The ideal surgical treatment modality for vitiligo should be effective in all cases, rapid, cheap, easy to perform and safe. None of the currently available modalities provides all the above advantages. Tissue grafts possess several limitations such as inability to cover large areas in a single sitting; nonuniform repigmentation and textural change (especially punch grafting and split thickness skin grafting). Noncultured epidermal suspensions have overcome many of these problems, as they are able to cover large areas with uniform pigmentation, from small grafts in less number of sittings, hence contributing to greater patient comfort with less textural changes of donor skin. However, the ratio of donor to recipient area is only 1:4–1:10 and this is a limitation. Cultured melanocytes have a donor to recipient area of around 1:100 and hence a very small donor graft is adequate to cover a very large area. The other major advantage of this technique is it contains the possibility to cryopreserve these cells in cell banks and reculture them whenever these are needed for transplantation in future. Hence cultured cellular graft represents a major advance in vitiligo surgery. However, the lack of complete standardization, relatively inadequate data, the need for expensive laboratory equipment and technical complexity of cell culture process limit the use of this modality to a few centers only at present. The technique still needs to evolve before it can find widespread practical application. Cultured melanocyte suspensions are of two types: (1) Pure melanocyte cell suspension and (2) Co-culture with keratinocytes. The latter are more manageable and make it easier to treat many large achromic patches at the same time. Cultured melanocyte transplantation is a promising technique for the management of resistant stable vitiligo with a special advantage of being able to cover large areas with small grafts. However, it requires technical expertise and expensive laboratory setup and hence has not gained widespread popularity. In the hands of experienced personnel, it has the potential to give satisfactory and gratifying results.