The chapter aims to focus on the modifications of cellular techniques for treatment of difficult vitiligo cases. In most patients, vitiligo can be best controlled or slowed down with the use of various immunosuppressive drugs, phototherapy and topicals. Many areas like fingers, toes, lips, nipples, periareolar, genitalia, perianal, dorsum of the hand and feet, etc. are difficult to treat vitiligo as there is difficulty in retaining the transplanted grafts whether tissue or cellular. When treating the difficult vitiligo, it is important for the treating dermatologist to understand that beyond a certain limit, medical treatment will not repigment patches and the injudicious and long-term use of systemic steroids, immunosuppressive, ultraviolet radiations is not only futile but is exposing the patient to innumerable risks and side effects. Deciding on the type of surgical procedure to suit a particular area is an important question to answer. Certain modifications and fine tuning have to be done on some specific sites to help in dermabrasion and retaining the cells transferred.