Beware of Fads
Wood Therapy and what I like to call the “Squeegee Technique” are the most common fads seen on Instagram, YouTube, Facebook and other social media pages aimed at post-operative cosmetic surgery. Using these sources are a lot like going to Instagram for medical care. That’s usually not a wise path. Some of the information you see is accurate and useful but much is not. I say this not to speak poorly of those providing these services, but rather to educate those who are not armed to know the difference. My 23 years as a lymphatic practitioner and instructor has taught me that many are practicing these techniques without proper licensure. They would never intend to cause harm but lack the proper training that would educate them about the dangers of these techniques. Wood therapy is one of the more harmful fads that has cropped up in many years.
To understand why these fads are harmful, we first need to look at the tissue regeneration cycle in bodily injury. Cosmetic surgery is extensive bodily injury. You will continue to swell and re-swell until the injury has healed completely, just like an ankle sprain. It takes time to heal and you must be patient with your body.
Tissue replication and Fibrosis
Tissue can heal in one of two ways. First, in an optimal environment, enough healthy cells have been left to perfectly replicate themselves. When the process is done, there is no physical sign that injury ever occurred. Second, if tissue damage is severe enough (or repeated back-to-back as in wood therapy or squeegee techniques), tissue cells are damaged beyond their ability to repair and it forms heavy collagen fibers that form scars. The common buzz word used in cosmetic surgery recovery is “Fibrosis”. Fibrosis is the correct term for scar tissue.
Early cell regeneration starts with a very delicate granulation tissue. This new granulation tissue is easy to re-tear, forcing the need to rebuild again. Remember that repeated rebuild leads to fibrosis. When tissues are rubbed, squeegeed, or rolled with wood tools or rolling foams, those delicate granulation tissues are torn. It is common for unlicensed medical professionals and massage therapists (it is not legal for massage therapists to re-open wounds) to squeeze interstitial fluids and blood from post-surgery swelling out of open wounds. When these wounds close up, they re-open them so they can continue to squeeze fluid out. Though they may call this Lymphatic Massage, if they are not using the body’s Lymphatic System to move the fluid naturally, it is inappropriate to use the term lymphatic at all. This is not lymphatic drainage.
Lymphatic Drainage is not “Massage”
Anyone properly trained in the anatomy and physiology of the Lymphatic system knows that 70% of lymphatics are superficial and these delicate lymphatic vessels spasm when too much pressure or speed is applied. They cannot be massaged using traditional Swedish Massage techniques. The terms ‘lymphatic” and “massage” are mutually exclusive. Lymphatic Drainage is not and cannot be referred to as massage. To massage or press deeply or use heat causes the granulation tissue to tear back apart and increases swelling, forming fibrosis (hence the pain it causes to receive). It is also important to remember that your body is not made from clay. You cannot be molded by the use of wooden tools or any other method. The surgeon you hired did the shaping, not the tools. It takes time (3-6 months) to see the results of that surgeon’s art because the swelling must subside as you heal. Healing cannot be forced. These procedures cause more harm than good. If they are offered to you, I encourage you to do your research and look into the provider’s credentials. Remember, a certificate of attendance for a weekend program (or online program) is different from a CERTIFICATION that is monitored, tested and meets strict criteria. They must have a license to touch the body (Massage Therapist, Physical Therapist, Occupational Therapist, Nurse, Doctor, Chiropractor) or they are operating outside of legal parameters. Seek out fully trained and certified professionals for the procedures they wish to perform or they could be causing damage.
Re-opening wounds, removing drain Tubes and needle aspirations require a medical license. A massage therapist is not trained or permitted by law to apply these procedures. Check credentials first. When any of these procedures are performed, the chances of infection are increased significantly. They should be avoided unless absolutely necessary, and only after being diagnosed and provided by a MEDICAL PROFESSIONAL. Obviously, drain tubes must be removed but criteria must be met as set by your surgeon first. We have a nurse who works with us for tube removal but scheduling must be made with her directly.
Cavitation therapy is also becoming quite popular in cosmetic surgery recovery. Cavitation is a non-invasive fat reduction treatment that uses ultrasound technology to reduce fat cells in targeted parts of the body. Ultrasonic cavitation is meant to help contour your body. It isn’t a treatment for people who are trying to lose a lot of weight. This is an effective body contouring treatment for those who are close to their goal weight. However, after cosmetic surgery, cavitation used too early in the recovery process can cause the same damage to the delicate granulation tissues as rubbing or using hard tools, and should not be applied until all wounds are completely healed (usually not before 4-6 weeks) to avoid ultrasonic sound waves reopening incisions. For cavitation treatments A LICENSE TO TOUCH THE BODY IS REQUIRED BY LAW AND MAY NOT BE PERFORMED BY A “TECHNICIAN” OPERATING UNDER SOMEONE ELSE’S LICENSE. Training is required. Too often these services are performed by technicians in a surgeon’s office without proper licensure or training. They have been told they may do this under someone else’s license, but without licensure of their own, they operate without full understanding of the possible dangers. They most certainly should not provide cavitation immediately after surgery. Don’t be injured. Be alert and ask question to avoid harm and pain. For best results, Lymphatic Drainage should be started as soon as possible, usually within a day or two, as long as it is applied by a licensed and certified professional. Cavitation comes later after the tissues have fully healed.
Foam Rolling and rubbing tissues is a no-no. Self-care at home begins with following doctor’s orders unless those orders fall outside of normal suggestions and appear to be causing you harm rather than good. What works for one person may not work for you. Start with your doctor’s post-op care. We’ve learned tricks over the years that are collected from hundreds of different surgeons. There is normal post-op care (with some variances), and many other suggestions others that are far away from normal.
Absolute no-no’s are hot showers or heating pads. Yes, they feel good temporarily but they are responsible for the increased swelling you experience later. Heat causes vasodilation that leads to additional swelling. Get back in your garment as soon as you can after self-care. It is good to have two. One to wash, one to wear. Normal doctor orders are compressive garments 23 hours per day for 8 weeks (some say 6 weeks and some 12 weeks, and some say not at all). Once you reach that time line, it is normal to decrease time to 12 hours per day. Some patients chose to sleep in it and work without it, and others do the reverse. Do what works best for you. We have noticed that about 60-70% of our patients are not ready for the drastic change from 23 to 12 hours all at once. If you find that this is you, step back up to 16-18 hours and the step back slowly as your body heals. You will also need to replace your garment as your swelling reduces and your body heals. A garment that is TOO TIGHT or TO LOOSE causes excess swelling. Foams, boards, pads, wraps and trainers are all individual per patient. We can discuss that with you on a case-by-case basis.
Never let a therapist massage or provide lymphatic drainage to your BBL or fat transferred to any area before 8 weeks post-op. The fat has to graft in first and since MLD and cavitation moves large fat cells, it can cause pitting and loss of the transferred fat if applied too early. We can use wood therapy at around 6 weeks’ post-op if it becomes obvious the surgeon transferred fat cells into an unwanted area or it was unevenly placed. Wood therapy can kill off the unwanted fat before it is fully grafted. Fat cells that die and do not graft in are not selective by area. They can leave pits anywhere.
Bromelain, found naturally in Pineapple juice, helps to reduce inflammation. If your surgeon left pineapple juice in your post-op care, that’s why. It’s amazing stuff! Our therapists use it for our joints routinely. We have found a source of pure bromelain capsules that work great and reduce the sugar intake from the pineapple juice which is important for diabetic patients. We always recommend you bounce it off our doctor first, especially if you are on other medications or have other health conditions. Massage Therapists are not permitted to diagnose or prescribe.
Another common fad is Lymphatic Drops. So, what are they? Mostly hog-wash with someone trying to get a corner of the cosmetic market. However, I have run across a few that have known beneficial ingredients. The question is whether the ingredients are in a therapeutic quantity or quality. That is up to the consumer to investigate. Just be weary when you look. Chances are they will just cost you money even if you don’t gain benefit. Probably not harmful.
“Dry Brushing” or using your hands to lightly brush your skin in the proper direction of drainage can help swelling between sessions. Make sure you visit with your therapist to learn the proper drainage patterns and lymphatic vessel directions and drainage nodes.
When a doctor says to “feed the fat”, that doesn’t mean juicy hamburgers, pizzas, nachos and fried foods. Look for healthy fats or you’ll be back in the same place you started before the surgery. Yes, the fat comes back. Healthy fats include olive oil, salmon, avocado and eggs. Do some research to find foods you like that are healthy
Seromas! A seroma is a build-up of clear fluid inside the body. It happens most often after surgery. A seroma is not often dangerous, but it can cause pain and discomfort. Many patients’ panic over this word with good cause but seromas don’t happen as frequently as our fearful brains want to imagine. Basic seromas can be manually drained (MLD) by a professionally certified lymphedema therapist. Needle aspirations present dangers of introducing infection so be cautious until it becomes necessary. Seromas can become a bigger problem if they become infected. Needle aspirations become necessary when infections exist. . A seroma has a palpable border and usually we can identify it’s potential existence. We are happy to assess but having a doctor take a look can also put your mind at ease and rule out other dangerous situations. We have drained many seromas manually and have referred out as well. It is a medical diagnosis, not within the legal scope of a massage therapist to diagnose.
Wound-care issues do arise. We keep a close eye on any open wounds. Wounds should be kept dry. Ointments usually create bigger problems as they keep a wound moist. When in doubt, always seek professional care. We will alert you to anything we see that you may not have noticed. Rejection of sutures is the most common complication we encounter and, if addressed early enough, this is easy to overcome. Early and active approaches are important.
Difference between a certificate and Certification
A certificate is earned by a licensed professional. The certificate will state that they have attended a course of training usually over a weekend, or watched an online program that presents an amount of information on that topic. These classes do not have a moderated curriculum and there is no control over the information that was presented, whether hands-on training actually occurred, or the correctness of the information imparted. Questions should be asked of your therapist to determine both education and qualifications. Just because the therapist isn’t fully certified doesn’t mean they are not qualified for your specific needs, but questions need to be asked to make that determination. Lymphatic Drainage is not taught in Massage School as part of the licensing program. It is a specialty that must be sought out by the individual therapist. Just because they hold a Massage Therapist license in the State of Texas does not mean they are qualified to practice all types of soft tissue manipulation. Texas, however, does not regulate certifications so any licensed therapist can claim to provide any service whether they have been trained or not. Always inquire and absolutely make sure they hold a license to operate as a therapist by the State of Texas. Buyer beware.
Certification is set out by the Lymphatic Association of North America (LANA) and prescribes a set curriculum that is tested 5 times and is a 135-hour minimum requirement of both practical and hands-on training. These certifications often take up to a year to complete and must be a single continuous training course. Students must pass at a 90% or greater rate. This is the certification required to work at MD Anderson or other medical facilities, for example. A fully certified Lymphedema Therapist will have their professional alphabet/credentials listed as CLT and CDT with certificates to back up the titles.
Watching a YouTube video does not qualify a person to provide treatment and is frequently misleading. Most videos show incorrect techniques and even when presented correctly, the touch is not what it looks like. Instructor supervised instruction is necessary. Please be careful.
I have posted this statement out of concern for the many patients we have inherited from other facilities. We provide around 120 lymphatic sessions per week in addition to other therapies, and spend much of our time correcting injuries from previous providers. It is easier to avoid than to correct. As Certified therapists, we also spend a lot of time educating our clients to better aid in their recovery.
For more information about Lymphatic Drainage, please see our page here. Please let us know if you have any additional questions. We’re here to help your recovery.
Barbara G White
LMT, MTI, BCTMB, CLT, CDT