Vitiligo is a depigmenting disorder characterized by the progressive loss of melanocytes. In cases of extensive vitiligo that is unresponsive to treatment and involves noticeable areas, such as the face and hands, total depigmentation is a clinical option. The choice to depigment is a difficult one for the patient given the irreversible nature of treatment and the psychosocial implications of skin color change. This issue can be particularly complex for black patients. Depigmentation has been practiced for decades and documented in the literature, but the practice in Fitzpatrick skin type VI is not well-documented. We present a case of depigmentation in a patient with Fitzpatrick skin type VI, as well as technical options for depigmentation, the clinical approach, patient preparation, and psychosocial issues involved with this treatment option.