The surgical management of vitiligo extends the opportunities offered through the medical approach to vitiligo. In some cases, such as those affected by leukotrichia or refractory to medical therapies, surgery can hold promise for patients that are otherwise unlikely to repigment. Despite this potential, utilization continues to be low, complicated by challenges of cost, complexity, and limited resources. Given the success of repigmentation with surgical modalities, enhancing education and encouraging practice is important in the comprehensive care landscape of vitiligo treatment. This chapter explores various aspects of the surgical approach to vitiligo, such as evaluating patient candidacy, comparing various techniques, reviewing recent advances, and discussing strategies to optimize outcomes.