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The Science of Seamless Recovery: Why MLD is Essential After Cosmetic Surgery
- Dec 29, 2025
- 6 min read
For health professionals in the aesthetic and plastic surgery space, achieving optimal client satisfaction involves meticulous surgical technique and a comprehensive, evidence-based post-operative recovery plan.
While transient swelling is a usual and expected consequence of body-altering procedures, the management of early post-operative swelling and the integrity of the lymphatic system are paramount to skin rehabilitation, scar minimisation, and preventing long-term complications (1).
Manual Lymphatic Drainage (MLD) is rapidly emerging as a essential, medically-based therapy for complete post-operative care (1).
The Vulnerable Lymphatic System: A Pathway to Complications
The lymphatic system works parallel to the circulatory system and is a key component in maintaining tissue homeostasis and supporting immune function (1). Aesthetic procedures routinely cause mechanical disruption to the superficial lymphatic vessels, especially when there is extensive skin dissection or removal of large areas of fat such as in abdominoplasty and liposuction (2).
This disruption produces a dynamic oedema, where the lymph obligatory load in the interstitium exceeds the transport capacity of the compromised lymphatics (1). While this is usually transient, it increases the risk of developing complications including secondary lymphoedema.
If the lymphatic system does not recover properly, excess protein-rich interstitial fluid may accumulate and develop into more persistent swelling and tissue fibrosis (2). Therefore, persistent or disproportionate post-surgical swelling may represent subclinical or early-stage secondary lymphoedema (3).
Aesthetic Procedures with High Risk for Lymphatic Disruption
Procedures that remove or resect large areas of skin and fat carry the highest risk for lymphatic disruption and potential progression to lymphoedema. These include;
Body Contouring Procedures: These procedures, especially in people with a history of massive weight loss, pose an increased risk (3).
Vertical Thigh Lift Techniques: This specific technique for thighplasty carries a higher risk of postoperative lymphoedema due to the placement of the incisions close to the the main collecting vessels in the medial thigh (3).
Extensive/Core Liposuction: Procedures that use large, sweeping cannula strokes to remove adipose tissue, such as core liposuction (including the upper and lower abdomen, back, hips, and flanks), disrupt lymphatic channels to a greater extent than more selective techniques (4,3).
Abdominoplasty (Tummy Tuck): This procedure involves separating the abdominal skin and tissue from the deep fascia and a low abdominal incision across lymphatic vessels draining to the inguinal lymph nodes (4, 2).
Multiple Surgeries: A history of multiple procedures, suggesting cumulative trauma to superficial lymphatic networks (e.g., prior abdominoplasty or Cesarean sections), can predispose the recipient to complications after subsequent cosmetic procedures (3).
Long-Term Changes in Lymphatic Drainage Pathways After Abdominoplasty
During abdominoplasty, some of the skin of the lower abdomen is removed and the skin above the navel is stretched down onto the lower abdomen. This means that lymph from the lower abdomen now drains toward the axillary nodes, not towards the inguinal lymph nodes - highlighting the long-term changes in lymphatic function that can be induced by surgery (3).
Studies using lymphoscintigraphy have demonstrated these long-term changes between one and six months postoperatively:
Pre-operatively:
100% of recipients exhibited lymphatic drainage to the inguinal lymph nodes.
Post-operatively:
This change from inguinal to axillary drainage indicates a lasting anatomical change in how the abdominal area manages lymphatic fluid following the surgery, and highlights the impact of scarring on lymphatic pathways.
The Precision of the Original Dr Vodder Method
MLD is not a traditional deep-tissue massage; it is a specialised, light-pressure technique utilising the natural elasticity of the skin.
Developed in the 1930s by Dr. Emil Vodder and Estrid Vodder, MLD uses precise circular movements and rhythmic pressure changes to mimic and activate the stretch-receptor-reflex responsible for increased lymphatic pumping (2,4).
Without additional stimulus, lymph vessels will usually contract around 10 – 12 times per minute. Higher lymph loads - or the application of MLD - can increase this to up to 30 times per minute, thereby maximising the removal of excess interstitial fluid (1).
Physiological effects of MLD
MLD treatments always begin by clearing the proximal lymphatic pathways which decreases distal lymphatic pressure. Simultaneously, MLD slightly increases the interstitial pressure whilst also gently moving the connective tissue, opening the gaps in the initial lymph vessels.
This combination of decreasing the pressure in the distal vessels, opening the intercellular gaps and increasing interstitial pressure, significantly improves lymph formation and removal of interstitial fluids.
The precisely directed skin stretches also guide interstitial fluid towards functioning regional lymph vessels and accessory lymphatic routes (2).
MLD also increases blood flow though the capillaries. But unlike other forms of massage which increase capillary pressure, MLD helps to increased diffusion of essential nutrients and elements required for tissue healing without increasing interstitial fluid loads (2). This is why MLD is indicated in the early post-surgical phase while regular massage and high pressure techniques are contraindicated.
One of the most powerful effects of MLD is to restore autonomic balance, minimising the body's sympathetic nervous system responses (fight or flight) to allow better parasympathetic tone (rest and repair), thereby providing an analgesic and non-stressed state to optimise the body's natural healing processes (1,2,4).
Therapists trained in the original Dr Vodder method will modified the pressure and length of the skin manipulations based on the stage of healing, and using tissue palpation to ensure that aftercare does not induce additional pain or trauma. This focus on gentle, hands-on therapy is considered crucial in the initial post-operative weeks (1).
Using MLD to Accelerate Healing and Minimising Scarring in Cosmetic Surgery Recovery
Manual Lymph Drainage is a critical intervention during all stages of wound healing, serving as an essential mechanism for returning the body to homeostasis (1).
Managing Inflammation and Oedema
The inflammatory exudate, which can be compounded by injected tumescent fluids used during liposuction (1), increases the diffusion distance - the space between the blood capillaries and tissue cells. If the diffusion distance is too large, normal metabolic and healing processes are inhibited (1) and tissue cells can suffer hypoxia.
The Dr Vodder method of MLD directly stimulates lymph motricity (lymphatic pumping), increasing the rate at which this post surgical oedema is removed, directly reducing the diffusion distance. The goal is to initiate lymphatic flow as early as post-operative day one to minimise this expanded distance.
One study on abdominoplasty and core liposuction patients suggested that MLD provided a greater mean reduction in oedema between weeks 6 and 8 post-surgery compared to compression garments alone (4).
Reducing Fibrosis and Optimising Scars
The proliferative phase of healing is marked by the rebuilding of new tissue and the laying down of collagen (1). When inflammation is prolonged due to fluid accumulation, it can lead to excess collagen deposition, forming hardened lumps and bumps known as fibrosis (2,4).
Vodder's MLD is instrumental during this stage to help reduce inflammation and excess collagen deposition to minimise the risks of irreversible fibrosis. By increasing lymph flow, MLD helps clear the debris that fuels the fibrotic response, which is crucial for achieving aesthetically pleasing results (1).
Once the tissue has healed, the quality of the remaining scar is also determined by the degree of oedema and the extent of collagen deposition that has occurred. By minimising the extent of these, MLD contributes to the formation of flat, mobile scar tissue.
Furthermore, there is a short widow of opportunity after a surgical wound where lymph vessels will reconnect and regrow across the healing scar. Applied in this early post-operative phase, MLD supports lymph angiogenesis and maximises the restoration of proper lymph flow across the healing scar.
Conclusion
As the prevalence of aesthetic procedures continues to rise, so does the responsibility of the health professional to ensure a seamless recovery (1). The integration of MLD, particularly by Dr Vodder Therapists who are certified in these Medical Aesthetic techniques, is a vital, evidence-informed adjunctive therapy in cosmetic surgery recovery.
By proactively addressing lymphatic and tissue damage caused during the surgery, MLD supports the body’s healing cascade to reduce fibrosis, prevent secondary lymphoedema, and minimise scarring.
Dr Vodder's MLD is the ultimate post-operative therapy to optimise aesthetic and functional outcomes for everyone.
Fenwick, B. (2025). Perspective Chapter: Lymphatic Therapy and Post-Operative Care – The Science of a Seamless Recovery. In A. L. Cuzalina (Ed.), Cosmetic Surgery - Techniques for the Most Popular Aesthetic Surgery Procedures. London: IntechOpen. https://doi.org/10.5772/intechopen.1008360
Marxen, T., Shauly, O., Goel, P., Tsan, T., Faria, R., & Gould, D. J. (2023). The Utility of Lymphatic Massage in Cosmetic Procedures. Aesthetic Surgery Journal Open Forum, 5. doi:10.1093/asjof/ojad023 https://doi.org/10.1093/asjof/ojad023
Phondge, V., Dornbrand-Lo, M., Deshpande, P., & Wong, A. K. (2025). Beyond Swelling: A Review of Postoperative Lymphedema in Aesthetic Surgery. Lymphatics, 3(3), 26. Retrieved from https://www.mdpi.com/2813-3307/3/3/26
Maningas, T., Sturm, L., Mangler, A., & Pazdernik, V. K. (2020). Manual Lymphatic Drainage in Postoperative Abdominoplasty With Core Liposuction Patients. The American Journal of Cosmetic Surgery, 37(1), 45-49. doi:10.1177/0748806819874941 https://journals.sagepub.com/doi/abs/10.1177/0748806819874941
Thank you Jan Douglass for sharing this important information and keeping me up to date with information relevent to this growing and complex health industry.