duration until subjects experienced clinical improvement to the extent that they no longer felt the need for further treatment was 5.5 months. No case of recurrence was observed during the follow-up period of up to 2 years post grafting.

3.3 | Adverse effects

No adverse effects, such as infection, active bleeding, or other sur- gical complications, were reported. Transient erythema and subtle differences in skin height were observed immediately after grafting. These minor effects resolved over time and became indistinguish- able later.


The present study demonstrated the efficacy and safety of micro- punch grafting with SST for the repigmentation of hypopigmented scars. Remarkable success was observed in all 21 subjects, and particularly noteworthy is the achievement of more than 90% re- pigmentation in 17 subjects. The mean duration of 5.5 months for improvements that satisfied the subjects was within a reasonable timeframe, offering practical insight into the expected timeline for scar disappearance following grafting. The absence of recur- rence during the 2-year follow-up period is a pivotal finding, con- tributing to the overall positive outlook on the long-term efficacy of micropunch grafting. The sustained benefits observed over an extended period endorse micropunch grafting as a durable and reli- able intervention for the repigmentation of hypopigmented scars. Encouragingly, the study revealed a lack of adverse effects, empha- sizing the procedure's safety and its potential for integration into routine clinical practice. The molecular and biological mechanisms of repigmentation in hypopigmented scars involve the transfer of melanocytes from the donor area, leading to melanocyte migration and melanogenic ac- tivation at the recipient site. A previous histopathological analysis of the procedure observed that transplanting tissue from a donor area onto vitiligo lesions resulted in the presence of melanocytes in the basal layer that were not originally present, along with their proliferation.6 While there may be differences in the immune status or mesenchymal environment between hypopigmented scar tissue and vitiligo, it is plausible that a similar mechanism may contribute to the therapeutic effects. It has been shown that split-skin grafts achieve good results in regard to the pigmentation of hypopigmented scars.9–11 However, the two limiting factors associated with these types of conventional skin grafting are that they are both painful and time-consuming.12 Motorized micropunch grafting with SST has been proposed as a promising option to treat hypopigmented lesions of refractory vitil- igo.5,6,13 The use of a motorized punch promises better efficacy due to it being an easier and faster procedure with less pain compared to conventional grafting.13 Furthermore, a punch with a small diameter of 0.4 mm resulted in a minimal wound size, reducing the potential for a cobblestone appearance.6,13 This approach also offers better compli- ance for children with vitiligo.13 Given our results, micropunch grafting with SST can be regarded as a promising alternative for patients with hypopigmented scars resistant to conventional treatments. A limitation of this study is its small sample size and the restricted lesional sites considered (face and neck), which may limit any gener- alization of the effectiveness of SST in the treatment of all areas of hypopigmented scarring. In summary, motorized micropunch grafting with SST is an effec- tive and promising alternative treatment for the repigmentation of hypopigmented scars. Further research with a larger sample size and controlled trials is needed.


None declared.


Informed consent was obtained from all patients involved in the study.


This study was approved by the institutional review board of Ajou University Hospital (IRB number: AJOUIRB-DB-2023-610).


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How to cite this article: Kim DS, Kim JC, Baek DJ, Kang HY. Successful repigmentation of hypopigmented scars with micropunch grafting with a skin-seeding technique. J Dermatol. 2024;00:1–4. 8138.17216