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Guide to Post-Operative Manual Lymphatic Drainage Therapy

Phuong Tran, LMT, BCTMB, CLT, MLD-C, NBCR

One of the most important components of the post-operative recovery process is choosing a properly-trained and experienced hands-on therapist who knows not only how to safely and effectively reroute protein-rich lymph fluid but also how to break up and reduce fibrosis. Your hands-on therapist should also be able to answer any and all of your post-op manual lymphatic drainage questions in person, over the phone or by email. Our in-house hands-on therapist, Phuong Tran, has extensive condition-specific training and certification both as a licensed massage therapist (LMT) and as a certified lymphedema therapist (CLT).

Phuong is well-versed and proficient with the Vodder Technique. This is regarded as the gold standard for pre-operative and post-operative manual lymphatic drainage. It incorporates purposeful, rhythmic skin pulling techniques precisely applied in specific sequences. What sets Spawell Massage apart is the use of Complete Decongestive Therapy (CDT). CDT is the hands-on component used by Certified Lymphedema Therapists. CDT goes a step further and uses a combination of additional manual techniques and intricate lymphatic pathways to connect the superficial and sub-fascial lymphatic systems together to optimize the flow and return of post-operative lymphedema back to your venous system. What's more, as much as post-op patients would love for their bodies to recover and normalize in a symmetrical and balanced manner, more often than not, the body will not bruise uniformly, it will not collect lymphatic fluids uniformly and thus it will not heal uniformly. Again, this is where the combined skills and experience of an LMT with Board Certification in Therapeutic Massage and Bodywork (BCTMB), Manual Lymphatic Drainage Certification (MLD-C) and a Certified Lymphedema Therapist (CLT) become an invaluable asset to your recovery process.

After cosmetic surgery the body undergoes numerous changes some of which include swelling, seroma leaking, heaviness, tightness, fibrosis (thickening or scarring of connective tissue) and small scars caused by cannulas and drainage holes. What's more, there are several significant lifestyle modifications that need to be taken into consideration during your recovery process. These include the following:

(1) Modifications to sleeping and resting positions (aside from the physical discomfort from the actual surgery itself, disruption to sleep is the biggest complaint our clients mention at our office!)

(2) Temporary but prolonged changes to posture

(3) Modified seating positions such as when traveling in an automobile, plane or sitting at a desk

(4) Altered breathing patterns attributed to compression garments, tissue tightness, pain and tenderness

(5) Modifications on how you shower, bathe and go to the bathroom

(6) Extended interruptions to your exercise regimen

We take all of these factors into consideration when you receive post-op therapies at Spawell Massage. We identify common post-op dressings such as bandages, drainage tubes, surgical tape applications, staples, stitches and lymphatic drainage tape. We then determine the most appropriate positioning options and hands-on techniques for you. Some clients prefer to stand and lean against the treatment table while other clients prefer to lie down on our electric height-adjustable tables with specialized bolstering- this way no pressure is placed on the buttocks for clients who have recently undergone BBL surgery. We also have clients who prefer a side-lying position while others are more comfortable kneeling on the table. We find that over time, as the body heals and recovers, positioning and bolstering preferences may change. We will do our best to ensure that the safest and most comfortable positioning and bolstering options are made available to you.

An ideal treatment plan will include 3 main components:

1. Fluid Drainage- facilitate and expedite the body's own ability to move an increased lymphatic load (swelling). Surgical procedures interfere with the body's fluid equilibrium. Manual lymphatic drainage massage will help your body restore this equilibrium.

2. Fibrosis and Texture Reduction- we perform light yet extremely precise, repetitive and rhythmic manual techniques to break up and smooth out uneven lumps & bumps. Foam boards and inserts are commonly used underneath compression garments for body contouring but, with such use, concentrated regions and pockets of dense fibrosis may develop. Proper MLD and CDT techniques performed on a consistent schedule will help you achieve smoother and more uniform tissue texture when such foam boards, inserts and compression garments are used.

3. Speeds Up the Healing Process- tissue composition changes dramatically after surgery. Liposuction regions often become soft, loose, slack and extremely tender and may exhibit fibrosis and uneven texture as swelling and inflammation subsides. Areas that receive fat transfer generally cannot be manipulated for a minimum of 4 weeks post surgery- these areas exhibit less swelling but do develop fibrosis as the fat settles and remodels into the tissue. MLD and CDT will help break up this fibrosis and unevenness. MLD and CDT also helps tissue regain its firm and taut composition which in turn increases blood flow- better blood flow translates to better healing.

Altogether, postoperative manual lymphatic drainage therapy and complete decongestive therapy accomplishes several important functions:

(1) Increases the lymphatic fluid transport rate

(2) Develops new routes toward less congested regions

(3) Serves as a vital holistic component for pain management

(4) Facilitates the body's natural process of breaking down protein deposits

(5) Mechanically breaks up fibrotic tissue

After your cosmetic procedure, it is vital to your recovery to start a consistent MLD and CDT regimen for the first 4 weeks at a minimum. We are able to start MLD and CDT as early as 24 hours after your procedure. During the first week, edema/swelling reduction is the primary focus. From thereon, we blend MLD and CDT with additional manual techniques to begin breaking up pockets of fibrosis. In some areas it may feel like crunchy sheets of miniature bubble wrap- we typically find this in the areas between the navel and the front of your hip bones, below the ribs and below the sternum. For some, if MLD and CDT is not performed on a regular basis, circulation becomes compromised and pockets of tissue may even develop a dense clay-like texture. Typically, it takes approximately two sessions to normalize these dense and congested regions.

In addition, certain muscles and muscle groups along postural and kinetic chains are undergoing quite significant changes in a short amount of time and, thus, are in need of skilled and purposeful hands-on therapy. So, starting around the 3rd week, we incorporate myofascial work to help clients alleviate tightness and trigger points that may develop from new holding patterns and postural changes.

We recommend coming in for an introductory session to determine if our work meets your expectations and if so then starting a recovery regimen of one to two sessions per week for as long as swelling remains and one session each week thereafter until fibrosis and uneven texture normalizes- we have seen very successful results for our clients in just the first month of MLD and CDT.

For your added safety and peace of mind, your treatment room is equipped with a True HEPA Filter coupled with a UV-C Light to reduce airborne bacteria, viruses and mold spores. Your post-op therapist, Phuong Tran, LMT, BCTMB, CLT, MLD-C is also current with his Moderna vaccinations and Moderna boosters with proof upon request and is masked at all times.

For reference, here is some information about swelling after liposuction. In the book, Bodysculpture: Plastic Surgery of the Body for Men and Women, Dr. Engler says after liposuction, "maximum swelling and bruising - and therefore discomfort - may not occur until 1-3 days after surgery. When bruising starts out relatively deep as after liposuction, it may take longer to peak, e.g., 5-10 days" (2000). In the study titled "Unfavorable Outcomes of Liposuction and Their Management," published in the Indian Journal of Plastic Surgery, Dixit and Wagh (2013) reviewed the cases of over six hundred liposuction procedures and found that "swelling will be apparent within 24-48 hours after the procedure and continues to mildly increase for the first 10-14 days."

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