Benefits of Postoperative Manual Lymph Drainage (MLD)
Updated: Feb 6
Written by Margaret Latham, MA, PT, DPT, CLT-LANA, ALM, MLD-PS
In their book High Definition Body Sculpting, Doctors Hoyos and Prendergast recommend manual lymph drainage (MLD) in the Vodder style beginning on post-op day 3 as part of the CARE (Cosmetic Active Recovery) System of Postoperative Care.
Benefits of the CARE System Include
Activates lymphatic circulation
Improves blood circulation
Enhances immune system function
Stimulates the parasympathetic nervous system (nervous system sedation / relaxation effect)
Promotes healing processes (reduces hypertrophic scars and keloids)
Why is MLD is Important
Speeds up the healing process by reducing swelling, fluid retention, and bruising
Increases the removal of cellular debris and other waste products from the traumatized area
Prevents fibrosis (development of thick, fibrous scar tissue under the skin as well as reduces swelling and bruising)
Reduces scar formation & buildup of fibrotic nodules (hard lumps)
Improves skin texture, appearance and tone by boosting healing responses
Decreases the risks of infection by improving the immune response
Decreases pain, sensitivity, and touch-avoidance by speeding healing
Provides a gentle and pleasant manual technique to support relaxation and relieves stress
The Specific Effects of MLD
Other Components of the CARE System of Recovery
External ultrasound (US)- Non-focused, continuous US waves at a frequency of 3-3.3 MHz provide cavitation and heat to the tissues which can reduce pain and inflammation and prevent the development of fibrosis. However, care must be used as the introduction of heat can increase lymphatic load. Training and skilled judgement are required for effective use of US within a practitioner's scope of practice to ensure effective use through selection of parameters and effective area. Use of US may begin 4-24 days post-op depending on client presentation.
Pressotherapy - Use of pneumatic compression can serve as an adjunct to MLD in assisting lymphatic and venous circulation. It is not a substitute for MLD.
Energy based therapies - After a course of MLD is completed over a period 3-12 weeks and tissue edema is well controlled, other energy based therapies may be introduced to help smooth and soften contours, improve cellulite, shrink fat cells, and tighten skin as needed. Devices may include radio frequency (RF), infrared light, vacuum, rollers, extracorporeal shockwave therapy (ESWT), or combinations of these. Dr. Margaret recommends waiting until compression is no longer needed to manage swelling before incorporating these modalities so that lymphatic load and tissue fluid is not increased.
Diathermy - Another deep heating modality which can increase circulation and decrease pain. It has largely been replaced by US in clinical practice. Again, use of this deep heating modality needs to be used judiciously so that lymphatic load is not increased while edema is still being managed.
Wet heat - Moist heat packs (MHP) may be beneficial to areas where superficial liposuction under thin skin is used to promote skin retraction due to the increased risk of fibrosis in these areas. Again, care must be used in order to prevent an increase in lymphatic load.
Carboxytherapy - This is the injection of filtered carbon dioxide gas into the tissues (by a physician) to stimulate tissue oxygenation and improve the microcirculation of the tissues and quality of the skin. It is indicated for use for cellulite, striae, skin laxity, fibrosis, and post-liposuction adhesions.
Negative pressure (compression) - The use of light suction (e.g. Lymphatouch) may be used as an adjunct to MLD in the direction of lymphatic flow to stimulate uptake of edema by the lymphatic system.
Kinesiology Taping - The use of elastic taping to apply a gentle lift on the skin to allow the lymphatic vessels underneath to absorb and drain lymphatic fluid from an edematous area. It helps to redirect the fluid from a congested area to an area with sufficient lymphatic flow.
MLD Improves Outcomes for Other Edemas and Surgical Protocols
The benefits of adding MLD to all forms of edema and surgical protocols has been shown to improve outcomes for
Total knee replacements
Venous leg ulcers
MLD Shortens Recovery Period
A 1999 study presented at The First Annual Conference of the American Society of Lymphology found that MLD (as part of Decongestive Therapy) and fibrosis mobilization techniques as needed significantly shortened the recovery period following plastic surgery procedures. The postoperative recovery phase decreased to 6 weeks to 3 months as compared to 9 to 18 months without treatment. The following is a summary of the study.
Hoyos, Alfredo, and Peter M. Prendergast. High definition body sculpting. Springer-Verlag Berlin An, 2016 (Chapter 19 - Postoperative Care, pgs 364 -387)
Academy of Lymphatic Studies Advanced MLD - Management of Post Plastic Surgery Procedures Course Manual, 2022
Academy of Lymphatic Studies Advanced Lymphedema Management Certification Course Manual, 2020
Academy of Lymphatic Studies Complete Lymphedema Certification Course Manual, 2019
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