What to Look for in a "Post-Op Massage" Provider

The short answer is someone who is trained to treat lymphedema and has training or knowledge in how plastic surgeries affect the anatomy and physiology of the lymphatic system and skin.

First, let me be clear - plastic surgery procedures are significant and invasive procedures that come with a host of precautions and possible complications. This is true of most major surgeries and plastic surgery is MAJOR. Just like after most surgeries, the best care will be from licensed medical professionals which should include a physician and possibly other professionals such as a nurse, physical therapist, occupational therapist, massage therapist, and more. They should hold a license from their state department of health or equivalent governing body. If your plastic surgeon is not local for you, I HIGHLY recommend that you establish a relationship with a local physician or nurse practitioner before your surgery who can direct your care after surgery should you have any issues.

All surgeries and traumas cause edema to varying extents. This edema is excess fluid the body produces as part of the natural inflammatory process in response to trauma. This excess fluid is a form of protein-rich fluid that must be removed from our tissues by our lymphatic system. As a result, this edema can be considered lymphedema because it is actually fluid that must be absorbed and processed by the lymphatic system. The lymphatic system is a system of specialized vessels and lymph nodes that has both a circulatory function (fluid removal and transportation) as well as an immune response function. The techniques needed to activate this system are very specific. They improve lymphatic system function and efficiency as well as redirect fluid from areas of damaged lymphatic vessels or nodes. This last part is very important. They also assist in allowing the lymphatic system to regenerate in a functional manner (in the absence of significant scar or fibrotic tissue).

Basic manual lymph drainage techniques can be used to effectively treat most forms of edema, but more specialized techniques (often called re-routing techniques) are needed to treat edema in the presence of a damaged lymphatic system. Liposuction damages and strips lymphatic vessels, and long incisions sever vessels. Some procedures actually change the anatomy of the lymphatic system and the direction of lymph flow. The most notable example of this is how a tummy tuck changes our lymphatic system anatomy in our lower abdomen. This understanding is needed because a practitioner needs to know how to change lymph drainage techniques to accommodate this change and make treatment safe and effective.

The system we have used for decades to treat lymphedema is called Complete Decongestive Therapy or CDT. The four components of CDT are compression, manual lymph drainage (MLD), skin care, and movement.

To recover the fastest and to prevent the most complications following plastic surgery, you need someone trained to treat your lymphatic system... in other words someone trained to treat the medical condition of lymphedema. This is not the same thing as being trained in "lymphatic drainage massage," "lymphatic massage," or "post-op massage." It is not even the same thing as being trained in just MLD.

There has been a big surge in practitioners, primarily massage therapists but also unlicensed persons, entering the market of post-op plastic surgery care. "Training programs" for post-op care are popping up every day as people try to capitalize on this growing industry. Licensed Massage Therapists (LMTs) are given the false impression that they have the required skills needed to treat post-op lymphedema from their initial massage therapy training or from courses in general stimulation of the lymphatic system, post-op massage, medical massage, or body sculpting. Unfortunately, this is not the case.

The industry of non-invasive body sculpting and application of incisional techniques used in countries outside of the USA have morphed into techniques being called lymphatic drainage or lymphatic massage. These are not the same thing as the use of MLD as part of CDT to treat the medical condition of lymphedema - which is what we get following most plastic surgery procedures. Let me be clear that post-op lymphedema is not the same thing as the disease of lymphedema. The disease of lymphedema is a complicated, permanent condition that requires lifelong management. Post-op lymphedema is a temporary condition that should resolve within 6-12 weeks depending on many factors including volume of lymphatic vessel damage. Effective aftercare, however, speeds up the process of healing and recovery significantly. See the article on Benefits of MLD for more information. Appropriate treatment with MLD will help the body remove fluid and waste faster, relieve pain, decrease infection risk, speed healing, prevent fibrosis, reduce scar formation (build up of fibrotic nodules or hard lumps), and improve skin texture and tone. It also ensures your damaged lymphatic system regenerates in functional manner so that you will not have an issue with prolonged or permanent swelling. The similarity between temporary post-op lymphedema and the disease of lymphedema is that the same treatment techniques are highly effective for both. We have been using and refining them since the 1930s.

The best practitioner to assist you with hands-on techniques (MLD and "fibrosis" techniques) and compression management following plastic surgery is a certified lymphedema therapist (CLT) with additional training and/or knowledge in how to use and adapt the techniques following plastic surgery. The Academy of Lymphatic Studies (ACOLS) is one of the top organizations that trains CLTs and practitioners in manual lymph drainage (MLD). There are other good schools as well that are listed below. ACOLS now offers an advanced course for CLTs and MLD providers in providing MLD and compression management specifically for recipients of plastic surgeries to include tummy tuck, liposuction, BBL, breast surgeries, mastectomy, vaginoplasty, and vaginal rejuvenation. Training as a CLT or in advanced application of MLD to plastic surgery procedures may also include training in several other appropriate post-op modalities such as high-frequency, non-focused ultrasound, negative pressure (negative compression/suction), and kinesiology taping. While radio frequency may help with some non-invasive body sculpting techniques, it is not an appropriate post-op choice.

Unfortunately, someone trained in just MLD (or not trained in MLD at all) is not qualified to help post-op plastic surgery clients in the first 6-12 weeks with hands-on techniques. Additional training or equivalent experience is required. Nurses, physical therapists, and occupational therapists may be able to offer additional needed services such as wound care or return to activity consultation, but they also need training in lymphedema management or work with a CLT or advanced MLD practitioner for comprehensive care. A good practitioner would also be someone certified in the classic techniques of MLD AND also trained in advanced techniques, rerouting, and medical precautions related to post-op plastic surgery care.

Finding a provider trained and skilled to use manual (massage) techniques to assist your recovery may not be enough. You may also benefit from services from other healthcare professionals such as nurses or physical therapists for wound and drain care. Nurse practitioners may also be able to provide additional services of medication management and IV support. These services should be performed by licensed healthcare practitioners and these services should also be within their legal scope of practice. A massgae therapist may be trained to remove drains, but it is not within their legal scope of practice to do so. Post-op plastic surgery care is a subset of the medical field. It requires specialized training, but it is still medical care, not spa or non-invasive body sculpting care. Neither is it new or novel.

I sincerely urge you to seek a practitioner who is a CLT. These providers will also typically be medical professionals: RN, NP, OT, COTA, PT, PTA, MD, DO, ATC, DC or Massage Therapists who have completed 500 massage school hours and/or National Therapeutic Massage and Bodywork Certification. Most, if not all, of the reputable lymphedema certification programs require one or more of these licenses. While most CLTs have the skills to adapt MLD and compression techniques to post-op plastic surgery, additional training and/or knowledge is extremely helpful. So far, the most reputable and long standing organization to develop a course to specifically adapt MLD to post-op plastic surgery is the Academy of Lymphatic Studies (ACOLS) with their course on Advanced MLD Management of Post Plastic Surgery Procedures (MLD-PS). Other training programs may also provide this knowledge in addition to other useful topics.

Keep in mind that while many Estheticians (or Aestheticians, which is the same thing in Florida) perform non-invasive body sculpting, they are not licensed by the Department of Health as a healthcare profession. In Florida estheticians are licensed by the Department of Business and Professional Regulation under the category of cosmetology. Phlebotomists are also entering the arena of post-op plastic surgery care, but they are not licensed at all in the state of Florida.

The next best type of practitioner would be someone certified in MLD AND has training in how to adapt MLD to post-op plastic surgery with the ACOLS's MLD-PS course or similar. Again, additional training programs may also provide information on other useful topics. Practitioners certified in MLD usually have the credentials of MLD-C or CMLDT and are usually required to be a licensed healthcare practitioner. These are the credentials used by the major lymphedema training programs. Be very wary of practitioners whose ONLY training in post-op care is through one of the many practitioner developed programs. Examples include programs offered by Kathleen Lisson, Taime Out Sculpting Institute (TOSI), Petra Erving, Shannon Goins, and more. Unfortunately, most of these are not endorsed by any credible lymphedema training organization. Be wary of practitioners whose only training is in "surgery massage," "post-op massage," "lymphatic drainage massage," "lymphatic drainage techniques," "lymphatic drainage therapy (LDT)", incisional drainage," or body sculpting. I encourage you to ask for credentials and how the practitioner obtained those credentials. A weekend program is NOT enough.

Other schools recognized by the Lymphology Association of North America (LANA) that offer comprehensive training for CLT certification include:

Brennan School of Innovative Lymphatic Studies

Dr. Vodder International School

International Lymphedema & Wound Care Training Institute (ILWTI)

Klose Training

LymphEd, LLC

Monarch Continuing Education

Norton School of Lymphatic Therapy

Toronto Lymphocare Training

University of Wisconsin