How can patients with Ehlers-Danlos Syndromes (EDS) and Hypermobility Spectrum Disorders (HSD) achieve improved surgical outcomes after a rhytidectomy (facelift)?

From the Guidelines

Patients with Ehlers-Danlos Syndromes and Hypermobility Spectrum Disorders can improve surgical outcomes after a facelift by preoperative optimization with vitamin C supplementation, modified surgical techniques, and extended postoperative recovery with careful activity restrictions and scar management. To achieve improved surgical outcomes, several key strategies should be employed.

• Preoperative optimization is crucial, including vitamin C supplementation (500-1000mg daily) for at least 3 weeks before surgery to enhance collagen synthesis and wound healing, as patients with EDS have defective collagen synthesis and tissue fragility 1.
• Patients should also consider taking zinc (15-30mg daily) and vitamin D (2000-4000 IU daily) to support tissue repair.
• During consultation, patients must fully disclose their EDS/HSD diagnosis to their surgeon, who should then modify techniques by using deeper structural support, additional sutures, and possibly platelet-rich plasma injections to enhance healing.
• Postoperatively, extended recovery time is crucial—typically 2-3 weeks longer than standard patients—with careful activity restrictions to prevent tissue stretching.
• Compression garments should be worn consistently for 4-6 weeks, and scar management should begin early with silicone sheets or gels once incisions have closed. These recommendations are important because EDS/HSD patients have defective collagen synthesis and tissue fragility, leading to poor wound healing, tissue laxity, and increased scarring, as characterized by their articular hypermobility, skin hyperextensibility, and tissue fragility 1. Their connective tissue abnormalities require these specialized approaches to achieve more durable facelift results and reduce complications like wound dehiscence and abnormal scarring. It is essential to prioritize these strategies to minimize morbidity, mortality, and improve the quality of life for patients with Ehlers-Danlos Syndromes and Hypermobility Spectrum Disorders undergoing a facelift.

From the Research

Surgical Considerations for Ehlers-Danlos Syndromes and Hypermobility Spectrum Disorders

To improve surgical outcomes after a facelift for patients with Ehlers-Danlos Syndromes and Hypermobility Spectrum Disorders, several factors should be considered:

• Tissue fragility: Patients with Ehlers-Danlos Syndromes have abnormal cutaneous texture, easy bruising, and joint hypermobility due to inherited abnormalities affecting the biogenesis of fibrillar collagens and other components of the extracellular matrix 2.
• Wound healing: The skin of patients with Ehlers-Danlos Syndromes is characterized as doughy/velvety, soft, thin, and/or variably hyperextensible, which may affect wound healing after surgery 2.
• Surgical technique: A careful and gentle surgical technique is essential to minimize tissue damage and promote optimal wound healing.
• Post-operative care: Patients with Ehlers-Danlos Syndromes and Hypermobility Spectrum Disorders may require specialized post-operative care, including pain management and wound care, to prevent complications.

Pre-Surgical Evaluation

A thorough pre-surgical evaluation is crucial to identify potential risks and develop a personalized surgical plan:

• Medical history: A comprehensive medical history should be taken to identify any underlying conditions that may affect surgical outcomes, such as anxiety disorders, chronic pain, fatigue, orthostatic intolerance, functional gastrointestinal disorders, and pelvic and bladder dysfunction 3.
• Physical examination: A physical examination should be performed to assess joint hypermobility, skin findings, and joint pains or recurrent dislocations 3.
• Imaging studies: Imaging studies, such as X-rays or MRI, may be necessary to evaluate the extent of joint hypermobility and tissue fragility.

Multidisciplinary Approach

A multidisciplinary approach is essential to provide comprehensive care for patients with Ehlers-Danlos Syndromes and Hypermobility Spectrum Disorders:

• Primary care physician: The primary care physician plays a key role in initial recognition, diagnosis, and patient education, as well as overseeing and coordinating the multidisciplinary team 3.
• Specialists: Specialists, such as orthopedic surgeons, physical medicine and rehabilitation physicians, and pain management specialists, may be necessary to manage specific aspects of the patient's condition.
• Physical and occupational therapy: Physical and occupational therapy can help patients with hypermobile EDS/hypermobility spectrum disorders manage symptoms, prevent joint injury, and improve functional abilities 3.