Plastic Surgery for Ehler Danlos Patients
Ehlers-Danlos Syndrome (EDS) is a group of inherited disorders affecting connective tissues, causing joint hypermobility, skin hyperextensibility, and tissue fragility.
Living with EDS can be challenging, and many patients may seek plastic surgery to remove excess hanging skin. However, EDS patients have unique needs when it comes to surgical procedures.
In this article, we’ll explore the special considerations for plastic surgery in EDS patients, focusing on safety, setting realistic expectations, and finding a surgeon experienced in treating individuals with connective tissue disorders so you can empower yourself to make informed decisions.
What is Ehlers-Danlos Syndrome?
Ehlers-Danlos Syndrome is a group of inherited disorders affecting connective tissues, primarily the skin, joints, and blood vessel walls. Connective tissues are made of collagen and elastin, and they provide support to various parts of the body, including organs and bones.
The most common type of EDS is Hypermobile EDS (hEDS), which accounts for about 90% of EDS cases and is thought to affect at least 1 in 3,100-5,000 people.
Other types, such as Classical EDS (cEDS) and Vascular EDS (vEDS), are much rarer, affecting 1 in 20,000-40,000 and 1 in 100,000-200,000 people, respectively. Several types of EDS are considered ultra-rare, affecting less than 1 in 1 million people.
EDS Causes
EDS is caused by genetic mutations that affect the body’s production of collagen, resulting in weaker connective tissues. These mutations can be passed down from one or both parents, or they can occur spontaneously in the person for the first time. The specific genetic mutation determines which type of EDS a person has and which parts of the body are affected.
EDS Symptoms
The most common symptoms of EDS include:
- Overly flexible (hypermobile) joints that may feel loose or unstable
- Stretchy, soft, and fragile skin that bruises easily
- Chronic joint and muscle pain
- Fatigue
- Difficulty concentrating
- Unusual scarring or delayed wound healing
Symptoms can vary depending on the specific type of EDS a person has. Some rare, severe types of EDS can be life-threatening, causing complications such as blood vessel or organ rupture.
Living with EDS can be challenging, as it affects every aspect of a person’s life. The chronic pain, fatigue, and joint instability associated with EDS can make everyday tasks difficult.
For women with EDS, especially those who have gone through pregnancy and childbirth, the changes in their bodies can be particularly distressing. Stretchy, fragile skin and weakened connective tissues can lead to feelings of self-consciousness and a desire to seek cosmetic solutions, such as plastic surgery.
EDS Types
There are several different types of this condition. Each type has its own unique set of symptoms, inheritance patterns, and potential complications.
Let’s take a closer look at all 13 EDS types.
| EDS Type | Prevalence | Symptoms | Plastic Surgery Management |
| Hypermobile EDS (hEDS) | 1 in 3,100 – 5,000 | – Generalized joint hypermobility- Joint instability- Chronic pain | – breast reduction or lift |
| Classical EDS (cEDS) | 1 in 20,000 – 40,000 | – Skin fragility with extensive atrophic scarring- Very stretchy skin with velvety or doughy texture | – skin removal surgeries- scar revision surgeries- blepharoplasty- breast reduction or lift |
| Vascular EDS (vEDS) | 1 in 100,000 – 200,000 | – Arterial fragility with aneurysm/dissection/rupture- Organ fragility and rupture- Extensive bruising- Pneumothorax | |
| Kyphoscoliotic EDS (kEDS) | Less than 1 in 1,000,000 | – Congenital or early-onset kyphoscoliosis- Congenital hypotonia- Fragile eyes that can easily be damaged- Soft, velvety skin that is stretchy, bruises easily, and scars | – skin removal surgeries |
| Periodontal EDS (pEDS) | Less than 1 in 1,000,000 | – Severe, early onset gum disease with tooth loss- Shin discoloration | |
| Spondylodysplastic EDS (spEDS) | Less than 1 in 1,000,000 | – Muscle weakness- Short stature- Limb bowing- Craniofacial features | – facial soft tissue procedures |
| Brittle Cornea Syndrome (BCS) | Less than 1 in 1,000,000 | – Severe cornea problems- Hearing loss | |
| Arthrochalasia EDS (aEDS) | Less than 1 in 1,000,000 | – Severe joint hypermobility- Congenital bilateral hip dislocation | |
| Musculocontractural EDS (mcEDS) | Less than 1 in 1,000,000 | – Congenital multiple contractures- Craniofacial features | – facial soft tissue procedures |
| Classical-like EDS (clEDS) | Less than 1 in 1,000,000 | – Stretchy, velvety skin without atrophic scarring- Leg swelling- Foot deformities | – skin removal surgeries |
| Dermatosparaxis EDS (dEDS) | Less than 1 in 1,000,000 | – Extreme skin fragility- Loose, excessive skin- Severe bruising- Craniofacial features | – skin removal surgeries- blepharoplasty- facial soft tissue procedures |
| Myopathic EDS (mEDS) | Less than 1 in 1,000,000 | – Congenital hypotonia- Proximal joint contractures | |
| Cardiac-valvular EDS (cvEDS) | Less than 1 in 1,000,000 | – Severe heart valve insufficiency |
Can EDS Patients Have Plastic Surgery?
EDS patients may seek plastic surgery to address some of the physical changes caused by this condition. But while plastic surgery can be beneficial for EDS patients, you need to understand the unique challenges and risks involved.
Getting plastic surgery for EDS patients is not a yes or no situation. It depends on the severity of EDS, the specific procedure, and a doctor’s assessment.
Challenges of Plastic Surgery in EDS Patients
EDS patients have fragile skin and tissues that can easily tear during surgical procedures, making suturing more difficult. This fragility can also lead to excessive bruising, a higher risk of hematoma (swelling from clotted blood), and issues with wound healing and stretched scars.
Plus, EDS patients may experience complications related to their specific subtype. For example, those with classical or vascular EDS may have droopy eyelids, which can lead to complications during eyelid surgery, such as bleeding in the eye socket or excessive skin removal.
Facelift surgery in EDS patients may also result in insufficient skin tightening, visible scars, and severe bruising.
Despite these challenges, recent studies have shown that EDS patients may not experience significantly higher complication rates compared to matched controls when undergoing plastic surgery. Still, it’s crucial to prioritize safety and choose a board-certified plastic surgeon experienced in operating on EDS patients, like Dr. Siamak Agha.
Common Plastic Surgery Procedures for EDS Patients
While safety should always be the top priority, there are several common plastic surgery options that can improve the quality of life of EDS patients.
Skin Removal Surgeries
For EDS types with severe skin hyperextensibility, such as Classical EDS (cEDS) and Dermatosparaxis EDS (dEDS), excess skin removal and tightening procedures may help manage skin-related symptoms and improve appearance.
Scar Revision Surgeries
Atrophic scarring is common in several EDS types, particularly Classical EDS (cEDS).
Scar revision techniques, such as surgical excision, dermabrasion, or laser treatments, may help improve the appearance of scars.
Blepharoplasty
In EDS types with severe skin laxity, such as Classical EDS (cEDS) and Dermatosparaxis EDS (dEDS), blepharoplasty may be considered to correct droopy eyelids and improve vision.
Breast Surgeries
In EDS types with skin hyperextensibility and joint laxity, such as Classical EDS (cEDS) and Hypermobile EDS (hEDS), breast reduction or lift procedures may help alleviate neck and shoulder pain caused by heavy breasts and improve overall comfort.
Facial Soft Tissue Procedures
For EDS types with characteristic craniofacial features, such as Musculocontractural EDS (mcEDS), soft tissue procedures like fat grafting or dermal fillers may help improve facial symmetry and appearance.
The decision to undergo plastic surgery should be made on a case-by-case basis, considering the individual’s specific symptoms, overall health, and the potential benefits and risks of the procedure.
What to Expect on Plastic Surgery as an EDS Patient
When considering plastic surgery, it’s essential to consult with your healthcare team to assess any potential heart, lung, or breathing issues and discuss the need for antibiotics to reduce infection risk.
During the procedure, your surgeon should take special precautions, such as avoiding intramuscular injections, minimizing tissue handling, and using appropriate suturing techniques. Post-surgical rehabilitation should be personalized and developed in collaboration with a physical therapist.
Remember, while plastic surgery can improve your quality of life, it’s essential to weigh the potential benefits against the risks. Each person’s unique needs must be considered when exploring surgical options.
Finding a supportive healthcare team and a surgeon experienced in working with EDS patients is essential for ensuring the best possible outcomes and maintaining overall health and well-being.
Conclusion
Understanding the unique challenges and considerations of plastic surgery for Ehlers-Danlos Syndrome patients is crucial for ensuring the best possible outcomes. Prioritizing safety, finding an experienced surgeon, and exploring minimally invasive options can help you make informed decisions about enhancing your self-confidence and quality of life.
Remember, every EDS patient’s journey is unique, and what works for one may not be suitable for another.
If you’re considering plastic surgery, schedule a consultation with The Aesthetic Centers, where our knowledgeable team is dedicated to providing personalized advice and expert care tailored specifically to the needs of EDS patients.
