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Benefits of Postoperative Manual Lymph Drainage (MLD)

Updated: May 28

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)

  • Reduces fibrosis


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

  • Stimulation of the venous return and lymph flow improves dermal perfusion & reduces side effects such as cutis marmorata, thinning of the skin, and ulceration

  • Reduction in fibrosis (decreases tendency of fibrotic tissue formation via reabsorption of protein)

  • Stimulation of the immune system

  • Improved cellular nutrition & tissue recovery

  • Improves reabsorption & promotes drainage of accumulated fluid

  • Removes waste products of cell metabolism

  • Analgesic through accelerating drainage of nociceptive substances

  • Analgesic through "gate-control" & reduction of perineural edema

  • Increase in local sympathetic response

  • Increase in general parasympathetic response (soothing / relaxation effect)

  • Stimulates lymphangiomotoricity

  • Improves activity of lymph vessels

  • Reverse of lymph flow

  • Creates suction effect on distal collectors

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.


Additional Modalities


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

  • Orthopedic injuries

  • CVI

  • Venous leg ulcers

  • Neurological diseases

  • Autoimmune diseases

  • Autism

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.


Research-Manual-Lymphatic-Drainage-An-integral-Component-of-Postoperative-Care
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Sources


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


Clodius, L. "JE Zuther: Lymphedema management: comprehensive guide for practitioners, Thieme, Stuttgart, New York 2005, Hard cover, pp 270 (ISBN 3-13-139481-1), $110.00 USD." (2005): 376-376.


Ebert, Jay R., et al. "Randomized trial investigating the efficacy of manual lymphatic drainage to improve early outcome after total knee arthroplasty." Archives of physical medicine and rehabilitation 94.11 (2013): 2103-2111.


Pichonnaz, Claude, et al. "Effect of manual lymphatic drainage after total knee arthroplasty: a randomized controlled trial." Archives of physical medicine and rehabilitation 97.5 (2016): 674-682.


Hong Zhang, J. Y. "Manual Lymphatic Drainage Therapy in the Knee Joint Functional Rehabilitation After TKA in Diabetic Knee Osteoarthritis Patients: A Randomized Clinical Trial." (2019): 50-56.


Majewski-Schrage, Tricia, and Kelli Snyder. "The effectiveness of manual lymphatic drainage in patients with orthopedic injuries." Journal of sport rehabilitation 25.1 (2016): 91-97.


dos Santos Crisostomo, Rute Sofia, et al. "Manual lymphatic drainage in chronic venous disease: a duplex ultrasound study." Phlebology 29.10 (2014): 667-676.


dos Santos Crisóstomo, Rute Sofia, et al. "Influence of manual lymphatic drainage on health-related quality of life and symptoms of chronic venous insufficiency: A randomized controlled trial." Archives of physical medicine and rehabilitation 96.2 (2015): 283-291.


Molski, P., et al. "Patients with venous disease benefit from manual lymphatic drainage." International angiology 28.2 (2009): 151.


Molski, Pawel, et al. "Manual lymphatic drainage improves the quality of life in patients with chronic venous disease: a randomized controlled trial." Archives of medical science: AMS 9.3 (2013): 452.


Crisóstomo, R. S. S., M. S. Candeias, and P. A. S. Armada-da-Silva. "Venous flow during manual lymphatic drainage applied to different regions of the lower extremity in people with and without chronic venous insufficiency: A cross-sectional study." Physiotherapy 103.1 (2017): 81-89.


Szolnoky, Győző, et al. "Adjunctive role of manual lymph drainage in the healing of venous ulcers: A comparative pilot study." Lymphology 51.4 (2018): 148-159.


Samuel, Vimalin, et al. "Manual lymphatic drainage in chronic venous disease: A forgotten weapon in our armory." Indian Journal of Vascular and Endovascular Surgery 5.4 (2018): 266.


Sun, Bao-Liang, et al. "Lymphatic drainage system of the brain: a novel target for intervention of neurological diseases." Progress in neurobiology 163 (2018): 118-143.

Schwartz, Noa, et al. "Lymphatic function in autoimmune diseases." Frontiers in Immunology 10 (2019): 519.


Antonucci, N., S. Pacini, and M. Ruggiero. "Manual Lymphatic Drainage in Autism Treatment." Madridge J Immunol 3.1 (2018): 69-72.


Ruggiero, Marco. "Clinical experience of integrative autism treatment with manual lymphatic drainage." EC Neurology 11 (2019): 21-28.

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