Manual Lymphatic Drainage
What Lymphatic Massage Is
Lymphatic massage is manual lymphatic drainage: a light, slow, rhythmic hand technique that stretches the skin in the direction of lymph flow, using almost no pressure, to move fluid out of swollen tissue. At Aesthetica by Ashley Howarth MD it serves two purposes: post-surgical sessions of 45 to 60 minutes, beginning only after Dr. Howarth’s clearance about a week after liposuction, tummy tuck, facelift, or eyelid surgery, in a series such as 6 to 10 sessions over 4 to 6 weeks; and 30-to-45-minute wellness sessions for puffiness after travel or a hard week.
Lymphatic massage is manual lymphatic drainage: a light, slow, rhythmic hand technique that stretches the skin in the direction of lymph flow to move fluid out of swollen tissue and toward the lymph nodes that drain it. It uses almost no pressure, because the lymphatic vessels that carry the fluid sit just under the skin and collapse when pressed hard. At Aesthetica by Ashley Howarth MD, the med spa of Howarth Plastic Surgery in Scottsdale, lymphatic massage has two uses. The first is post-surgical: after liposuction, tummy tuck, and other body contouring, and after facelift and eyelid surgery, where surgery has divided the small lymphatic channels in the skin and swelling, firmness, and fluid pooling follow. A 2022 study in Plastic and Reconstructive Surgery mapped how abdominoplasty changes the pattern of superficial lymphatic drainage of the abdomen, and a 2014 clinical trial of 18 women after liposuction and lipoabdominoplasty found that manual lymphatic drainage with therapeutic ultrasound reduced pain, swelling, and tissue fibrosis. Post-surgical sessions run 45 to 60 minutes and begin only when Dr. Howarth has cleared the patient, typically about a week after surgery, in a series such as 6 to 10 sessions over 4 to 6 weeks. The second use is wellness: a 30 to 45 minute facial session for puffiness after travel, sinus congestion, or a hard week, and as a step in the practice’s facials.
What the technique does is mechanical and modest. Lymph fluid has no pump of its own; it moves when muscles contract, when we breathe, and when the skin over a vessel is stretched, and a trained provider stretches the skin in sequences that open the nodes first and then move fluid toward them from the swollen area. After liposuction that means directing fluid from the treated flanks and abdomen toward the groin and armpit nodes; after a facelift, from the cheeks and jaw toward the nodes in front of the ear and along the neck. The evidence base is strongest in lymphedema after cancer treatment, where a 2015 Cochrane review found manual lymphatic drainage safe and of some added benefit with compression in mild cases, and it is smaller but consistent in aesthetic surgery recovery. Lymphatic massage does not remove fat, does not tighten skin, and does not change the surgical result; it changes how quickly and how comfortably swelling resolves, and it lets a provider who sees the patient twice a week notice a problem early.
Why Patients Ask for Lymphatic Massage
What Patients Who Choose Lymphatic Massage Notice
Most people who ask Aesthetica by Ashley Howarth MD about lymphatic massage are in the second or third week after surgery, when the drains are out, the garment is on, and the swelling is not going down as fast as they hoped. The rest are people whose faces hold fluid: after a flight, during allergy season, or before an event. These are the findings the team hears most.
- Flanks and lower abdomen that feel hard, lumpy, and tender two weeks after liposuction
- Swelling above a tummy tuck incision that pools by evening and is better by morning
- A face and neck that still look full three weeks after a facelift
- Puffiness under the eyes and along the jaw after a long flight
- Sinus fullness and a heavy, congested feeling in the face
- A compression garment that feels tighter at night than in the morning
Post-surgical swelling and firmness after liposuction and body contouring are the problems lymphatic massage helps most, because the fluid is real, the drainage pathways are known, and the sessions are timed to the healing. Facial puffiness responds for hours to days. What the technique does not do is remove fat, lift skin, or replace a compression garment.
Surgeon-Directed Care
More Tools in the Toolbox: Why a Plastic Surgeon Directs Post-Surgical Lymphatic Massage
Aesthetica by Ashley Howarth MD is the medical aesthetics practice of Ashley Howarth, MD, FACS, a board-certified plastic surgeon and instructor in plastic surgery at Mayo Clinic. Lymphatic massage after surgery is a good idea only when the surgeon knows it is happening, and the value of having it inside the surgical practice is exactly that. Dr. Howarth performed the operation, so she knows where the cannula passed, where the incision sits, where the drains were, and where the lymphatics were divided, and she sets when massage starts, how light it must be, where the hands go, and where they do not. She examines the tissue before clearing the first session and again when anything looks wrong, and she is the one who distinguishes ordinary firmness from a seroma that needs to be drained, ordinary swelling from cellulitis that needs an antibiotic, and an achy leg from a deep vein thrombosis that needs an ultrasound the same day. A provider working alone in a spa cannot make those calls and may massage over them. Under her protocols the trained provider who performs the sessions is also a second set of eyes on the patient twice a week during the period when complications appear.
Because Aesthetica by Ashley Howarth MD is the med spa of a plastic surgery practice, the care around lymphatic massage is not limited to the massage. Liposuction, tummy tuck, and body contouring after weight loss are performed by Dr. Howarth; facelift, neck lift, and eyelid surgery are performed by Dr. Howarth; and the recovery facials, Cooling Recovery and Lymphatic Lift, are performed by the licensed aesthetician under her protocols once she has cleared the skin. More tools in the toolbox, and an honest answer about which one you need.
SCOTTSDALE · MODERN OFFICE SETTING
Where to Start
Who Lymphatic Massage Is For, and What Happens First
Lymphatic massage at Aesthetica by Ashley Howarth MD is for two groups. The first is patients recovering from liposuction, tummy tuck, arm lift, thigh lift, or other body contouring, and from facelift, neck lift, or eyelid surgery, who have been cleared by their surgeon to begin. For Dr. Howarth’s own patients that clearance is built into the post-operative plan: at the first post-operative visit she checks the incisions, the drains if any, and the tissue for fluid collections, and if the healing is on track she clears massage to start, usually about a week after surgery. Patients whose surgery was performed elsewhere are asked for their surgeon’s clearance and their operative details before the first session. The second group is anyone with facial puffiness, sinus congestion, or fluid retention who wants a wellness session or a lymphatic step added to a facial. Before every session the provider reviews the intake for the conditions that rule massage out: active infection or cellulitis, a suspected or known deep vein thrombosis, untreated heart failure, kidney failure, an open or draining incision, and fever. A calf that is painful and swollen on one side, a fever, or spreading redness means a call to the office, not a massage.
Dr. Ashley Howarth, MD, FACS is a board-certified plastic surgeon and an instructor in plastic surgery at Mayo Clinic. Aesthetica by Ashley Howarth MD is the medical aesthetics brand of her practice, Howarth Plastic Surgery, at 7373 N. Scottsdale Road, Suite C150, Scottsdale, Arizona 85253.
Light Hands, Known Pathways
How Lymphatic Massage Is Used in Scottsdale
After Liposuction
After liposuction, manual lymphatic drainage starts about a week post-op once cleared by Dr. Howarth and runs 1 to 2 times a week for a series such as 6 to 10 sessions over 4 to 6 weeks.
Liposuction leaves tunnels through the fat where the cannula passed, and the body fills them with fluid and then with scar. Swelling peaks in the first 1 to 2 weeks, and firmness, sometimes lumpy, follows as that fluid organizes. At Aesthetica by Ashley Howarth MD, manual lymphatic drainage after liposuction starts about a week after surgery once Dr. Howarth has cleared it, runs 45 to 60 minutes, and is repeated 1 to 2 times a week in a series such as 6 to 10 sessions over 4 to 6 weeks, with the compression garment going back on afterward. The provider opens the groin and armpit nodes first, then moves fluid from the treated flanks, abdomen, or thighs toward them with light, directional strokes. In a 2014 clinical trial, manual lymphatic drainage with therapeutic ultrasound reduced pain, swelling, and fibrosis after liposuction and lipoabdominoplasty.
After Tummy Tuck and Body Contouring
After abdominoplasty, lymphatic massage begins on Dr. Howarth’s clearance about a week after surgery and once drains are out, working gently around the incision and never over a fluid collection.
A tummy tuck divides the superficial lymphatics of the lower abdomen along the incision, and a 2022 Plastic and Reconstructive Surgery study showed that drainage above the scar reroutes after surgery. Swelling above the incision that pools by evening is the ordinary result. Lymphatic massage after abdominoplasty and other body contouring begins on Dr. Howarth’s clearance, typically about a week after surgery and after the drains are out, and is gentler and more cautious than after liposuction alone: the provider works around the incision and any area of firmness, never over a fluid collection, and directs fluid up toward the armpit nodes and down toward the groin according to the new pattern. A fluid collection that is enlarging, an incision that drains, or a fever is examined by Dr. Howarth before any further session.
After Facelift and Eyelid Surgery
After facelift, neck lift, or eyelid surgery, facial lymphatic massage starts on Dr. Howarth’s clearance, usually in the first week, in 2 to 4 short sessions that move fluid away from the incisions toward the nodes near the ear and neck.
After a facelift, the lifted skin flap drains toward its base rather than along the old pathways, and a 2002 study in Aesthetic Plastic Surgery found the facial lymphatic network still disrupted a week after surgery; that paper describes starting manual lymphatic drainage on day 3 to 5 with a trained professional using a modified technique. At Aesthetica by Ashley Howarth MD, facial lymphatic massage after facelift, neck lift, or eyelid surgery starts on Dr. Howarth’s clearance, usually in the first week, in 2 to 4 short sessions that move fluid from the cheeks, jaw, and eyelids toward the nodes in front of the ear and along the neck, always away from the incisions. It is also the Lymphatic Lift step in the practice’s facials, once the incisions have healed.
Wellness and Facial Sessions
Outside of surgery, a 30-to-45-minute wellness session reduces puffiness after travel or a hard week with results lasting hours to a few days, though lasting contour requires Ellacor, laser, or surgery instead.
Outside surgery, lymphatic massage is a 30 to 45 minute facial session for puffiness after travel, sinus congestion, allergy season, or the week before an event, and it is a step in the Signature and Lymphatic Lift facials. The effect on facial contour is real and temporary: fluid moved out of the cheeks and under the eyes refines the face for hours to a few days. It is safe for all skin types and for sensitive skin, because it uses no heat, no pressure, and no exfoliation, and it can follow injectables or a laser treatment once the skin has healed. It is not a treatment for laxity, and a patient who wants lasting contour is directed to Ellacor, laser, or a surgical consultation instead.
At a Glance
Lymphatic Massage at a Glance
The uses of manual lymphatic drainage at Aesthetica by Ashley Howarth MD, when each starts, how many sessions are typical, and what the massage does; post-surgical timing is always set by Dr. Howarth’s clearance.
| Use | Timing | Sessions | What it does |
|---|---|---|---|
| Post-liposuction | Starts about 1 week after surgery on the surgeon's clearance; 1 to 2 times a week | About 6 to 10 sessions of 45 to 60 minutes over 4 to 6 weeks | Moves fluid from the treated fields toward the groin and armpit nodes; eases swelling, firmness, and tenderness |
| Post-tummy tuck and body contouring | Starts on clearance after drains are out, usually about 1 week; gentler around the incision | About 6 to 10 sessions of 45 to 60 minutes, tapering over 4 to 6 weeks | Redirects fluid along the post-surgical drainage pattern; never over a fluid collection or an unsealed incision |
| Post-facial surgery | Starts in the first week on clearance after facelift, neck lift, or eyelid surgery | 2 to 4 sessions of about 30 minutes in the first two weeks | Moves fluid from the cheeks, jaw, and eyelids toward the nodes in front of the ear and along the neck, away from incisions |
| Wellness and facial sessions | Monthly, after travel, in allergy season, or before an event; no clearance needed | Single 30 to 45 minute sessions, or a step in a monthly facial | Clears puffiness under the eyes and along the jaw for hours to days; safe for all skin types |
Recovery Support
Post-Surgical Recovery Support
How a lymphatic massage series fits inside recovery from the operations Dr. Howarth performs, and the signs that mean a call to the office rather than a session; individual timing is set at the first post-operative visit.
| Surgery | When massage starts | Typical series | Signs to call the office |
|---|---|---|---|
| Liposuction | About day 5 to 7, after Dr. Howarth confirms sealed incisions and no fluid collection | 6 to 10 sessions, twice weekly then weekly, over 4 to 6 weeks; garment continues | Fever, spreading redness, drainage, a rapidly enlarging swelling, one-sided calf pain or swelling |
| Tummy tuck | About 1 week, after drains are out and on clearance | 6 to 10 gentler sessions working around the incision, over 4 to 6 weeks | Swelling that grows or sloshes, opening or drainage of the incision, fever, calf pain, chest pain or shortness of breath |
| Arm lift, thigh lift, and contouring after weight loss | About 1 week on clearance; limb sessions direct fluid toward the armpit or groin | 6 to 10 sessions over 4 to 6 weeks; garment continues | Increasing limb swelling on one side, wound separation, fever, numbness or color change of the hand or foot |
| Facelift, neck lift, and eyelid surgery | Day 3 to 7 on clearance, with a light technique directed away from incisions | 2 to 4 short sessions in the first two weeks; Lymphatic Lift facial once incisions have healed | Sudden one-sided swelling or pain, bleeding, fever, vision change, or an incision that opens |
A Session Timed to Healing
What to Expect at a Lymphatic Massage Visit at Aesthetica by Ashley Howarth MD
A lymphatic massage visit at Aesthetica by Ashley Howarth MD has three parts: a check of the treated area and the intake, the massage itself, and instructions for the garment, hydration, and warning signs. Post-surgical sessions take 45 to 60 minutes; facial sessions about 30 to 45.
Clearance confirmed, the area examined
The provider confirms Dr. Howarth’s clearance, reviews the operative details and the day since surgery, and looks at the treated area and incisions for redness, warmth, drainage, or a fluid collection. Any of those, a fever, or one-sided calf pain stops the session and sends you to the physician.
Nodes opened first, then fluid moved toward them
You lie draped on the table with the garment off. The provider begins at the neck and the nodes that drain the area, then uses slow, light, skin-stretching strokes to move fluid from the swollen region toward those nodes, working around incisions and never over a collection. It feels like light, rhythmic pressure, not massage.
Garment on, water, and the next session
The compression garment goes back on. You leave with instructions to drink water, walk, and keep the garment on as prescribed, a list of the signs that mean a call to the office, and the date of the next session, usually 3 to 4 days out during the first weeks.
Clear Information. Informed Choices.
Safety and Limitations of Lymphatic Massage
Lymphatic massage is safe when it is light, when it is timed to healing, and when it is not done on someone who should not have it. Its risks come almost entirely from the second and third conditions. Deep or early pressure on a fresh liposuction field can bruise, increase swelling, or open a small vessel; massage over an incision that has not sealed can delay healing; and massage over an infection, a clot, or a large fluid collection can spread the infection, dislodge the clot, or worsen the collection. That is why every post-surgical series at Aesthetica by Ashley Howarth MD starts on Dr. Howarth’s clearance and why the provider examines the area before each session. The other limitation is expectation: lymphatic massage speeds and smooths recovery, and some patients also credit it with less firmness, but it does not remove fat, tighten skin, or fix a result, and a practice that promises otherwise is selling something else.
Possible Side Effects Include
- Mild tenderness or pinkness in the treated area for a few hours
- Temporary increase in urination as fluid is cleared
- Fatigue or light-headedness after a session in the first weeks
- Bruising if pressure is too firm on fresh tissue
- Rarely, worsening of a fluid collection or spread of an infection if massage is done when it should not be
What Treatment Cannot Guarantee
- Fat removal or a change in the surgical result
- Tightening of loose skin
- Prevention of every seroma or area of firmness
- A replacement for the compression garment
- Lasting facial contour from a wellness session
What Happens Over a Series
The Course of a Post-Surgical Lymphatic Massage Series
Lymphatic massage has no recovery of its own; the timeline that matters is the surgery’s. The stages below follow a typical liposuction or tummy tuck recovery at Aesthetica by Ashley Howarth MD with a lymphatic massage series inside it, and the same logic, on a shorter clock, applies after facial surgery. Every step depends on Dr. Howarth’s clearance, and the compression garment stays on as prescribed throughout. The facials page covers the wellness use.
The first week belongs to the surgery: drains if any, the compression garment, short walks, and the first post-operative visit, at which Dr. Howarth checks the incisions and the tissue for fluid collections. If healing is on track, she clears lymphatic massage to begin at about day 5 to 7. No massage happens before that clearance.
Sessions of 45 to 60 minutes, 1 to 2 times a week. Swelling is at its peak and the tissue may feel hard and tender; the strokes are light and directional, and many patients notice the garment fits more loosely and evening swelling is less by the end of this stage. Any fever, spreading redness, drainage, or one-sided calf pain is a call to the office, not a session.
Bruising is gone, swelling is clearly receding, and the firm areas under the skin begin to soften as organized fluid resolves. Sessions taper to weekly and then stop as the series of about 6 to 10 finishes. The garment continues as prescribed, usually through week 6. Patients whose firmness persists are examined by Dr. Howarth rather than massaged harder.
Swelling after liposuction and body contouring continues to resolve for 3 to 6 months, and the final contour is judged then. Lymphatic massage changes the comfort and speed of that course, not the destination. Some patients return for occasional sessions for residual firmness, and many continue with facial sessions or a lymphatic step in their monthly facial.
Before & After
Recovery With Lymphatic Massage, Before and After
The result of lymphatic massage is a recovery, not a transformation, and it is best seen in the surgical galleries: liposuction and tummy tuck results photographed at 3 to 6 months, when swelling has resolved, and facelift results at the same interval. Aesthetica by Ashley Howarth MD maintains before-and-after galleries for those procedures, and the team can show you how recovery typically progresses week by week, and where a lymphatic massage series fits inside it, during your consultation.
Patient Case Summaries
Selected Lymphatic Massage Case Summaries
These deidentified case summaries illustrate how the physician-led team at Aesthetica by Ashley Howarth MD plans lymphatic massage in Scottsdale. They include a liposuction series started on the surgeon’s clearance, a tummy tuck patient with a fluid collection that was drained rather than massaged, a facelift recovery, a patient whose surgery was performed elsewhere, a wellness patient with facial puffiness, and a patient whose calf symptoms sent her to the physician instead of the table. Each summary connects the patient’s concern and assessment with the treatment performed or the recommendation made.
Case 01
After liposuction
Flank and abdominal liposuction in a summer patient, with an eight-session series from day 7
Patient presentation
A woman in her forties, a long-term Scottsdale resident, had liposuction of the flanks and abdomen in June and asked at her first post-operative visit whether massage would help the swelling and the hard, lumpy feeling under the skin.
Skin assessment
At day 6 Dr. Howarth found intact incisions, no fluid collection, expected diffuse swelling and early firmness across the treated fields, and a garment that was being worn as prescribed. She cleared lymphatic massage to begin.
Procedure performed
A series of eight 60-minute manual lymphatic drainage sessions, twice a week for three weeks and then weekly, opening the groin and axillary nodes and directing fluid from the flanks and abdomen toward them, with the garment replaced after each session and a summer plan of indoor walking and hydration.
Clinical rationale
Liposuction leaves fluid-filled tunnels that organize into firmness, and a light, directional technique started once the tissue has sealed moves that fluid along known pathways; a published trial found reduced pain, swelling, and fibrosis with manual lymphatic drainage after liposuction.
Follow-up
By week 5 the firmness had softened and the garment fit loosely; her contour was photographed at 4 months.
Case 02
Seroma, not massage
A tummy tuck patient whose swelling was a fluid collection that needed draining first
Patient presentation
A woman in her fifties, two weeks after a tummy tuck, arrived for her second lymphatic massage session reporting that the swelling above her incision had grown over three days and sloshed when she moved.
Skin assessment
The provider found a soft, fluctuant collection above the incision that had not been present at the first session, and under protocol stopped the session and sent her to Dr. Howarth the same day, who confirmed a seroma.
Recommendation
No massage that day. Dr. Howarth aspirated the seroma in the office, adjusted the compression, and re-examined her three days later; lymphatic massage resumed once the collection had not reaccumulated, working around the area for the rest of the series.
Clinical rationale
Massage over a seroma does not drain it and can enlarge it; a provider working inside the surgical practice recognizes the change and hands the patient to the surgeon who can treat it.
Follow-up
The seroma did not return, the series finished at week 6, and her result was photographed at 5 months.
Case 03
After facelift
Facial lymphatic massage in the first two weeks after a facelift and neck lift
Patient presentation
A woman in her sixties who had a facelift and neck lift with Dr. Howarth felt at day 5 that her cheeks and jaw were still full and heavy and asked what would help.
Skin assessment
Dr. Howarth found normal post-operative swelling with no hematoma, sealed incisions, and the expected fullness over the lifted flaps on Fitzpatrick II skin. She cleared gentle facial lymphatic drainage starting that week.
Procedure performed
Three 30-minute facial sessions between day 5 and day 14, moving fluid from the cheeks and jawline toward the nodes in front of the ear and down the neck, always away from the incisions, followed by a Lymphatic Lift facial at week 4 once the incisions had healed.
Clinical rationale
A lifted skin flap drains toward its base and the facial lymphatic network is still disrupted a week after surgery, so gentle, redirected drainage by a trained provider in the first two weeks eases the fullness without stressing the incisions.
Follow-up
Her swelling settled ahead of the usual course and she was comfortable at a social event at week 3; she continues monthly facials.
Case 04
Surgery elsewhere
A patient after liposuction in another state who needed clearance before her first session
Patient presentation
A woman in her thirties who had spent the winter in Scottsdale returned from liposuction of the thighs performed in another state and asked to begin lymphatic massage at ten days.
Skin assessment
The practice asked for her surgeon’s operative details and written clearance before booking. Her surgeon confirmed the areas treated, no drains, and clearance for gentle massage from day 10. The provider examined the thighs at the first session and found intact incisions and diffuse swelling without a collection.
Procedure performed
A series of six 45-minute sessions over four weeks directing fluid from the thighs toward the groin nodes, with her surgeon’s instructions for the garment followed, and a plan to contact her surgeon and Dr. Howarth for any warning sign.
Clinical rationale
Lymphatic massage after surgery performed elsewhere is safe when the operating surgeon has cleared it and the provider knows what was done; a physician-led practice will not start on a patient it knows nothing about.
Follow-up
Her swelling resolved on schedule and she returned to her surgeon for the follow-up photographs.
Case 05
Wellness
Facial puffiness after travel and allergy season, managed with monthly lymphatic sessions
Patient presentation
A man in his forties who traveled weekly for work reported a puffy face and heavy eyes every Monday morning and worse during the spring pollen season in Arizona.
Skin assessment
The assessment found fluid fullness under the eyes and along the jaw on Fitzpatrick III skin with no laxity, no sign of illness, and no contraindication to massage. The cause was travel, sleep, salt, and allergies, not skin.
Procedure performed
A 30-minute facial lymphatic massage session every month, timed after his longest trip, with a lymphatic step added to his facials and advice on hydration, sleep position, and allergy management.
Clinical rationale
Facial puffiness is fluid, and light drainage toward the neck nodes clears it for hours to days; a wellness session is the right tool for a problem that is not laxity or volume.
Follow-up
He describes the session as the reset after travel and has kept a monthly schedule for over a year.
Case 06
To the physician instead
Calf pain and one-sided swelling at week 2 after a tummy tuck that meant an ultrasound, not a massage
Patient presentation
A woman in her fifties arrived at week 2 after a tummy tuck for her third session mentioning that her left calf had been achy and a little swollen for two days, which she assumed was from the garment.
Skin assessment
The provider found the left calf visibly larger and tender compared with the right. Under Dr. Howarth’s protocol that finding stops the session and goes to the physician immediately as a possible deep vein thrombosis.
Recommendation
No massage. Dr. Howarth examined her the same hour and sent her for a venous ultrasound, which confirmed a deep vein thrombosis; she was started on anticoagulation, and lymphatic massage was held until her treating physician cleared it weeks later.
Clinical rationale
Massage in the presence of a clot risks dislodging it, and a trained provider working inside a surgical practice knows that a one-sided swollen calf after surgery is an emergency rather than a sore muscle.
Follow-up
She recovered fully, her series resumed gently after clearance, and she now knows the signs to report the same day.
From First Visit to a Plan You Can Keep
Booking, Planning, and Follow-Up at Aesthetica by Ashley Howarth MD
Aesthetica by Ashley Howarth MD is a medical practice with a spa’s convenience. Established patients book online. New patients can book online or request a consultation, and the team responds usually the same day.
Online booking or a consultation request
Dr. Howarth’s surgical patients have their series scheduled at the first post-operative visit. Others can book online or request a consultation and describe the surgery, the date, and the surgeon, or the facial puffiness they want addressed. Post-surgical sessions need a surgeon’s clearance first.
A series timed to the surgery
You leave with a written plan: when the first session falls; how many sessions and how often; how the compression garment and activity fit around them; which signs mean a call to the office; and, for wellness patients, whether a stand-alone session or a lymphatic step in a monthly facial fits better.
Tapering sessions, then as needed
Post-surgical series taper over 4 to 6 weeks and end when the swelling is clearly resolving; results are judged with the surgical photographs at 3 to 6 months. Wellness patients return monthly or after travel. A-List members have the next visit scheduled before they leave.
Your Questions, Answered
Lymphatic Massage Frequently Asked Questions
Manual lymphatic drainage uses light, slow, skin-stretching strokes to move fluid out of swollen tissue along the lymphatic pathways toward the nodes that drain it. After surgery that reduces swelling, eases firmness, and improves comfort while the tissue heals; on the face it clears puffiness under the eyes and along the jaw for hours to days. It does not remove fat, tighten skin, or change a surgical result.
At Aesthetica by Ashley Howarth MD, after Dr. Howarth has examined the treated area and cleared it, typically about a week after liposuction once the incisions have sealed and there is no fluid collection. Sessions then run 1 to 2 times a week in a series such as 6 to 10 over 4 to 6 weeks, with the compression garment worn as prescribed between them. Patients treated elsewhere need their surgeon’s written clearance first.
Yes. A tummy tuck divides the lymphatic channels along the incision and reroutes drainage, so the provider works around the incision and any firm area, never over a fluid collection, and directs fluid toward the armpit and groin nodes according to the new pattern. It starts on Dr. Howarth’s clearance after the drains are out, usually about a week after surgery, and any enlarging swelling, drainage, or fever is examined before the next session.
For most people, yes, because it uses no heat and almost no pressure, and it is safe for all skin types and sensitive skin. It is not done on anyone with an active infection or cellulitis in the area, a suspected or known deep vein thrombosis, untreated heart failure, kidney failure, an open or draining incision, or a fever, and post-surgical sessions never start without the surgeon’s clearance. The intake before every session screens for those.
No. The lymphatic vessels sit just under the skin and collapse under firm pressure, so the technique is deliberately light, slow, and rhythmic, closer to skin stretching than to a deep tissue massage. After surgery the treated area may be tender, and the provider adjusts to that; most patients describe the session as calming. If a session hurts, the pressure is wrong and the provider should be told.
A typical post-liposuction or post-tummy tuck series at Aesthetica by Ashley Howarth MD is about 6 to 10 sessions of 45 to 60 minutes, 1 to 2 times a week, tapering over 4 to 6 weeks as swelling resolves. After a facelift or eyelid surgery, 2 to 4 shorter facial sessions in the first two weeks are usual. Dr. Howarth sets the number at the first post-operative visit and adjusts it to how the tissue is healing.
Monthly is the usual rhythm for ongoing puffiness or sinus congestion, and many patients add a lymphatic step to their monthly facial instead of a separate session. It can also be booked as needed after travel, during allergy season, before an event, or after facials, injectables, or laser treatment once the skin has healed. A wellness session is 30 to 45 minutes and needs no clearance.
Temporarily. Moving fluid out of the cheeks, jawline, and under-eye area refines facial definition for hours to a few days, which is why patients book it after travel or before photographs. It is not a sculpting treatment and does not tighten skin or reduce fat; lasting change in facial contour comes from Ellacor, laser, fillers, or surgery, and the team will say which applies.
No downtime. After a post-surgical session the compression garment goes back on, and you are asked to drink water, walk, and watch for the warning signs on your instruction sheet. Mild tenderness or pinkness for a few hours, increased urination, and some fatigue in the first weeks after surgery are normal. After a facial session most patients leave with visibly lighter, fresher skin and go about their day.
A fever, spreading redness or warmth around an incision, drainage or an opening in an incision, a swelling that is rapidly enlarging or sloshes, pain or swelling in one calf, and chest pain or shortness of breath. Each of those is examined by Dr. Howarth before any massage, and the last two are treated as emergencies the same day. In Arizona’s heat, dizziness and very dark urine also mean stopping to rehydrate.
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