Manual Lymphatic Drainage

You just had a medical procedure done. Wouldn’t you want your clinician to have medical expertise while providing the necessary Manual Lymphatic Drainage in your post-operative recovery? Manual Lymphatic Drainage (MLD) is a methodical and gentle skin stretching technique using a variety
of specialized and careful rhythmic pumping on the skin to move lymphatic fluid through the lymph pathways, and out of the swollen area or limb.

MLD is often recommended by plastic surgeons for recovery. It can assist in decreasing the time of recovery, and reduce swelling and fibrosis, therefore
improving the results. MLD is not a massage and is based on gentle, and constant movements that mimic the rhythm of your body’s lymphatic system.

MLD stimulates lymph nodes and increases rhythmic contractions of the lymph vessels to enhance their activity so that stagnant lymphatic fluid can be rerouted. Keeping the lymphatic system in good condition is imperative to promoting your health, and for restorative purposes when the system has been compromised through events such as illness, surgery, or injury.

There is an increase in abdominoplasty with core liposuction, also known as tummy tucks, which is one of the procedures included in mommy makeovers. While surgery can take several hours the road to recovery can be painful and long for some. Glenn uses a multimodal approach that uses evidence-based research (scholarly articles listed below) that has helped many of his clients heal faster with less swelling and pain that many other therapists do not utilize.

Your face is what the world sees first. Performing Manual Lymphatic Drainage (MLD), post-facelift can markedly improve your healing.

“Glenn was nothing less than perfect. My surgeon did not recommend manual lymphatic drainage despite my swelling in and around my surgery area on my chest. I was unable to sleep for a couple of weeks – grew desperate and pain was intolerable despite taking prescribed medications. Glenn educated me on lymphatic massages [post liposuction from gynecomastia], additional resources to use in my healing process and he followed up by email thoroughly. I am definitely scheduling him again. He’s awesome and I recommend him to anyone who could use his services. Glenn definitely cares about his customers and their well-being.” – Robert R.

Manual Lymphatic Drainage stimulates lymph nodes and increases rhythmic contractions of the lymph vessels to enhance their activity so that stagnant lymphatic fluid can be rerouted.

This is an illustration of normal flow of interstitial fluid from the space between tissues and cells going into the lymphatic vessel. During surgery some of these lymphatic vessels are compromised and even damaged resulting in fluid backup and

FIBROSIS:

Our bodies are amazing – When we succumb to an injury, including during surgery, cells rush to the area to help stabilize the tissue. If the body is healing normally, overtime these cellular debris are gently removed, and our bodies normal functions are restored. This natural response is a very good thing because it helps to protect us from further damage.

Different hand strokes on your skin directs the excess fluid from your body to the lymph areas. There is a systematic process that Glenn will use to help your body go through to efficaciously drain the fluid to move in a specific direction. Remember wearing your Faja or compression garment is advisable if you continue to experience edema or whatever your surgeon has recommended you to do.

Post-surgery, lymph flow can be compromised, and the accumulation of these stabilizing cells can be significant, causing lumps to form, known as fibrosis. These lumps may become visible, or you may feel them to the touch. Sometimes, they can restrict motion,
and cause a feeling of tightness.

MLD can prevent or greatly reduce fibrosis, as it helps to drain fluid buildup and break down the accumulation cell debris, proteins, and waste products.

“I had a BBL (Brazilian Butt Lift) surgery and I needed to have as many Manual Lymphatic Drainage sessions as possible to get good results. Am glad I landed on Glenn. He knew what exactly I wanted and how it should be done. I scheduled MLD with him and he did a great job. He helped me so much to bring down the swelling.
Thank you Glenn.” – Fausta N.

SCARRING:

As scar tissue forms, the proper function of lymph vessels can be affected. This results in prolonged swelling, numbness and pain. Scarring will naturally diminish over time as the tissue gradually heals itself, although this process can be long, and some scarring can take 6 to 12 months to resolve. MLD helps to heal the damaged lymph vessels. Over time pathways can be restored in scars and adhesions. This results in proper healing and flow.

Your orthopedic surgeon may recommend MLD post-surgery to alleviate and expedite your healing and pain management after your knee or other types orthopedic surgery, e.g., total hip repalcement.

Below we answer a few common questions:

What makes Glenn’s techniques different from other therapists?

He has created his technique called TISSUES (Therapeutic ultrasound and manual lymphatic drainage Improves Surgical site Swelling Ultimately Enhancing wound tissue healing generating Swift post-operative recovery).

Using the latest research to guide his clinical practice his patients are astonished by the recovery time using non-surgical and non-invasive techniques.

Here are a few scholarly articles that guide his clinical practice:

https://journals.sagepub.com/doi/epub/10.1177/0748806819874941
A March 2020 article from The American Journal of Cosmetic Surgery took 20 women who had abdominoplasty (tummy tuck) with core liposuction noted that “receiving MLD after abdominoplasty and core liposuction reduced edema more than the standard compressive garments, but not by a statistically significant amount [due to the small sample size of 20 women].”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4075221/
A January 2014 article from the Indian Journal of Plastic Surgery took 18 women who had abdominoplasty and/or liposuction to the abdomen and flank areas which tissue fibrosis had developed then used Manual Lymphatic Drainage (MLD) and Therapeutic Ultrasound (TUS) on the experimental group. The conclusion of the study found that “MLD and TUS reduced swelling and tissue fibrosis and made pain disappear in the liposuction and abdominoplasty with core liposuction in the post-operative period.”

https://www.scielo.br/j/rbcp/a/MDkVHrKZrp4vN9BfpC3qwCd/abstract/?lang=en
A June 2021 Revista Brasileira de Cirurgia Plastica (Brazilian Journal of Plastic Surgery) took 20 female patients who has liposuction and abdominoplasty and found that the experimental group that had lymphatic [kinesiology] taping “found that it reduced or annulled the formation of ecchymosis in the postoperative period, contributing to the decrease in the number of physical therapy visits, the incidence of pain and thus accelerating the reestablishment of patients from abdominoplasty and/or liposuction surgeries.”

https://plosjournal.deepdyve.com/lp/wolters-kluwer-health/anti-inflammatory-and-healingeffects-of-pulsed-ultrasound-therapy-on-K01hqf2xR2?impressionId=5da98489a8a0f&i_medium=docview&i_campaign=recommendations&i_source=recommendations
A January 2020 article from The American Journal of Physical Medicine & Rehabilitation looks at how Therapeutic Ultrasound using pulse settings impacts the formation of fibroblasts (the specialized cells that results in fibrosis) and showed that “low-intensity
pulsed ultrasound therapy had a biostimulatory effect on semi confluent in vitro L929 fibroblast cells, where the group with a dose of 0.2 W/cm2 presented higher responses, in all the analyzed aspects, toward the dose pulsed to 20%, confirming its therapeutic
properties related to the initial phases of tissue healing.”

(Please request a doctor’s order for Manual Lymphatic Drainage and Therapeutic Ultrasound prior to scheduling a visit if you would like to be seen).

Is Manual Lymphatic Drainage painful?
MLD is not painful. A lymphatic drainage performed by Glenn, will be soothing, gentle, and relaxing.

When should I start?
Please consult with your physician, but for best results, MLD should be started immediately post-surgery. Based on anecdotal evidence with patients receiving MLD with various methods I would used compared with patients waiting 4-6 weeks post-operation for MLD to begin in which fibrosis would have settled in, doing just MLD would not be appropriate. At that later stage in the post-operative healing, e.g., post-op week 4-6, for example, fibrosis management massage therapy is then the recommended course of treatment.

How many sessions will I need?
This depends on the type of surgery you had. Glenn will do a consultation with you beforehand, to help you determine this. For liposuction surgeries, damage can be rather extensive to the lymphatic system. To fully re-establish healthy lymphatic flow, a several
week regimen may be in order.

 If we are dealing with liposuction fibrosis, aka “lumps and bumps”, at least eight sessions are recommended.

Kinesiology tape, or K-tape, used in conjunction with Manual Lymphatic Drainage is proven in managing edema and post-operative recovery. Safe to shower with, K-tape usually stays on for three to four days.

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Are there other supportive techniques that can help manage the swelling in between sessions?

Kinesiology Taping or K-tape can increase the lymphatic drainage benefits of your treatments to decrease bruising and swelling, which will help speed up recovery and decrease post-operative edema.

Therapeutic ultrasound can also used, once it is cleared by your surgeon, to help with blood flow and healing while managing pain and edema. It is used alongside MLD during your treatment session.

Therapeutic Ultrasound also helps with angiogenesis (the formation of new blood vessels). The Focused Ultrasound Foundation states about the use of ultrasound and how it can impact angiogenesis:

“Angiogenesis – The mechanical effects of focused ultrasound can interact with endothelial cells in a manner that induces angiogenesis – the process through which new blood vessels form from pre-existing vessels.1,2

This interaction causes the release of various angiogenic factors such as IL-8, bFGF, eNOS, and in particular VEGF.3,4 Microbubbles can be used to enhance this effect, and VEGF expression has been found to be positively correlated with the concentration of microbubbles administered.5,6 Possible mechanisms for this effect include intercellular communications with the endothelium and nearby cells4 and the activation and infiltration of immune cells that are capable of inducing neovascularization.7,8

Angiogenesis therapies have commonly been used in the treatment of chronic wounds, peripheral arterial disease, and ischemic heart disease.4,5 The drawbacks of current angiogenesis treatments for these disorders include invasiveness and non-specificity.5 Focused ultrasound may be able to overcome these obstacles by providing a non-invasive and targeted means of inducing angiogenesis.” (https://www.fusfoundation.org/the-technology/mechanisms-of-action/angiogenesis)

The connecting dots with your post-surgical swelling, the use of therapeutic ultrasound, and recovery is highly dependent on the formation of blood vessels to bring in valuable nutrients and oxygen to your healing cells while also removing waste products and dead cellular debris. Expediting and establishing vascularity to your surgical site as soon as possible will allow you to heal faster and have less unwanted effects: pain, scar tissue, and liposuction fibrosis.

Contact Glenn for your consultation and start receiving the benefits of MLD massage to improve your surgical results.

“Glenn was very professional, informative, clean, gentle and extremely hands-on. I will definitely book him again and recommend him to all my friends. He does great MLD and takes his time with each area of concern.” – Tiffany C.

Plastic Surgeons I have worked with:

1. Dr. Usha Rajagopal (https://www.sfcosmeticsurgery.com)
2. Dr. Karen Horton (https://www.drkarenhorton.com)
3. Dr. Kenneth Bermudez (https://www.plasticsurgery-sf.com)
4. Dr. Michael MacDonald (https://www.plasticsurgery-sf.com)
5. Dr. Barry Weintraub (https://www.drbarryweintraub.com)
6. Dr. Alexander Facque (https://www.genderconfirmation.com)

Additional Educational Links:

1. https://www.lipotherapeia.com/the-peach-factor-blog/fibrosis-after-lipo
   A London, UK company that breaks down in understandable language what is happening with your tissues as it heals during the wound healing process after liposuction.
2. https://www.youtube.com/watch?v=hpMFI7UPwMo
   Dr. Tim Watson, is a PhD of physical therapist and professor based in the UK. He is a world expert in electrophysical modality agents, specifically in the role of therapeutic ultrasound (TUS) and its impact in wound and tissue healing. The video above discusses how TUS (briefly) impacts the inflammatory process so wound and tissues can then progress into the next phase of healing which would be the proliferation stage.
3. https://www.youtube.com/watch?v=axzfN-PJuFU
   Kathleen Lisson, is a CMT and expert on post-operative massage especially for patients who have undergone plastic surgery. She has a high presence in both YouTube and on Instagram providing educational videos on everything post-operative plastic surgery, e.g.,
   managing liposuction fibrosis, specific garments to wear, diet, dos and don’ts post-surgery, etcetera.
4. https://www.youtube.com/watch?v=lICxOlYYa8E
   The Aspen After Surgery Center focuses on all different forms of healing and education for
   post-plastic surgery patients. The above video discusses the prevention, formation, and
   treatment solutions for liposuction fibrosis.