> Avoid rejuvenation surgery for patients with Ehlers-Danlos syndrome and progeria because of wound healing issues. > Cutis laxa and pseudoxanthoma elasticum are the only congenital skin disorders that are responsive to surgical rejuvenation. ## EHLERS-DANLOS SYNDROME (CUTIS HYPERELASTICA) - Incidence: 1:5,000 - Variable inheritance patterns - Connective tissue disorder, collagen cross-linking problem - Hypermobile joints - Thin, friable, hyperextensive skin predisposing patients to - **Poor wound healing**, hypertrophic scarring - Redundant periocular skin (e.g., epicanthal folds, wide nasal bridge) - Ventral hernia ## PROGERIA (HUTCHINSON-GILFORD SYNDROME) - Incidence: 1:1,000,000 - Autosomal recessive - Skin laxity, loss of subcutaneous fat - **Poor wound healing** - Growth retardation, premature death - Craniosynostosis, micrognathia - Baldness, prominent ears - Findings similar to premature aging ## WERNER’S SYNDROME (ADULT PROGERIA) - Rare, autosomal recessive disorder - Features of premature aging - Scleroderma-like skin - Hyperpigmentation and hypopigmentation of skin - **Microangiopathy (contraindication to plastic surgery)** - Diabetes, cataracts - High-pitched voice, baldness ## CUTIS L AXA (ELASTOLYSIS) - Incidence: Only several hundred cases known worldwide - Variable inheritance patterns, can also be acquired - Hypoelastic (degeneration of elastic fibers in the dermis), does not spring back immediately when stretched (hyperextensible) - Appearance of premature aging - **Wound healing normal** - Other associated problems - ↗ risk of ventral hernia - Cardiopulmonary and gastrointestinal issues ## PSEUDOXANTHOMA ELASTICUM - Incidence: 1:25,000–100,000 - Variable inheritance patterns - Skin laxity from calcification and degeneration/fragmentation of elastic fibers - Cobblestone yellowish plaques characteristic - **Wound healing normal** - Ocular and cardiac manifestations #clinicalscience