Comparative Efficacy and Safety of Tissue Grafting Versus <scp>ReCell</scp> Autologous Cell Suspension in Stable Vitiligo: A 12‐Month Retrospective Study

ABSTRACT Background Vitiligo surgery is often the last resort for treatment‐resistant lesions with stable conditions. Between tissue grafting (suction blister epidermal grafting [SBEG] and ultra‐thin split‐thickness skin grafting [UT‐STSG]) and cellular grafting (ReCell), large‐scale comparative data are lacking. Methods We conducted a comprehensive retrospective cohort study of 277 patients (1501 lesions) undergoing tissue grafting ( n = 111, 451 lesions), or ReCell ( n = 166, 1050 lesions) for stable vitiligo between December 2023 and March 2026. The primary endpoint was 12‐month repigmentation rate, with secondary outcomes including adverse events. Predictors of treatment success were identified via binary logistic regression. Results At 12 months, ReCell achieved superior repigmentation compared with tissue grafting (median 89.7% vs. 60.1%, p &lt; 0.001), with ≥ 75% repigmentation in 62.8% versus 24.0% of lesions. Stratified analysis revealed site‐dependent effects: no significant difference was observed for facial/trunk lesions (98.6% vs. 92.9%, p = 0.562) or acral lesions (46.9% vs. 50.8%, p = 0.077), whereas ReCell was superior for peri‐mucosal sites (81.0% vs. 50.0%, p = 0.028). In nonsegmental vitiligo, ReCell outperformed tissue grafting (87.5% vs. 53.9%, p &lt; 0.001), with no difference in segmental disease (95.0% vs. 81.3%, p = 0.374). Adjuvant 308‐nm excimer lamp therapy (24–47 sessions) increased success fourfold (OR = 3.90, p = 0.002). ReCell demonstrated superior safety (2.4% vs. 16.2% adverse events, p = 0.001). Conclusion ReCell may offer superior 12‐month repigmentation and safety for stable nonsegmental, non‐acral vitiligo. Traditional tissue grafting retains viability for limited lesions and resource‐limited settings. Postoperative phototherapy is crucial for optimal outcomes. These real‐world data are hypothesis‐generating; prospective randomized trials with extended follow‐up are needed.