Manual Lymphatic Drainage & Post-Op FAQs
FAQ Specifically About MLD for
Q: Why is Lymph Drainage Therapy better than a deep massage after cosmetic procedures?
A: Although it may seem that deep massage would assist in decreasing the hardness following lipo or other procedures, this would actually increase the circulation to the treated areas making it harder to evacuate the lymph fluid. Even though MLD is extremely light work, it is the most efficient way to reduce swelling and bruising. It is based on scientific knowledge of the anatomy and physiology of the Lymphatic System.
It is a myth that deep massage and heat are beneficial in healing after liposuction. So, even though it may seem to you that a deep massage or other forms of therapeutic or Swedish massage would be helpful, they would generally be counterproductive.
Q: Why do I need Lymph Drainage Therapy after my liposuction or other cosmetic surgery procedure?
A: You may notice a hardness or lumpiness to the areas treated with liposuction especially in the abdominal area and even more so if combined with other body contouring procedures (such as fat injections for what is popularly known as the Brazilian Butt Lift) This is normal right after your procedure. This post-surgical lymphedema is caused by inflammation and trauma from the cannula (an instrument that sucks out the fat) moving under the skin. Channels are formed by the cannula that can fill up with fluid and the tissue also becomes swollen.
Manual Lymph Massage helps to move the fluid by gently pumping it back into the lymph vessels. Reducing swelling can reduce discomfort. Without Lymph Massage (MLD) the inflammation can evolve into fibrosis (a permanent hardening of the tissue) or a seroma (pocket of serum) can form. Many doctors prescribe Lymph Drainage Therapy after liposuction to make sure their patients get the best possible results from their procedure.
Q: But...is it REALLY worth investing several hundred dollars on Manual Lymphatic Drainage sessions after I've already spent money on my procedure(s)?
A: Manual Lymph Drainage is an up-and-coming modality. Do not simply choose the first practitioner you come across. Shop around and ask question.
Many massage therapists haven't attended classes specifically for lymphatic drainage, much less post-op lymphatic drainage - which requires additional knowledge & training (they learn from YouTube or other websites.)
This does not provide the client with true MLD and can even cause more damage as many therapists use pressure that is too deep, which will increase the swelling. It's advisable to work with a therapist who has an in-person training certificate to ensure they know what they're doing.
Additionally, compare the cost of getting Lymphatic Drainage work versus not getting Lymphatic Drainage work.
Odds are, your body will recover either way. But not getting MLD means a longer recovery. - So this means more time off work, more pain medication, drains put in to remove the swelling, and possible future surgeries to remove fibrosis tissue. All of which would easily add up to at least several thousand dollars. The less invasive, less risky, and clearly less expensive choice is to budget for MLD sessions and invest in your recovery.
Q: How many treatments will I need?
A: There are many different things that can influence healing - including your procedure, lifestyle, circumstances, & how your body responds,
Some patients get 1-6 treatments post-operatively and that is enough, especially if the only area of liposuction was the legs, knees, or flanks. Or if you've had a face or neck lift, or breast lift - swelling tends to subside a little more quickly that someone getting 360 Lipo. People getting liposuction to the abdomen may find they require up to 12 sessions, sometimes more.
Patients who get multiple procedures at the same time (lipo and a tummy tuck, or lipo and a buttock enhancement...Brazilian Butt Lift) may need more sessions than someone who only gets one procedure.
Additionally, if you're someone living with lipedema and are having lipo for lip edema, please know that because lipedema is a fat disease, it has already had some impact on your lymphatic and circulatory system already. - Be patient with your body, as it may have a longer road to recovery that someone who does not have lipedema.
We can discuss a plan for your recovery at the end of the first session, and agree on what might work best for you.
I HIGHLY encourage you not to just get 1 or 2 sessions then stop. You will feel SO much better and will likely be happier with your results if you stick with post-op sessions for a few weeks. So plan ahead and budget for this if you can. Sessions may be paid for individually, or in slightly discounted packages.
It is recommended that you pre-schedule your sessions ahead of time so that you can attend your sessions at times that work for your schedule and so that you can commit to healing & maintaining the results you were seeking with your procedure.
Q: How soon after my procedure can MLD begin?
A: As long as your doctor or surgeon approves, it is possible to begin within 48 hours. Most people wait until they can comfortably drive themselves to appointments. I start working with most clients around 72 hours after their procedure.
Q: It has been over a month since I had my procedure. Is it too late to begin Manual Lymphatic Sessions?
A: Not at all. The healing process after these types of procedures is several months. If it has been over a month since your procedure you can still get the benefits of MLD. If it has been over 6 months since your procedure and you are still feeling lumps and hardness you should contact your doctor to make sure you have not developed fibrosis or a seroma. But ideally, MLD should help reduce the risk of developing either.
Q: So....what about fibrosis & seroma? How do I know if I have one of these? And what do I do about them?
Fibrosis is essentially a hardening of swelling which usually does not develop until the 4 week mark or later. So if you're feeling hardness a week after your surgery, don't panic that's usually just lot of accumulated fluid. And even if you feel some harder, putty-like spots after the 4 week mark - don't panic, we can work with this.
In addition to lymphatic drainage I also offer sessions to address and soften fibrosis. This work is a bit more aggressive; more like scar tissue work that involves kneading and rolling the tissues, followed by lymphatic drainage to flush out the area worked.
While it's not ideal and I cannot guarantee outcomes, it IS possible to get tissues feeling back to "normal" for the most part.
A seroma is more or less, a pocket of fluid that feels like a waterbed when touched. While some surgeons may recommend MLD to help fluid be reabsorbed by the body, if the seroma is small, most will have you return to the office to drain it manually with a syringe.
**Please note: ONLY a surgeon or nurse practitioner can drain a seroma. - No one else (massage therapist, CLT, esthetician, body contourist) is legally licensed to do so, unless they are also a nurse practitioner. Do not risk your health or your life by seeing someone who works outside their scope of practice and says they can drain you. Sepsis is real.**
Your surgeon's office should be the one you turn to if you suspect you've developed a seroma.
Q: I've seen some folks on Instagram having fluid pushed out of their open incisions. Is this something you do?
My post-operative sessions consist of using gentle, Manual Lymphatic Drainage (Vodder Method), with other modalities safe for the body during the post-operative healing process.
I do not offer any sort of work that pushes fluid out of incisions or drains, Nor do I reopen incisions to do so. -- This sort of work is not Manual Lymphatic Drainage but is in fact, referred to as "incisional drainage" by certified MLD therapists.
Be aware that there are also many bad practices that have become popularized through social media. - Massage therapists in North Carolina are not licensed to do incisional massage; as this is outside our scope of practice.
Please do not believe everything you see on social media, there are many people offering post-op treatments that are not within their scope of practice or experience. Some people practicing incisional drainage are trained and experienced in it and are able to do this work because they work directly with a surgeon within their surgical practice. OR (worst case scenario) they are doing this work illegally or without training. Please do your research and ask questions.
This information is not intended to criticize all practitioners who practice this technique, but more to clarify the differences between the two services.
My personal opinion?:
------There is no other surgery that I can think of in which anyone recommends reopening a wound or incision, except in cases of infection. SO why in the world has this become acceptable in the post-op and cosmetic surgery world? It doesn't make logical sense to me, and in most cases causes more inflammation to the wound, increases the probability of atypical scar tissue, and increases chances of infection.
Q: I might need help with my compression garments. I'm not sure if they're compressing me enough or fitting me the right way. Can you help?
I can definitely help you reassess your garments and compression. I have some experience with foams, boards, & fajas and am always trying to learn about improving compression for my clients. I can sometimes help during the course of your consultation or session, depending on your needs. But I can also make recommendations if there's something I can't supply in office.
General FAQ About Lymphatic Massage:
Q: What exactly is the Lymphatic System and what does it do?
A: 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.
Q: What is a Manual Lymphatic Drainage treatment like?
A: The atmosphere is the same as a massage treatment room with dim lighting and soft music. Although you are in a massage setting, it is important to understand that MLD is a specific form of bodywork designed to efficiently move lymph fluid in your body.
MLD is completely different from a deep tissue, Swedish or relaxation massage that you may be expecting or have had in the past. Treatments involve a very light touch that (though it may not seem so) is extremely effective in reducing swelling and discomfort.
Like a typical massage therapy session, a client receiving an MLD treatment undresses when the therapist leaves the room, lays on a massage table and is covered by the sheet and blanket - and only the areas being worked will be uncovered/undraped.
Gentle rotating, pumping motions with the therapist's hands and fingertips begin at the collarbone area, then focus on areas where there is a concentration of lymph nodes...the underarms, abdomen, groin (along the crease of the leg), and back of the knees.
Usually, the session begins with the client lying in the face-up position because all of the areas of lymph nodes that need to be decongested are located on the front of the body. Starting on the back (even for fat injections to the buttocks) would not be indicated because it is necessary to open up the major lymphatic areas on the front of your body before the backside of the body can drain. It is very 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 up first increases the discomfort and overwhelms the nodes, leading to increased recovery time.
Increasing the blood circulation with deep massage and heat can actually inhibit the movement of lymph fluid by changing the permeability of the lymph and blood vessels.