Lymphatic Drainage after Cosmetic Surgery

Swelling after surgery

 

All cosmetic plastic surgeries will produce swelling as a normal healing reaction. Some cosmetic surgeries, such as tummy tucks and liposuction, will disrupt the natural body conduits more by the sheer area that undergoes surgery. Other body areas, such as the nose, have different types of swelling that persist for up to a year, such as after a rhinoplasty. Some procedures, such as face lifts, will have swelling persist for up to six months. I have discussed in the past some of the ways to reduce swelling after surgery:

https://tavmd.com/2012/11/13/how-to-decrease-swelling-after-cosmetic-plastic-surgery/

Today I want to specifically discuss the use of lymphatic drainage massage as a way to reduce swelling after cosmetic surgery such as liposuction and abdominoplasty.

lymphatic drainage

What is lymph and what are lymphatics?                         

 

Most people know that our bodies have a series of vessels that carry blood from the heart to tissues (arteries and arterioles) and others that carry blood back from tissues to the heart (veins and venules). What most people do not know is that there is a whole other system of vessels running parallel to arteries and veins that transport lymph throughout the body. These are lymphatics, and they carry around lymph! You have all seen lymph when you have burnt yourself and your skin has formed a blister. Lymph is essentially blister fluid!

Lymph is a yellow liquid that can be thought of as the fluid in which blood cells travel. The combination of blood cells and lymph (plasma) is blood.  When blood arrives at our tissues, oxygen is released from red blood cells and dissolved in lymph, which, because of pressure differentials between arteries and veins, is distributed into tissues.   While most of this fluid goes back into the  blood vessels, a small portion, about three liters a day, stays around the tissues and is then collected in lymphatic vessels and taken back to be re-introduced into the bloodstream in three main areas after going through a series of collection areas called lymph nodes. Each side of the body, thigh and leg empties into the femoral vein on each side of the groin, and the lymphatics of the head and neck drain into the subclavian vein on the left side of the neck.

 

Injury and lymphatics

When a part of the body is injured, there is an increase in the permeability of blood vessels in that area, and more lymph spills out into tissues. We see this as swelling. The more “injury” to an area, such as after a tummy tuck with liposuction, the more swelling and lymph in tissues. In some surgeries, such as abdominoplasty, where skin is elevated from underlying abdominal muscles, lymphatics must be cut and must re-establish continuity and grow together before they can remove the fluid from the area. If this does not happen fast enough and lymph hangs around, you have what is known as a seroma.

When there is an injury or infection, the increased amount of lymph and increase in white blood cells that get recruited to the area of injury will lead to enlargement of the lymph nodes. This is why you feel lymph nodes when you have a cold!

In surgeries where lymph nodes are removed for disease, as occurs after breast cancer mastectomy, injury to lymph nodes and lymphatics can lead to accumulation of fluid within the limb or area of injury, a condition known as lymphedema (swelling due to lymph).

While providing a series of channels for white blood cells and body defenses to get to areas of injury or trauma, the lymphatics also provide for a way for infection to spread through the body. Red streaks up an arm after an injury to a finger are a sign of infection in the lymphatics!

 

Lymphatic drainage

Most swelling a cosmetic plastic surgeon sees after surgery such as tummy tucks or liposuction is expected. There are a number of techniques to decrease swelling, such as garments, elevation of the affected body part and icing of the area to decrease the amount of blood coming and hence the amount of swelling. Once swelling is present, though, massage can help greatly. Lymphatic drainage is a type of massage to help empty lymphatics in the area of surgery that has retained lymph. It is a very superficial massage and is more like a firm stroke rather than a deep tissue muscle massage. Lymph is pushed through the lymphatics, and swelling decreases.

Lymphatic drainage is a useful and beneficial ancillary procedure to cosmetic surgery procedures such as tummy tucks and liposuction where there are large areas of  damage to lymphatics. For smaller areas of cosmetic surgery, such as the nose after rhinoplasty or face after a facelift, patients can massage themselves, but for larger areas, help from a massage therapist trained in lymphatic drainage is well worth any cost.

Morad Tavallali, M.D., FACS