Manual Lymphatic Drainage (MLD)

General, Injuries, Surgeries

How MLD Can Improve Wound Healing And Optimise Your Scarring Process:

In my 15 years of working with post-op patients, I’ve seen firsthand how MLD supports and accelerates the healing process. And that includes improving and optimizing the outcome of scars.

Factors That Contribute To Perfect Wound Healing:

There are three main factors that contribute to optimal wound healing:

  1. A healthy body before surgery is a definite bonus. Someone who exercises and has a healthy and nutritious diet that includes plenty of protein, vitamins, and minerals generally heals much better.
  2. Wearing the correct post-op compression helps any dissected tissues knit together better and it limits the amount of tissue fluid/swelling after surgery.
  3. Manual Lymph Drainage to remove swelling more quickly. Post-op swelling contains dead cells that if left in the tissues can disrupt wound healing and may cause infection which will ultimately mean poor scarring.

While numbers 1 and 2 are important, they should be a matter of course. Most surgeons I know will recommend their patients don’t drink or smoke and stipulate they improve their overall general health at least 3 months before their surgery. And the majority recommend wearing medical compression.

However, although there are now lots of surgeons who recommend MLD to their patients, many surgeons still don’t know how beneficial integrating Manual Lymphatic Drainage into the acute postop recovery phase is in optimizing and accelerating their patient’s healing process and therefore scarring. So, as an experienced MLD therapist working with post-cosmetic and plastic surgery patients, this is why I recommend it to anyone having a surgical procedure.

How The Lymphatic System Works:

First, I think it’s important to understand what the lymphatic system is, how surgery affects it, and then how MLD can benefit the healing and scarring process.

The human lymphatic system

The Lymphatic System is little understood by many and certainly isn’t often considered during surgery. However, this amazing body system plays a vital role in maintaining body fluid equilibrium, it forms part of your immune system and keeps your skin and body tissues healthy, and is a key component in the wound healing process.

It is a network of tiny vessels and nodes that work together in conjunction with your venous system. In everyday life, you have fluid that filters out of the vein walls into the surrounding tissues. This fluid contains blood cells, hormones, fat cells, and various proteins. The lymphatic system’s job is to pick up that fluid from the tissues and transport it to lymph nodes which work like filtration stations to filter out any damaging cells, like viruses and bacteria. The ‘cleansed’ fluid goes back into the lymphatic system and eventually spills back into your venous system at your collar bone. It’s this continual process that keeps your skin and tissues healthy.

When The Lymphatic System Is Challenged:

If something happens to your body that creates more fluid in the tissues, like the body’s natural response to surgery when inflammation (part of the wound healing process) causes swelling, the transport capacity of the lymphatic system becomes overwhelmed and swelling builds up. If the fluid lingers and isn’t being removed from the tissues all those ‘dead’ cells can cause havoc and impair wound healing.

Surgery And Your Lymphatic System:

Although your extremely clever body’s response to surgery is a natural response, surgery is not a natural trauma. So the lymphatic system is not prepared for the sudden onset of swelling. And unlike the venous circulatory system which has the heart continually pumping blood around the body, the lymphatic system relies upon muscle movement to encourage fluid into the lymph vessels, then flow of that fluid through those vessels to create a muscular impulse within the lymph chambers to propel the fluid onwards.

However, when you’re lying on the operating table, not moving, lymph drainage efficiency is dramatically reduced. Added to this, the surgeon will sever many superficial lymphatics while performing his surgery, adding to the reduced fluid drainage. During surgery, your body is reacting to the trauma by producing swelling. And the production of swelling is greater than the draining capacity of the lymphatics, resulting in what we all know as postoperative swelling.

Why Swelling Matters After Surgery:

So how does post-op swelling affect wound healing and scarring? As you might imagine, following surgery, there will be a lot of dead blood cells in the swelling fluid, along with other cellular debris. If the lymphatic system can move the fluid to the lymph nodes, the lymph nodes will do their job and clean up the fluid, then the lymphatic system can continue doing its job of keeping your skin and tissues healthy. However, if that fluid lingers, it can become stagnant and the normal wound healing process is compromised, making you more susceptible to infection (your lymphatic system forms part of your immune system. If it can’t send lymphocytes – immune cells – to the area that is affected by some invading bacteria, infection will occur) impeding and compromising the wound healing process.

Long story short, lingering swelling affects wound healing and therefore the scarring process. The best way to reduce and remove that swelling more quickly is by supporting the functioning of the lymphatic system by doing Manual Lymphatic Drainage.

The Role Of MLD After Surgery:

Manual Lymph Drainage is a special type of massage that sustains and attains the proper functioning of the lymphatic system. It is a series of gentle, rhythmic, pumping, skin stretching hand movements that mobilizes tissue fluid – swelling – and encourages it into the lymphatic system, into lymph drainage pathways, and ultimately to lymph nodes which will filter it.

The picture below it’s clear to see the reduction in swelling, redness and the improvement in movement.

Brachioplasty (arm lift) patient before and after Manual Lymphatic Drainage Therapy

A qualified and experienced MLD therapist works WITH the lymphatic system, not against it. It is not what many believe, pushing fluid out of incisions. MLD performed correctly, is gentle and pain-free. It supports the natural functioning of the lymphatic system when it becomes overwhelmed by too much fluid in the tissues. By integrating MLD in the acute postop phase i.e.: within the first week after surgery, you are supporting your lymphatic system’s natural functioning by helping it remove the swelling. This encourages the regeneration of lymph vessels and tissues. By reducing swelling and removing stagnant fluid you will optimize your wound healing and therefore, the scarring process.

Not only does MLD reduce swelling and therefore accelerate your healing, but it is also deeply relaxing and works as an analgesic so is beneficial in reducing pain and discomfort. It promotes better sleep and can help with constipation both of which are common after surgery.

Qualified MLD Experts:

It’s vitally important your MLD therapist is knowledgeable with the lymphatic system and how it is affected by surgery. Ideally they will have completed at least 135 hours of training with a reputable school. Good therapists should be able to recognise if there are any issues following surgery, such as seroma or infections. Please check out their training, qualifications and experience before booking in.

About The Author

Petra Erving

PETRA ERVING is a Certified Lymphedema Therapist & Scar Tissue Therapist. She has worked with post-op patients since training at the Centre For Plastic & Reconstructive Surgery & The School of Orthopedic Massage & Bodywork, Ann Arbor, Michigan in 2006. In 2008 she completed her lymphedema certification through Klose Training Inc in Manual Lymph Drainage & Complete Decongestive Therapy. Since then, she has attended the Foeldi Clinic in Hinterzerten, Germany four times to complete her Advanced & Review CPD training updates. After living in Berkshire for 10 years and working in London in NHS and in private practice in the renowned Harley Street. She now lives in County Down, Northern Ireland with her husband Jason and daughter Erin (and dog, Clover).

To find out how Petra can help support your recovery and accelerate your healing process, please follow her on IG: or Facebook: or email:

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