Lymphatic massage, otherwise known as Manual Lymphatic Drainage (MLD), is increasingly being employed to accelerate the recovery of cosmetic surgery patients, including those who have undergone facelift and neck lift surgery. Starting approximately 4 – 6 weeks after surgery, the goal of MLD therapy is to accelerate the resolution of any remaining post-operative swelling. This is based on the concept, albeit with limited evidence supporting it (1), that a significant contributor to post-operative swelling is the fact that the lymphatic drainage system needs time to heal after surgery. After all, swelling is expected after any surgery in the head and neck. Furthermore, swelling is expected to improve and resolve over a period of weeks to months after facelift and neck lift surgery, regardless of the intervention. MLD is believed to improve the flow of lymphatic fluid away from the treatment site(s) while the body is healing. We at Harmon Facial Plastic Surgery have found this to be one of multiple effective treatment options for normal post-operative swelling in our patients. It is important to have a consultation with your surgeon prior to considering any treatment, including MLD.
What is Lymphatic Massage and What Can it Do After Facelift and Neck Lift Surgery?
Dr. Jeffrey Harmon and Dr. Ricci Hoover
Research on the Effectiveness of MLD is Incomplete and Reported Good Results Real but Anecdotal
Almost all the literature on MLD therapy has been on therapy as one component of multi-modality treatment for swollen arms after a mastectomy for breast cancer. A systematic review of the literature including randomized controlled trials (RCTs) utilizing MLD therapy as well as a Cochrane Library review of RCTs concluded that MLD is safe in the treatment of lymphedema after mastectomy. The effectiveness of the therapy was mixed in the studies, partially due to the lack of standardization of methods and outcome measurements (2, 3). The benefits of this therapy in cosmetic surgery are anecdotal and, therefore, will require quality studies to determine its effectiveness definitively. However, the reported benefits from patients and surgeons are such that it is an area of therapy worth exploring, especially because it is a gentle, safe therapy when performed by a trained and certified therapist.
It is Important to Have a Trained, Certified Lymphedema Specialist Perform MLD
It is important that a trained, certified lymphedema therapist perform MLD therapy. A certified lymphedema physical therapist (CLT) is someone who has earned their doctorate in physical therapy and has gone on to become certified in MLD. The certification is a ten-day, twelve hour per day course that includes education on the anatomy and physiology of the lymphatic system as well as the various sequences of manual treatments for lymphatic drainage.
MLD Consists of Gentle Hand Movements Over the Face and Neck
MLD consists of gentle hand movements over the face and neck. There are four major methods of MLD, including the Volder, Foldi, Casey-Smith, and Leduc methods. Each method involves slightly different hand movements. The physiological mechanism of treatment with these methods is poorly studied and, therefore, poorly understood. However, as previously explained, each of these methods has long been implemented in the context of multi-modality therapy for post-mastectomy patients with arm swelling.
There are four total hand strokes and techniques that are used to affect the lymphatic system: stationary circles, pump technique, rotary technique, and scoop technique. A combination of strokes is used in different areas of the body. They can all be used during one treatment session if the practitioner sees fit. However, the primary method used in the head and neck is stationary circles.
The average number of therapy sessions is three to four. The CLT may then teach patients how to perform a modified version of this therapy at their home.
Patients usually feel relaxed during each MLD therapy session. It is normal to feel a cold sensation or tingling where MLD is performed. Patients may also feel tired after treatment.
There are Instances in Which MLD is Not Appropriate
MLD is not appropriate for patients with acute infections, untreated or incompletely treated cancer, cardiac problems including, but not limited to, arrhythmias, or poorly controlled hyperthyroidism.
MLD is One Component of Multi-Modality Therapy for Expected Post-Operative Swelling
It is also important that MLD be only one component of multi-modality therapy to treat normal or abnormal post-operative swelling. One important component of multi-modality therapy is time, as the swelling is secondary to a typically normal healing process that simply requires time to resolve in most cases.
Trust Your Face to a Facial Plastic Surgeon
It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck.
Request a Consultation for Facial Plastic Surgery with Dr. Jeffrey Harmon
Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon’s credentials, style, and approach. Build a relationship with our dedicated team. Do not stop searching “plastic surgery near me.” Get in touch with us to learn more.
Request a Consultation for MLD with Dr. Ricci Hoover at Elevate Physical Therapy
Request a consultation with Ricci Hoover, PT, DPT, CLT at Elevate Physical Therapy in Blue Ash, Ohio if have questions about MLD, including whether it may be appropriate for you.
Email: @elevatepelvicpt
Instagram: ricci@elevatepelvicpt.com
References
- Meade RA, Teotia SS, Griffeth LK, Barton FE. Facelift and patterns of lymphatic drainage. Aesthet Surg J. 2012 Jan;32(1):39-45.
- Thompson B, Gaitatzis K, Janse de Jonge X, Blackwell R, Koelmeyer LA. Manual lymphatic drainage treatment for lymphedema: a systematic review of the literature. J Cancer Surviv. 2021 Apr;15(2):244-258.
- Ezzo J, Manheimer E, McNeely ML, Howell DM, Weiss R, Johansson KI, Bao T, Bily L, Tuppo CM, Williams AF, Karadibak D. Manual lymphatic drainage for lymphedema following breast cancer treatment. Cochrane Database Syst Rev. 2015 May 21
This blog post is for educational purposes only and does not constitute direct medical advice. It is essential that you have a consultation with a qualified medical provider prior to considering any treatment. This will allow you the opportunity to discuss any potential benefits, risks, and alternatives to the treatment.