Facelift for an Ehlers Danlos Syndrome Patient: A Case Report.
Ehlers Danlos syndrome (EDS) is a group of inherited connective tissue disorders caused by genetic mutations that result in faulty production of collagen.1,2 Multiple body systems can be affected, though the type of EDS depends on which collagen sub type is involved. There are ten subtypes of EDS. Types 1 and 2 are the classical types and cause hypermobility with moderate skin involvement. These types are caused by autosomal dominant type V collagen defects.2 Patients with EDS have fragile skin and tissues that tear easily during operative procedures, which can complicate undermining and suturing strategies. Vessel wall fragility and problems with platelet aggregation can cause excessive bruising and higher risk of hematoma formation in the immediate postoperative period. There can also be increased problems with wound healing, stretched scars, and recurrence of redundant skin folds due to poor collagen synthesis during the proliferative phase after injury.1 Facelift and necklift procedures have previously been deemed to have inappropriately high risks of complications in EDS. We present an interesting case to highlight these principles in a patient whose quality of life was severely affected by her preoperative physiognomy. A 55 year old woman with EDS (type 2, classical) presented in April 2013 with severe skin laxity of her face and neck, requesting rejuvenation surgery to address her premature facial and cervical ageing in order to restore her self esteem. She had experienced extensive postoperative bleeding and bruising previously from surgical procedures undertaken on her wrist and knee joints, and had profound awareness of her condition at her initial consultation with the senior author. At subsequent assessments, spanning over four months, it was mutually agreed that standard face and neck rejuvenation procedures were high risk
Aesthetic surgery journal