The lymphatic system, like the circulatory system, is a vital system of vessels that removes cell wastes, proteins, excess fluid, viruses, and bacteria. However, lymph vessels are mostly located just below the skin, so very little pressure is needed to affect them. If more pressure than that of the weight of a nickel is used, it would essentially "squish" these lymphatic vessels which would prevent lymph fluid from moving through the body. The lymph system picks up fluids and waste products from the spaces between the cells and then filters and cleans them. Like the roots of a tree, the lymph system starts as tiny vessels--only a single-cell wide--that eventually branch into larger and larger tubes that carry these fluids back to the bloodstream. This network of delicate vessels and lymph nodes is the primary structure of the immune system. The lymph nodes act as checkpoints along the pathways of the vessels. They filter the fluid (called lymph) and serve as the home for lymphocytes—little Pac Man-like cells that attack and destroy foreign bacteria and viruses and even abnormal cells, like cancer cells.

The atmosphere is similar to a massage treatment room with dim lighting and soft music. However, MLD is a specific form of bodywork designed to efficiently move lymph fluid in your body. It is different from deep tissue, Swedish, or relaxation massages. Treatments involve a very light touch that is extremely effective (though it may not seem so at first) in reducing swelling and discomfort. During an MLD session, you will undress when the therapist leaves the room, lay on a massage table, and be covered by a sheet and blanket. Only the areas being worked on will be uncovered. Gentle rotating, pumping motions with the therapist's hands and fingertips begin at the collarbone area, then focus on areas with a concentration of lymph nodes such as the underarms, abdomen, groin crease (along the crease of the top of leg) and back of the knees. The session usually begins with you lying face-up because the major lymphatic areas that need to be decongested are located on the front of the body. It is important to decongest the areas of drainage in the groin, abdomen, underarms, and collarbone areas before sending extra lymph fluid to them. Directing lymph fluid to nodal areas without opening the lymph nodes first can increase discomfort and recovery time.

I have been a Licensed Massage Therapist in the state of North Carolina since December of 2008. As per the state of North Carolina at the time of my education, my education hours were 550 hours. Since that time have taken hundreds of hours of continuing education and ethics classes - including my certification as a Certified Manual Lymphatic Therapist (MLD-C) through The Academy of Lymphatic Studies (ACOLS.) Also included are advanced trainings in "Management of Post-Plastic Surgery Procedures" through ACOLS, various post-operative care courses through Kathleen Lisson, CMT, CLT, and training in Advanced Breast Health and lymphatic drainage from Effie Spurlin, LMBT of the Spurlin Institute. Additionally it is important for me to continue to take courses in Trauma Informed Bodywork, as well as D*versity, Eq8ity, & Inclu$ion (I've altered the spelling of these in case the current administration wants to censor my site.) I've taken a course specifically focused on T0p Surgery with Egan McGee, RMT (they/them) and hope to be able to find more resources like this to build my knowledge and understanding. **It's important to note that I currently am NOT certified as a Certified Lymphedema Therapist (CLT.) This is someone who has trained extensively to work with advanced lymphedema and is able to wrap limbs to treat lymphedema. This is something I'd like to certify in eventually, but time, money, and resources factor into this training and thus far I have not had these in adequate amounts to take a 9 day, 10 hour a day training. ::Whew!:: Kuddos to those that have! If you need connecting with a CLT in the NC Triad area, reach out and I can give you a few contacts that may be able to help. Most of there are Occupational Therapist and Physical therapists that work for either Atrium Health or Novant Health. ***I also currently do not work with folks ACTIVELY undergoing cancer treatment. While I have a lot of knowledge about treatments, I am not certified specifically in Oncology Massage. I DO however work with many people AFTER cancer treatment, when cancer is in remission. The majority of my clients in this category are survivors of breast cancer, OR who have taken measures like mastectomy to prevent the occurrence of breast cancer. I work with both the lymphatic system and with gentle scar tissue mobilization techniques. As such, I have a few clients who see me to manage and soften fibrosis from radiation treatments.

Unfortunately, no. Cellulite is formed my bands of connective tissue that, simply put, connect the skin to lower layers of tissue. When there is the addition of fat to fluid to the area, it can magnify the appearance of cellulite. Lymphatic drainage can TEMPORARILY reduce the APPEARANCE of cellulite as fluid is moved, but the appearance will return. **Currently, the ONLY treatments that have proven to help get rid of cellulite are medical/surgical treatments that require a surgical instrument inserted below the surface of the skin to "break up" these connective tissue bands. And there is evidence to show that these treatments may not be 100% effective, in that some dimpling or appearance of cellulite MAY return after 6 months to a year. As with any procedure, your body will likely respond differently that the next persons. As of now, there are no guarantees. As of right now some of these therapies are : Cellulaze and Cellfina. There are other treatments available but these have not been extensively studied yet. The bottom line is - please don't spend exorbitant amounts of money looking for quick fixes. Many of the creams and other options out there will again, likely REDUCE THE APPEARANCE of cellulite, but will not "get rid" of it. ***If this is something you feel really strongly about changing in your body - please read up on surgical procedures for this and consult with surgeons who do this work to see if it's right for you. You are likely better off saving the money you'd spend on creams and other solutions and using that money toward something that is longer lasting. You can read more on the American Academy of Dermatology Association's website, by clicking the button below.:

Most clients can safely receive manual lymphatic drainage (MLD) around 72 hours after surgery, or when incisions have have closed. This of course is also dependent on being cleared by your surgeon to receive this work. With this said, if you are a few weeks out from surgery and have just found out about MLD, it's not too late to begin. If you are experiencing discomfort due to swelling, lymphatic drainage can help at any stage.

This is a question not easily answered. This depends on a number of factors, including: what type or procedure(s) you had, your lifestyle, your age, your health history, how you are eating and hydrating during healing, how well your compression garments are fitting, etc. In general, most clients benefit from coming at least 2 times per week in the first and second week after surgery. As you heal and progress, and swelling or firmness starts to reduce, often times we begin to schedule one session per week for about 4 to 6 weeks. By around the 6 to 8 week mark, we typically begin to stretch this time out a bit further to one session every 1 & 1/2 to 2 weeks until you are a full 12 weeks out from surgery. Most of your active healing takes place in the first 3 months, so it's most beneficial to receive Manual Lymphatic Drainage during that window. A quick note here: the more procedures that you have at once, for example, a "Mommy Makeover" the more sessions you might need. You will also likely need to do perhaps 3 sessions per week for the first couple of week. Your body is working hard to heal several areas at once and sometimes it can take a while to get swelling to a more comfortable level. Additionally, as you reach 8 to 12 weeks I am also monitoring your incisions and the quality of the tissue and scar tissue around it to insure things are healing optimally and as smoothly as possible.

Manual Lymphatic Drainage has been around since the 1800's, but has only become recognized in the last couple of decades. And it has only really been publicly recognized as a tool to help with post-operative healing within the last few years. In the 1800's it was impossible to prove the effects of MLD, much less be able to prove that lymphatic vessels actually existed. Lymphatic vessels are tiny (the width of a hair) and lay very superficially along the surface of the skin. It wasn't until recent medical advances allowed us to visually SEE lymphatic vessels. Therefore, many surgeons were taught a very minimal amount about how lymphatic drainage can assist in post-operative healing and with swelling. However, some surgeons are catching on and are choosing to learn more about how Manual Lymphatic Drainage can help their patients recover. Massage therapists have been practicing Manual Lymphatic Drainage for a while, but it hasn't been popularized until recently. Most of the reason that MLD has been becoming more popular is because more people have been sharing information on social media. If your surgeon didn't discuss lymphatic drainage with you, it may be because they haven't had a chance to explore how it can help. Surgeons' opinions, experience, and protocols can vary quite a bit. If you aren't sure where your surgeon stands, check with your surgeon's office to see if they recommend it for your specific procedure.

No. If you receive an actual Manual Lymphatic Drainage session from an educated and seasoned practitioner, it should not hurt. - It's a very light, gentle, but effective modality. If it hurts, they are either doing something wrong, OR the practitioner was actually doing what we call "Incisional Drainage." Many surgeons offices and practices in and around Miami (and in Latin American countries) have practitioners that practice a modality that pushes out fluid (a mixture of blood, lymph, and sometimes tumescent fluid) out of open incisions. Often the pressure is heavy, and patients/clients often report that they were in an intense amount of pain during these treatments. While I will not disparage another modality or practice, it is not something that I would personally recommend to clients as the body is already in a state in which there is a lot of inflammation occurring. Unless you are someone who is looking for dramatic results (i.e.- you want to look like a Kardashian or IG influencer) I really feel like incisional drainage is a bit overkill. BUT, if your surgeon is insistent on it, my advice does not surpass that of your surgeon. However, if you've had a few sessions and then travelled home, just know that your local MLD therapist will likely not be doing the same, although this can depend on state regulations. As a licensed massage therapist in the state of North Carolina, I could not legally, intentionally push fluids out of your body, even if I did believe if it was of benefit. Make sure you thoroughly research and vet your post-op providers.

Manual Lymphatic Drainage is a light pressure touch modality. The massage therapist or practitioner focuses on priming the "terminus points" at the collar bone first get the lymphatic system to start working faster and more efficiently. Then moves on to priming/stimulating areas of the lymph nodes. And finally they start using light pumping motions on the surface of the skin to help guide lymphatic fluid back to the closest lymph nodes. Essentially, the lymphatic system can become overwhelmed after surgery; having a hard time re-regulating itself and the amount of swelling that occurs. MLD after surgery helps "remind" the body where this fluid is supposed to move (to the lymph nodes) and helps guide it there. This is particularly important when I comes to liposuction. - The lymphatic vessel are housed in the layers of tissue under the skin. When fat is removed, many of those vessel and lymphatic structures are also removed or damaged. Not to worry though, your body will re-grow new lymphatic vessels. But in the meantime, it needs assistance moving lymphatic fluid. Incisional Drainage is exactly what it sounds like. - A practitioner pushes fluid out of open incisions with their gloved hands. This usually occurs in the first few days after a surgery and is mostly common in and around Miami and in countries like Columbia and the Dominican Republic. Hence why it has become more common in Miami, as many folks from those countries have immigrated to the Miami area. This type of work is usually done with a good deal of pressure and most people find it quite uncomfortable and even painful. (And while they may be pushing out some lymphatic fluid, the rest of what is pushed out can be tumescent fluid and blood.) While I am personally not a fan of Incisional Drainage, some surgeons (especially in Miami, Dominican Republic, and Columbia) recommend it for their patients. My stance is that the body already undergoes a traumatic experience with surgery, and inflicting more pain on the body can sometimes hinder healing where the nervous system is concerned. It can also increase inflammation. While I will never tell any one not to receive this work, as I am not trained in it and it is illegal for massage therapists in my state to intentionally work with a wound, I WILL implicitly recommend that you never let anyone re-open your incisions to push fluid out. - This practice increases the chance of infection and also can cause more noticeable scaring. Logistically there is no other surgery that I can think of where it is common practice for incisions to be reopened afterward. If someone suggested you do this after an appendectomy, you'd think they were crazy. So why should we suggest this with cosmetic surgeries?? And finally - Body Contouring is again, a modality that can be done using a practitioner's hands, button also incorporate machines and other tools. This is something that can be done on it's own - meaning you could get body contouring on it's own. But most people are curious about exploring it as an adjunct to their cosmetic surgery in order to fine tune their results. Typically I tell clients to avoid body contouring until after the 3 month healing period after surgery. This is because some of the work can be a bit more aggressive and you already are experiencing inflammation during the 3 months after your surgery. And you definitely don't want to you go using wood tools aggressively while you're still swollen and tender. Ouch! With each of these modalities, ALWAYS look into any practitioner you are interested in working with. - Check their training and credentials. Look for photos of their spaces to make sure that they maintain cleanliness and disinfect their space between clients (particularly if they do incisional drainage.) And look to see if there are testimonials from previous clients.

No. I do not drain seromas via needle aspiration. Nor do I remove drains. In the state of NC, only certain licensed medical providers can do so. It would be illegal and outside of my scope of practice to offer this. However, some surgeons whose clients I see often will first send a client with a seroma to me before trying to needle aspirate - as a conservative measure. Their goal is to try and get the patient's body to drain this pocket of fluid on its own. Sometimes that happens. However, if there are no changes, the surgeon will opt to aspirate on the patient's next follow up appointment. This is usually not painful and is a quick and simple fix. If you have travelled for surgery and had to travel home before your drains were ready to be removed - ask your surgeon for suggestions. Typically you will be advised to contact an urgent care facility or go to an emergency room to have it removed. The majority of doctors are reluctant to remove drains that they have not themselves placed in a client for liability reasons. But the easiest thing you can do is get instructions from your surgeons office on how to remove the drains yourself. - It's not fun or comfortable, but not painful either. Most clients find it unsettling, but it it's quick and easy to do. But you will need a second person to help you do so.

As Lipedema is becoming more and more recognized and understood, I feel as though we are going to find that Lipedema is much more common than we once thought. Most doctors and physicians have learned a good deal about Lymphedema in their schooling and there are arguable more resources and information available. Lymphedema usually involves the swelling in one limb or area only. Typically this is either caused by damage to or a blockage within the lymphatic system. This can occur due to inherited conditions, cancer treatments, injections, or infections. Treatments for lymphedema can be compression wraps or garments, movement and gentle exercise, manual lymphatic drainage, and pneumatic compression pumps used in a medical office or at home. At this time, there is no "cure" but the goal is to keep symptoms manageable. Lipedema has only really become more recognized and diagnosable to a greater degree in this century. (I don't know about you, but that statement made me feel old. I was born in "The 1900's." Lol.) I started to become familiar with it in 2018 and have seen a big uptick in clients who are being diagnosed or who are seeking diagnosis. Many in the medical community are starting to understand and recognize that Lipedema is a valid condition and diagnosis. And there are also many who are not there yet, or who are not familiar with it. If you are considering Lipedema and a medical practitioner that you work with is not familiar with it, don't be surprised. Often times with conditions like this (which are "newer") you are going to have to actively seek out information on it or find others online who have travelled down the same path. Lipedema differs from lymphedema in that it is not necessarily a lymphatic disorder (though it can become one) but is primarily considered a fat disorder. ("Lipe" is similar to the word Lipid which refers to fat compounds in the body.) It effects both sides of the body equally. It will not just affect one leg or one arm it's more symmetrical. We are still learning, but what is thought to happen is that the body begins to grow irregular fat in hardened nodules. The nodules can cause pain, heaviness, and a tendency to bruise easily. In most cases it almost always effects the legs - sometimes upper, sometimes lower, or both. It depends on the stage one's body is in. But lipedema nodules can also be found in the upper arms and abdomen. Almost all known cases are thought to occur in women and are usually triggered by hormonal changes - particularly puberty, childbirth, or peri-menopause. In the earlier stages, particularly if you have always had a smaller body size - lipedema can be harder to detect or see from the outside. In later stages, there are visible cuffs of fat that hang over the sides of the knees or ankles. It's thought that lipedema is primarily genetic. And many women who experience symptoms will note that their mothers, grandmother, or other close relative had legs like theirs - larger, heavier, more painful, etc. With Lipedema on can also have symptoms of Lyphedema as well. The theory is that the further the disorder progresses, the more the fat nodules expand and are thought to compress or block the flow of lymph in the body. Some people refer to this as Lipo-Lymphedema. You can read more about Lipedema by clicking the button below.:

Most things about a post-op lymphatic drainage session for clients with lipedeam are the same as a typical post-cosmetic surgery session. The main difference that I have noticed is that it often takes longer for the swelling to subside after surgery when you've had Lipedema. My theory on this is that the body's lymphatic system is coming from an already compromised state. Depending on the stage of lipedema you have, the fat nodules have been, in a sense, overcrowding the lymphatic vessels and structures in that area of your body. It's likely that the lymphatic flow to the area was already affected before surgery. After surgery, not only is your body healing itself, but it's also re-regulating and "re-learning" how to move lymph again. What this all means is that typically my clients healing from Lipedema removal usually require more sessions, and sometimes for longer than the 3 month period. However, the most important things is that you receive 2-3 MLD post-op sessions those first 4 weeks after surgery. Swelling can be intense during this time and we want you to feel more comfortable, and perhaps more importantly, we reduce the chances of fibrosis and hardening. Some insurance plans will reimburse you for your sessions so make sure to talk to your insurance provider, and if you can, get an advocate to help you file the right kind of paperwork. If your surgeons office can provide me with diagnosis codes, I can always try to create something similar to a "Super-bill" that can be submitted to your insurance provider. **Keep in mind that insurance is more likely to cover these treatments coming from a CLT - Certified Lymphedema Therapist which I am currently not. (But hopefully will be at some point.) I am an MLD-C which is a Certified Manual Lymphatic Drainage Therapist. - But I have still had clients who have had success submitting a Super-Bill that I created along with their surgeon's provided diagnosis codes. So there is hope! It just depends on your insurance provider and surgeon.

Because of my status as a sole practitioner and the nature of the insurance industry. I am not set up to accept insurance. And unless there is a major overhaul of health insurance, I likely never will. HOWEVER, some insurance plans will reimburse you for your MLD sessions so make sure to talk to your insurance provider beforehand. And if you can, get an advocate to help you file the right kind of paperwork. (I highly recommend this if you can afford it.) If your surgeons office can provide me with diagnosis codes, I can always try to create something similar to a "Super-Bill" that can be submitted to your insurance provider. **Keep in mind that insurance is more likely to cover these treatments coming from a CLT - Certified Lymphedema Therapist which I am currently not. (But hopefully will be at some point.) I am an MLD-C which is a Certified Manual Lymphatic Drainage Therapist. - But I have still had clients who have had success submitting a Super-Bill that I created along with their surgeon's provided diagnosis codes. So there is hope! It just depends on your insurance provider and surgeon.

I can't give you a definitive "Yes' or "No" answer, but I can provide you with the information I know from working with dozens of clients after Lipedema removal surgeries. Everyone's goals, needs, and lifestyle is different. So find out as much as you can and make your decision from and informed space. In order to receive a diagnosis, it's likely that you will need to search for a physician or doctor that specializes in or is very familiar with Lipedema. - Which might be a little challenging in itself, depending on where you live. If you live near a large metropolitan area, it will be easier to find a medical professional who can diagnosis, than it would be if you live in a fairly rural area. - So keep in mind that you might have to travel. And if you choose to have surgery, you will most definitely have to travel a bit. The process of treating Lipedema through surgery is a long journey. Often you will have to have a series surgeries in order to address and control the lipedema nodules in various areas of the body. A surgeon experienced with Lipedema can a diagnose which areas of your body are affected and advise you on a plan to treat them. Often patients have liposuction/lipedema removal on one area first like the front of the thighs, then have a 6- 12 week healing period. Then are scheduled to have a second surgery for example on the backs of the thighs with a recovery period. Then the lower legs, etc. If you have several areas to be treated, if may end up being a year long process. You will also need to wear adequate compression garments during your healing process. These can sometimes be quite expensive if they are custom made. But the type of garment you need will be determined by your surgeon. Just know that you may be wearing compression for many months if you have several surgeries. Something to note.: Because we are still learning about lipedema and surgeries for fat nodule removal have only occurred in recent years, we currently don't know much about how the body maintains its results 10-20 years down the line. There is some evidence that the nodules don't come back or re-occur to a much lesser degree. But so far I haven't seen any studies on this. (That's not to say that they aren't out there, I just have not had a chance to look recently.) The choice to have surgery is yours, but of all of my clients who have gotten surgery with a surgeon who specialized in Lipedema, none of them have ever regretted it. Was it difficult at times, absolutely. But many report feeling lighter, having more energy, and feeling more able bodied. And some of my clients' self-esteem improved dramatically, in such a way that they feel better in their clothing and even enjoyed wearing a swimsuit again. The alternative to surgery is management of symptoms via diet and movement; as well as will compression garments and compression pumps used at home. This is something that you will have to be committed to daily if you choose this route. So make sure that those around you and who live with you are able to help support you in your healthy habits and allow you time to used your compression pumps regularly.