Ablative lasers vaporize the top layers of damaged skin. They are usually more aggressive than nonablative lasers that leave the skin intact.
An article in the Seminars in Plastic Surgery reports: “Although ablative lasers result in far more down time and a more difficult recovery process, they remain the lasers that produce the most dramatic outcomes.”[i]
Skin must be whole and intact to provide most hands-on bodywork, including MLD.
Because ablative laser treatment destroys the outer layer of skin, bodywork and all hands-on services including massage and MLD are contraindicated until the skin has healed.
Practicing MLD is a wonderful nonpharmacological benefit for clients who have pain or swelling; however, practitioners should be thoroughly trained in all treatment precautions and contraindications prior to practicing. To learn more, please register for manual lymphatic drainage training with us at: https://ceinstitute.com/collections/lymphatics
[i] Preissig, Jason, et al. “Current Laser Resurfacing Technologies: A Review That Delves beneath the Surface.” Seminars in Plastic Surgery, Thieme Medical Publishers, Aug. 2012, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3580982/#:~:text=Ablative%20lasers%20vaporize%20tissue%20and,produce%20the%20most%20dramatic%20outcomes.
Manual lymphatic drainage (MLD) is used to reduce swelling, which can result in pain relief, increased range of motion, physical function restoration and more. It is often performed post-surgery to help prevent secondary injury and increase healing times and outcomes. The two most common post-surgical MLD treatment requests are for cosmetic and orthopedic surgeries.
MLD practitioners must have post-surgical MLD training when working with post-surgical clients. They must also communicate with the surgeon to ascertain each MLD client's specific requirements for their post-surgical treatment and healing processes. The following are some suggested questions a MLD practitioner can ask a surgeon when providing post-surgical MLD.
Practitioners can request this information in the form of a treatment prescription if desired. It is always best to request treatment directions in writing:
Would an increase of circulation be harmful to this client?
When can I start MLD appointments for this client?
Does the client have any surgical drains, implants, injectables or joint replacements?
Does the client have any areas I should not touch? If yes, where?
Can I work around the client’s stitches and if yes, how far of a distance should be maintained between my hand and the client‘s stitches (Practitioners can add: I will use only the weight of my hand to manipulate the skin to create drainage).
Do you want me to wear gloves when working on the client’s skin, or are well sanitized hands acceptable? Follow-up: If I must wear gloves, when would it be acceptable to use well sanitized bare hands?
Is there anything that could happen with the client where or when I should not administer MLD? (Practitioner can add: I do not work with active bleeding, fevers or any sign of infection).
How long of an appointment and how frequently can MLD be provided?
Are there any special directions that should be followed or considerations to be made?
Practitioners should add any other questions that seem appropriate and useful.
Practicing MLD is a wonderful nonpharmacological benefit for clients seeking a reduction of swelling and pain after surgical procedures. To learn more, please register for training with us at: https://ceinstitute.com/collections/lymphatics
For years, we have taught our MLD stretching, stroking and v-flushing strokes to be applied in retrograde, from distal to proximal on the arms and legs. Some of our students questioned this because of training they received elsewhere, where they were trained that taught all MLD strokes are to be applied from proximal to distal which is different than how we teach at CE Institute LLC.
We allow students to apply MLD strokes in whichever direction they feel is appropriate, whether it be distal to proximal or proximal to distal, as long as they are working towards the regional nodes of the area. And we will continue our distal to proximal MLD strokes because of the recent published science that supports this successful retrograde practice:
In the Plastic and Reconstructive Surgery Publishing:September 2021 - Volume 148 - Issue 3 - p 425e-436edoi: 10.1097/PRS.0000000000008252, there was an article published called: Retrograde Manual Lymphatic Drainage following Vascularized Lymph Node Transfer to Distal Recipient Sites for Extremity Lymphedema: A Retrospective Study and Literature Review
In this article, they stated that after a vascularized node transfer procedure: "standardretrogrademanual lymphatic drainage significantly improved circumferential reduction rates and Lymphedema-Specific Quality-of-Life Questionnaire scores."
We have found this and so much more research to build supportsour MLD teachings and practice. We said we'd post updates for our training on our social media whenever possible, as new information develops. This information was only published a couple months ago, and we hope you enjoy the knowledge that working distally to proximally with MLD strokes can be effective! To learn about this and more, please register for one of our MLD classes at: https://ceinstitute.com/collections/lymphatics
Past CE Institute LLC MLD students! Make sure you are following us on social media and check your emails for refresher classes and dates that are periodically sent, when available!
Manual ymphatic drainage practice has branched into many different types of treatments, some are effective and some not so much.
In this 12 1/2 minute video, we'll explain 5 different types of treatments that are commonly advertised as lymphatic drainage services, and provide some basic information about each treatment. The different types of treatments that we will quickly review are:
Manual lymphatic drainage (MLD) does not provide one protocol to fit all scenarios.
There are three distinct type of manual lymphatic drainage appointments that cna be scheduled and practiced, including full body, local and hybrid MLD treatments. Our manual lymphatic drainage full body training teaches all three of these MLD applications.
Clearing the terminus is a common way to start and finish an MLD appointment, whether the practitioner provides a full body, hybrid or localized session.
In this video below, watch where the lymphatic terminus is located and how to clear or pump the lymphatic terminus with your hands. For professional MLD training, please visit and register at: https://ceinstitute.com/collections/lymphatics
With the increase of plastic surgery, skin cancer and nasopharyngeal cancers, painful post-medical treatment facial swelling is increasing amongst the American population. MLD (manual lymphatic drainage) facial services can relieve painful and sightly swelling and as such, is a service in growing demand.
The lymphatic system is partly responsible for removing excess fluid from human tissue to relieve swelling. It collects the excess fluid that the body’s cardiovascular veins cannot collect and leaves behind. As such, swelling is a normal result when the lymphatic system is damaged or when human tissue is traumatized.
HOW LYMPHATIC DRAINAGE WORKS Lymphatic drainage primarily uses human touch over the epidermis to help relieve swelling. Drainage is achieved through specialized strokes and techniques that are applied in a specific order with professional training. In a lymphatic facial session, the practitioner uses their finger pads to apply these very fine movements around the collarbone, jawbone, through the neck, around the ears, and over the entire face during the service. Most lymphatic facial appointments can be completed within about 30 to 60 minutes.
LYMPHATIC DRAINAGE WITH ONCOLOGY About twenty years ago, lymphatic facials were mostly provided for cancer patient survivors. Oncology treatments often include the surgical removal and/ or radiation of lymph nodes, which could subsequently cause swelling. And because we now have more cancer survivors living longer, we still see plenty of this work.
LYMPHATIC DRAINAGE FOR ESTHETIC AND COSMETIC PURPOSES Today, many lymphatic facials treatments are practiced for cosmetic procedures, with most of those being in conjunction with plastic surgeries. Unfortunately, facelifts, blepharoplasty, nose jobs, and other aggressive esthetic enhancements can result in immediate swelling. While most clients will heal beautifully, it can be a slow and painful process. Lymphatic drainage treatments can help clients recover more quickly with less pain when excessive swelling is reduced.
Lymphatic facials can also be practiced daily after a facial operation when working directly with the surgeon. Surgeons who have recognized that increased circulation aids in the healing process have started prescribing lymphatic facials before a facial procedure so that the client can have a more effective healing process and result.
Brides, grooms, models, and anyone who wishes for a noninvasive improvement of facial features can also benefit from a lymphatic facial. A lymphatic drainage practitioner can temporarily ameliorate facial puffiness and the appearance of fine lines or wrinkles. It is a wonderful option for a client who might have partied a bit too hard the night before a big event and woke up the next day wondering what happened to their face.
There are other cosmetic bonuses to a lymphatic facial. It can temporarily reduce dark under eye circles and relieve sinus pressure. While these are not lymphatic facial goals, given their unreliable and limited results, they are common side effects that many clients will experience with this work.
LYMPHATIC DRAINAGE FOR MEDICAL PURPOSES And although it is less common, other medical procedures such as dental implants, wisdom tooth removal, and jaw correction can all benefit from multiple lymphatic facial appointments. These procedures can cause extreme swelling in some clients who will do almost anything to relieve it.
The best part of a lymphatic facial is that it is a nonpharmacologic option to reduce swelling and pain, which is terrific for clients who are either allergic or unable to take opioids or NSAIDS. There are many medical facial procedures, including facial cancer skin grafting procedures where an adverse opioid client would find little relief – except for perhaps an ice pack or a lymphatic facial.
IN SUMMARY I know this technique and information must sound wonderful for those who did not realize that they could achieve any of this by simply learning how to work with the lymphatic system. But I must reemphasize that lymphatic drainage results are only temporary. That is because we are working on living human tissue, which is continually fed by blood supply. So, while the client continues to live and breathe, their tissues will continue to receive blood supply, which can cause more potential swelling. The medical reason why someone would seek this quick result is because any immediate swelling reduction could accelerate the healing process. There are additional reasons why lymphatic drainage is beneficial despite the temporary results, which are thoroughly reviewed in a formal lymphatic drainage training class.
In this brief 8-minute video below, we'll review these details including some of the medical conditions that are seeking lymphatic facial services, aka MLD.
Manual lymphatic drainage (MLD) education for post-surgical conditions is a growing interest amongst our students. But, many manual lymphatic drainage techniques were created for oncology treatment and chronic swelling conditions. What's important to note today is that old school MLD techniques used for lymphedema should not be the same treatment for acute post-surgical MLD. Treating a client's post-surgical swelling the same as chronic lymphedema with MLD is ill-advised.
SWELLING IS A GENERAL PHYSICAL BODYWORK CONTRAINDICATION! Almost ALL chronic or acute swollen soft tissue can TEAR with inappropriate pressure and movement. As such, MLD practitioners must be extremely careful when working with swelling. Manual lymphatic drainage techniques are designed to relieve swelling without damaging the underlying tissues when properly applied.
As such, practitioners should be using different MLD techniques and protocols to treat acute swelling versus chronic swelling. If you are new to the MLD industry, be sure to seek education including protocols and techniques that provide both. And if you have previously trained in MLD, think about the strokes and techniques that you are using and adapt accordingly if you are able, or consider training in these new adaptions with an educational provider like us. Anyone who is practicing the same techniques for both acute and chronic swelling may have less effective treatment than a practitioner who has specific strokes, techniques and protocols for chronic versus acute medical conditions.
To learn more, please register for quality, affordable, professional training at: https://ceinstitute.com/
Here's an 11-minute free manual lymphatic drainage training video that explains this concept and more:
Manual lymphatic drainage (aka MLD or simply "lymphatic drainage") is a light-touch modality that is applied to reduce swelling of the face or body through specialized skills, techniques and practices. It is often applied by massage therapists, despite being quite different from massage.
In "regular" massage, clients can request work almost anywhere they wish, in any order they wish, with a variety of pressures that can be changed from one appointment to the next. In lymphatic drainage, a specific order or routine is followed, with minimal pressure that cannot be altered without medical reasoning.
Why Massage Therapists Learn and Practice Lymphatic Drainage
Lymphatic drainage can be practiced on clients who are contraindicated for massage therapy because of swelling. A reduction of excess swelling will often decrease pain and increase healing, especially in most oncology, sports injury and post-surgical medical situations. That is why massage therapists learn and practice lymphatic drainage. Lymphatic drainage skills can provide extra appointments for clients who would be normally contraindicated for massage.
For example: A client with a strained, swollen ankle might book a full-body massage appointment because they are in pain. However, it is contraindicated to massage an acutely swollen ankle. As such, the practitioner can provide lymphatic drainage on the swollen ankle and regular massage skills throughout the rest of the body. A trained lymphatic drainage practitioner is more likely to relieve this client’s pain rather than send them home without working on the one area the client might want or need it most: their swollen ankle.
The Practice of True Lymphatic Drainage
A practitioner’s lymphatic drainage goal is to encourage excess interstitial fluid—swelling or edema—within the body’s tissues to enter the lymphatic capillaries to form lymph. When this fluid is within the body’s interstitial tissues, it is called interstitial fluid. Once the interstitial fluid enters a lymphatic capillary, it is called lymph.
This fluid transference is known as forming lymph. This newly formed lymph is then gently manipulated toward regional lymph nodes where it is filtered and then travels through progressively larger lymphatic vessels back to the cardiovascular system.
Lymphatic drainage follows different pathways than a typical Swedish massage therapy session. Massage is generally provided in one direction—toward the heart—to increase overall cardiovascular circulation through venous return. Lymphatic drainage has several different pathways that include working toward the cervical, inguinal or axillary nodes. These sophisticated pathways become complicated when a client has an obstruction due to surgery, oncology treatment, birth defect or other physical trauma. (A high-quality CE course in lymphatic drainage will explain the different directions, pressures and tissues that are manipulated and used in this highly specialized bodywork.)
Lymphatic Drainage Bodywork Pressure and Application Explained
True lymphatic drainage is commonly called capillary work because practitioners work to encourage permeable superficial lymphatic capillaries to absorb excess interstitial fluid to form lymph, with extremely light touch and highly specialized skills. Gentle techniques are then applied to encourage this newly formed lymph to travel to lymph nodes and progressively larger lymphatic vessels.
Extremely light pressure is used because applying any type of moderate-to-deep pressure around a swollen or stretched tissue could further stretch or tear the swollen tissue. Also, too much pressure bypasses the initial lymphatics where most of the interstitial fluid is collected to form lymph and reduce swelling.
Despite this fact, there are some who perform lymphatic massage, skipping the light, skilled touch of lymphatic capillary work by claiming to do greater work on larger lymphatic vessels. A lymphatic massage applies kneading or ischemic compression over the lymphatic system’s unique pathways with moderate pressure, which is not a true holistic application of lymphatic drainage, nor is it an appropriate amount of pressure to work with on swollen tissues. Some of these lymphatic massages are performed through clothing, which requires a practitioner to apply even more pressure which could harm a swollen client.
It is critical to properly advertise and provide lymphatic drainage services. In the State of Florida, a licensed massage therapist was recently served an emergency restraining order for advertising lymphatic drainage as forcibly expelling bodily fluids out of their client’s surgical incisions. In the emergency restraining order, the state focused on the fact that lymphatic drainage bodywork is a gentle application that would not include any such forceful practice.
Is Your Lymphatic Drainage Client Taking Opioids?
Many acute medical conditions that cause swelling are indicated for lymphatic drainage but contraindicated for massage. Most acute medical conditions such as surgery, sports injuries or oncology treatments can be traumatic to the body, which could result in that client’s doctor prescribing an opioid.
Lymphatic drainage is one of the lightest forms of hands-on bodywork. It is difficult for a client to feel the light touch of lymphatic drainage bodywork when they are swollen and in pain but on opioids. As such, a client on opioids may ask a practitioner for more pressure during their lymphatic drainage session so they can “feel it working.”
Unfortunately, the excessive use of opioids over the past few decades has likely led to practitioners feeling compelled to apply greater pressure in lymphatic drainage to satisfy their clients’ request to feel the work.
Instead of applying more pressure, it is a practitioner’s ethical duty to explain how lymphatic drainage works with light, skilled touch and to find different ways to show the client how their lymphatic drainage is working, especially when the client cannot feel it.
How to Show Lymphatic Drainage Therapeutic Results
Practitioners should physically show a client their tangible lymphatic drainage appointment results though pre-treatment and post-treatment measurements or pictures. This is important because some lymphatic drainage clients might not be able to feel their lymphatic drainage bodywork for various reasons. Cloth-type measuring tapes can be used to measure a swollen extremity and photos are the best option to review any reduction of swelling or puffiness in the face.
To conclude, almost the only thing in common between massage and lymphatic drainage is it can be offered by a massage therapist on a standard massage therapy table. Beyond the practitioner and table, these two modalities are extremely different for important therapeutic reasons, which becomes increasingly apparent with greater lymphatic drainage training.
In this brief 17-minute video below, we'll review this information in detail, and review why the lightest pressure is used to relieve swelling amongst other medical reasonings.
Suggested appointment prices for manual lymphatic drainage (MLD) services are difficult to develop for some practitioners, especially when they first get started in the modality.
In this brief 7-minute video, we'll review some tips to follow if you're trained in lymphatic drainage and wondering what to charge for your service. This video was primarily created for CE Institute LLC students who train in our MLD application - however some others may find it helpful.
Here is some basic info about setting prices in general for massage therapy and bodyworker services:
Here are some common questions, answers and tips about setting these massage prices:
What should I charge for a one-hour treatment or service? Look to your local peers and consider what they are charging? Consider their property amenities, training or years of experience with their one-hour price. Then, look to your own practice and try to determine if your service is the same, less or better than what they are providing and charge accordingly.
It is important to consider your market’s average price for viability of your own.
Should I charge more for specialized work more so than a "regular" appointment? This can be one of the most puzzling questions and situations in practice today.
One solution would be to charge a fairly high hourly rate and tell the client that they can have any type of service for this charge. Then, I may discount the service if it’s an easy appointment, or they book regularly, or whatever feels appropriate.
Sometimes I feel that massage therapists should charge a little more than their “average” market price so that there is room to offer discounts on slow days/seasons and for repeat/good clients.
Some customers may also be intrigued as to why you “costs” more than average, too. Keep in mind that good pricing involves providing your best possible service for the best possible charge.
How do I explain a price difference for different services? While I personally charge an “expensive” one-size-fits-all price for services, some therapists will have a low base price for massage, and charge more for additional modalities.
It’s perfectly acceptable to charge more for harder or complicated work. Here are three reasons why therapists can (and sometimes should) charge more:
Additional equipment and/or training was involved to provide the service; therefore, a higher price will recoup the financial investment for training and/or equipment. This is often applicable for prenatal, stone, aromatherapy, NMT and so forth.
The work is physically “harder,” which means you will not be able to provide as many appointments that day. This is often applicable for deep tissue and hot stone work.
Extra time is required to provide the service. This often applicable to mobile appointments, stone work, prenatal, shirodhara, etc. (Be sure to add any parking expenses to a mobile appointment price, too!)
What is the best practice to charge for add-on services? You should always charge for “add-ons” such as a foot scrub, paraffin or anything else that would not be normally added to the scheduled service.
If you do provide “add-ons,” it’s important to publicly post a detailed price list of these add-on services on your website, at the reception counter and/or in your service menu.
And, if a client requests an “add-on” during service, tell them the additional costs for the “add-on” before it is provided. While it’s never ideal to talk about money during a service, it could also be considered unethical to charge more than agreed without the client’s informed consent.
Setting your own appointment prices can often feel confusing and conflicting.
Using these guidelines will hopefully help make decisions about this important process. Be upfront, honest and clear about pricing. Regardless of what you charge, you should always provide a professional, reputable service that is reliable for your customers.
Good business usually provides good prices, so don’t be shy to charge what you’re worth, and let those cash registers ring!
