Manual Lymphatic Drainage Therapy: An Integral Component of Postoperative Care in Plastic Surgery Patients. By Laurie A. Casad, MD FACS; Patricia DePoli, MD [1]
“We see complete resolution of post-operative oedema and fibrosis in patients between 9 months to 18 months following surgery. In the ten groups who underwent MLD and Deep Tissue Massage, post-operative swelling and fibrosis resolved within 6 weeks to 3 months, thereby shortening their recovery significantly."
Lymphatic drainage has been proven to reduce swelling, relieve pain, detoxify the body and speed up the regeneration of tissues and cells. When we look at the common complications of cosmetic surgeries, MLD treatments are performed to address these and ensure a full, speedy recovery. How so? Well first, let’s take a look at the lymphatics.
Our Lymphatics:
An optimally functioning lymphatic system is necessary for health and vitality, but this crucial component is often overlooked, unappreciated or simply not known of by many of us. Our lymphatic system exists as our body’s built-in sanitation centre, the plumbing that filters and rids us of waste products from every living cell, tissue and organ.
It absorbs fat and fat-soluble vitamins from the digestive tract. But most of all, it exists as an essential part of our immune system, maintaining fluid homeostasis, fighting infection and manufacturing disease-fighting white blood cells.
Twice as extensive as the arterial blood supply system, lymph functions as the largest circulatory system in the body. The loss of the lymphatic system would be fatal within a day, so it is essential to keep it flowing. But the lymphatic system needs us. Without an automatic pumping mechanism, like the heart, the lymphatic system relies on our help to move the fluid through the body.
Lymphatic System Back Up:
Lymphatic congestion is a major factor leading to inflammation and disease. In the absence of properly flowing lymph, cells become poisoned from their own waste, forming a toxic cesspool of lymph fluid. Results vary from fatigue, swelling, infection, inflammation and those of figure 1.
So what backs up lymph? A combination of few to several factors may be influential, but not to worry, rapid improvements can be achieved with simple and easy changes and additions.
Figure 1. Signs and Symptoms of a Backed Up Lymphatic System
Lymphatic Drainage in Surgery:
All cosmetic surgeries produce swelling to some extent, since it is a part of the body’s normal healing process. However, some procedures, such as liposuction and abdominoplasty’s (due to their location), disrupt the natural pathways taken by the lymphatic system. Alternative body regions, such as the face and nose particularly, produce swelling so intense that it can persist for anything up to one year.
When the lymph drifts out into surrounding tissue following a surgical procedure, the disruptions to the lymphatics gives rise to a wealth of issues, with swelling being just one. The good news is that there are strategies to combat this, and lymphatic drainage should be at the top of everyone’s list.
So what does treatment look like?
Cosmetic lymphatic drainage comprises 3 phases. The 1st phase would entail a full body lymphatic drainage (MLD) treatment a day or two prior to surgery. It is recommended that at least 1-2 sessions are performed, to prepare the body for surgery, advance the healing process, facilitate the immune system and stimulate the drainage of toxins and excess fluids.
During surgery, well-decongested tissues are easier to see and work on, enabling clean cuts and incisions.
The 2nd phase would likely take place a few days post-surgery, depending on the patient’s response. At this stage, the MLD treatment will predominantly focus on the surgical site(s). Phase 3 comprises a slightly different approach, and can be coupled up with phase 2’s treatment. In this instance, cross friction and deep tissue work around the surgical site helps break up any adhesions that may be forming.
It is now advised to continue MLD sessions as appropriate, to manage the post-operative swelling and bruising in the weeks to follow.
Treatment Benefits and Outcomes:
- Reduction in bruising. It is said that cells are transported by the lymphatic system up to 10 times faster with the addition of MLD. Bruising is therefore able to heal in a fraction of the time, allowing the patient to resume activities of daily living without the worry or need to cover up.
- Reduction in oedema. MLD reroutes lymph fluid to the collateral and viable pathways untouched by surgery, enabling accelerated drainage as opposed to the usual slow trickle of tissue fluids at the operative site.
- Pain management. With a reduced pressure of lymph around the nerves, pain and discomfort are relieved. The treatment also benefits from being painless and relaxing – try not to fall asleep!
- Minimises scarring and prevents fibrosis. The build up of lymph fluids sitting either beneath the incision or within interstitial space can solidify. The formation of scar tissue and fibrotic tissue takes place. MLD prevents the build-up and hence solidification of lymph fluid, leaving a more seamless and less-restricted scar.
- Prevents infection. In this instance, post-surgical MLD is essential when we consider stagnating lymph fluid. It can become an infectious substance and warrant an artificial drain, which is in turn painful, costly and time consuming.
- Stress relief.The treatment relaxes the sympathetic nervous system – helping to relieve stress.
Taking into account the above benefits, it is understandable why the modality is growing in interest and practice by surgeons.
It is necessary to ensure you take the right steps in ensuring a healthy lifestyle post-surgery AND more importantly post MLD treatment - lymphatic drainage is not a forever fix.
Couple aftercare with:
- Hydrate. Drinking plenty of fluids post treatment will ensure you get the best possible results.
- Consume a healthy diet. Nutrient-rich foods will help support your body and healing process from the inside out.
- Move. After surgery, and more importantly after MLD, it may be tempting to stay in bed or be sofa-bound. Movement, such as walking, helps keep your lymph fluid pumping so will only support your healing journey.
If you're looking to incorporate lymphatic drainage treatments into your practice please get in touch with us.