If you have ever had a cosmetic surgery done, you are familiar with the intense and persistent swelling that inevitably follows. Or, perhaps you are looking ahead at a procedure to come and are trying to prepare yourself and figure out what recovery might look like for you.
Regardless of what particular procedure you have done, the swelling resulting from surgery is often more painful than the incision areas themselves - though this can be particularly intense after liposuction. You may have felt that areas of your skin became hardened and stiff, and even lumpy as time went on. This is horribly uncomfortable, but also totally normal if you haven't been receiving lymphatic drainage after your procedure.
Why is the swelling so bad?
The swelling is intense after surgery, and your body will do its very best to process the extra fluid and inflammation. The problem is, it will struggle a bit because the lymphatic system, which is in charge of draining fluid from your body's tissues, will be damaged from the surgery. Don't worry, it should be fine in the long term, it just means that your body may need a little extra help getting over the initial difficulties of the recovery process.
There are lymphatic pathways all over your body, and some of the major ones are in unfortunate places when it comes to the most common cosmetic surgeries. The channels running between your hips get
interrupted from a tummy tuck. The channel running from your armpits down your abdomen gets bisected from breast surgeries. And the channel under the breasts of course sustains significant damage from breast reduction, augmentation, mastectomy, and masculinizing chest surgery. Liposuction, in my observation, is the most destructive to the lymphatic system as it removes the entire subcutaneous layer of lymphatic pathways wherever the liposuction is performed.
The bad news is, the lymphatic system is not great at healing and reconnecting pathways like your circulatory system is. For the most part, if lymph nodes or lymph vessels get damaged, they will never recover. Now, as bad as this sounds, the good news is your lymphatic system is just about everywhere in your body. So damage to one area, though not ideal, can usually be compensated for pretty well by the remaining intact system. Your body should be able to handle the day-to-day fluid processing no problem once you have fully recovered. You would really only notice a problem when there is significant swelling in the areas where the lymphatic system has been damaged. Of course, this describes post-surgical swelling perfectly.
How does lymph drainage help?
The lymphatic system doesn't have an organ that keeps things moving along like the heart does for your circulatory system. It doesn't even get dedicated muscles like the intestines get to keep your digestive tract moving along properly. It just has to rely on whatever movement happens to take place around it. This is one reason why physical therapy starts immediately after joint replacements (as in, you-might-still-feel-groggy-from-the-anesthesia type of immediately). The fluid needs to be pumped through and processed by your system, and movement or gravity are the only ways to do that.
When it comes to procedures that have a major impact on the skin (think the cut of a tummy tuck vs. the pencil-eraser-sized incisions that are all that is needed to take out a torn meniscus) it can be hard to provide the lymph the movement needed since providing movement to the skin itself is trickier than moving muscles. This is why your surgeon likely has (or will) recommended you gently massage the swollen areas to help you heal. This helps the lymphatic system get the movement it needs to get to work and process all that fluid.
Can I do the lymphatic massaging myself?
Absolutely! In fact, even if you are receiving professional lymphatic drainage, you should also be working your swollen areas yourself. If you are diligent about this and also are lucky enough to have an easy recovery, self-massage might be all you ever need to fully recover. Just be sure to work gently in small circles on swollen areas.
However, every body is different and every recovery is different. Sometimes your body will simply respond to a procedure with a ton of swelling, bringing with it a lot of stiffness and pain. If that happens, it can be hard to do a lymph drainage on yourself that is effective enough to let your system catch up. That's where working with a professional can help. With knowledge of the locations of lymphatic pathways a gentle hands-on work to redirect fluid toward intact pathways, you will likely feel much more improvement after an hour of Manual Lymph Drainage (the official name of this therapy) than you feel when working on yourself for the same amount of time.
I completely understand that it isn't realistic for everyone to get the ideal 8-10 lymph drainage sessions after a procedure. However, the other reality to consider is that people who get lymph drainage after a surgical procedure will likely have an easier, less painful, and faster recovery than people who don't.
What are the benefits of lymph drainage?
Interestingly, there are several significant ways in which lymph drainage can actually improve your outcomes long-term, as well as helping you get back to functioning normally more quickly in the short-term. These are the most significant benefits after a surgical procedure.
As I mentioned earlier, much of the pain experienced after surgery is from the intense swelling that makes your skin feel like an overfilled sausage casing. Relieving this swelling by moving the fluid along definitely helps with pain and will make your recovery more comfortable.
All that fluid that appears actually does serve a purpose. Lymphatic fluid carries lymphocytes which help you fight off infection, and clear dead cells from an area so new ones can thrive. When this movement gets choked off, your immune system may struggle to work as it's supposed to in swollen areas and new cells may find themselves fighting to grow amidst cellular waste. Getting that fluid out of the way is crucial to supporting both of those functions properly.
As old fluid goes out, new fluid can come in. This is important because lymphatic fluid provides crucial building blocks for healing and building new tissue, so a constant supply of fresh lymphatic fluid speeds recovery because your body is getting everything it needs to repair the area.
Minimize scar appearance
As your body knits back together, scar tissue will form. Healthy scar tissue should be soft
and pliable and not painful to the touch. However, if a scar is formed under pressure from too much unmanaged swelling, that tension can cause the scar tissue to have a thick, ropey appearance.
This is called a hypertrophic scar, and it can take years to smooth down if it ever does.
Prevent lumpy scar tissue formation
Especially after liposuction, the formation of lumps and ripples in the skin can form, becoming most noticeable 2-4 weeks after surgery. There is a pretty long window where working these areas with lymph drainage or myofascial release can be effective in softening these lumps, so it isn't too late if you are a month or two post-op and you have these lumps still. Left untreated, however, these can harden into structures called fibrosis, which creates a cellulite-like appearance in the skin, but instead of being soft and pliable like cellulite, the bumps feel hard because it is formed by an over-production of scar tissue.
When should I start lymph drainage after my surgery?
You can start lymph drainage as soon as 24 hours after surgery, and I would recommend not waiting more than 3 days post-op at most. If your surgeon partners with a recovery center, this will likely be built in to your care. If your surgeon is doing your surgery as an out-patient procedure, you will want to have your lymph drainage sessions scheduled ahead of time. Either way, you will want to plan on about 8-12 sessions after your procedure. At my practice, I offer flexible packages that allow me to shift to more scar or muscle-focused work as you recover and your needs change.
If you live in southwest Michigan, you can come see me in Holland, MI. No matter where you are, know that lymph drainage is a powerful tool for making your recovery process as smooth as possible.