IN SUMMARY: The evidence for manual lymphatic drainage (ie massage), particularly after cosmetic liposuction, is limited. The recommendation by people for postoperative care is based mostly on physiologic rationale. The most effective post liposuction treatment is compression garments.
Liposuction causes fluid accumulation, bruising, postoperative swelling, and disrupts the superficial system of lymphatic channels. Manual lymphatic drainage and massage involves gently compressing the lymphatics, trying to help move the fluid into the lymphatics and move it along the lymphatics.
Looking at lymph channels using lymphoscintigraphy (where they can visualize the lymphatic channels which run throughout the body like veins) you can see significant changes in the superficial lymphatics after tummy tucks and liposuction. 85% of patients showed altered drainage pathways at 1 and 6 months postoperatively. So the disruption is real. The body gradually makes new channels over time.
There is no great post liposuction surgery massage treatment study. There is only one study looking at manual lymphatic drainage after cosmetic liposuction, but it was looking at skin quality. It compared massage to extracorporeal shock wave therapy for cellulite reduction– not looking at edema or healing.
Note: This is not truly a study for massage following liposuction- it was focused on cellulite skin changes. In the study there was not mention of compression garments, how much fat was removed, technique of fat removal (?ultrasound ?laser). The thing I really found interesting is that they used topical retinol following the procedure, and that really seemed to help skin quality. That is something I will research more. “A stabilized retinol formulation (Retinol ActifPur®, Roche) was applied twice daily for 4 weeks on the affected area for both groups. The amount to be applied was demonstrated by creating a layer of about 0.1 mm to coat the affected area, and gentle massage was applied for equal distribution of the topical treatment on the whole area “
This information really comes from the breast cancer literature, where women get swelling of their arm from lymph node removal and radiation in the treatment of their breast cancer. The studies on lymphatic massage are conflicting.
COMPRESSION.
When you look at the studies of how to help post liposuction surgery recovery, compression garments are the best supported intervention for swelling management and are “standard of care.” I like good compression, layering of garments, smooth compression.
The most important time to wear compression is when you are up and about- that is when you generate swelling. Preventing the swelling form happening will help you feel better faster. This is something we can review in the office. Note: Garments should never be painful.
It is good for me to research these questions to see what the science shows. My recommendations in my 20+ years of doing liposuction are 1. compression garments and 2. gentle massage you do to yourself.
Reading the literature, there is no science showing massage after liposuction helps recovery. When I do recommendations, I want to do things which are shown to help. I find the study which used topical retinol showing it helped with cellulite reduction interesting- that I will research to see if I should add it to my recommendations. When applying it you are massaging. Is that helping too?
I think massage in liposuction areas is fine. I recommend you do it to yourself, as you won’t do it too hard. I have had patients get INCREASED swelling and bruising from too vigorous of lymphatic massage. Where should you spend your time, energy, and money after surgery? For me, post surgical massage is not a focus. Again, looking at the studies even in lymphedema patients with terrible lymphatic issues, compression was found to be the gamechanger, not massage.
I don’t know how much massage helps, but if you want to do it and it feels good, go for it.
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