Dirty Little Secrets
Plastic Surgery Recovery Industry
Dirty Little Secret #1
Did you know that many people who work in the plastic surgery recovery industry are not licensed and have little (if any) training in anatomy and physiology? Know how to assess your therapist.
Dirty Little Secret #2
Did you know that most of the videos on YouTube and Instagram portraying lymphatic massage as painful are actually not showing lymphatic massage at all?
Did you know that it is illegal in most states for a licensed massage therapist to work directly on a wound? That means that anyone who is reopening incisions or just simply draining fluid from incisions (incisional drainage) is breaking the law? Not only is it illegal, but it is painful, unnecessary, and could possibly cause an infection serious enough to kill you. Find out what real lymphatic massage is.
Dirty Little Secret #3
Did you know that many people who do this work are not insured? So what happens to you if a person who is not trained hurts you with their work? (As in that person ends up giving you an infection that at best may require IV antibiotics and at worst could kill you.) Ask what insurance your therapist carries.
Dirty Little Secret #4
There are a number of unethical people who prey on the fact that many people coming out of plastic surgery don’t really understand what they need to get better. Be wary of practitioners who will tell you that you will need a lot of extra expensive services without ever having laid eyes or hands on you to figure out what your unique healing journey will be like.
Dirty Little Secret #5
Did you know that many plastic surgeons give out scripts for Deep Tissue Massage and Cavitation Therapy right after surgery, despite the fact that both of these techniques are completely inappropriate for someone who is in the first few weeks of surgical recovery? Find a therapist who is has advanced lymphatic training and who has training in compression therapy.
If you are about to have plastic surgery or you have just had plastic surgery and you are confused by all of the misinformation out there, you are not alone.
Many well-trained lymphatic therapists have begun speaking out recently about these problems. We are tired of hearing stories of people who spend their hard-earned dollars thinking that they are doing the right thing by getting what they think is lymphatic massage after their surgery.
Many of them end up paying for services from unlicensed, untrained, uninsured, and / or uneducated individuals who are using ineffective and sometimes dangerous techniques that can cause harm.
The worst part about that is that because so many of these “practitioners” are great with social media, there has been a culture created that propagates the myth that you must suffer through massages after your surgery. So, when they go for these painful therapies, they think they have found the right therapist. Meanwhile, those of us who have had proper training spend hours trying to convince people not only that it doesn’t have to be that way, but that it shouldn’t be that way.
But, don’t take my word for it.
Here’s an article from December 11, 2020 regarding just such a practitioner who is being sanctioned for performing incisional drainage (incorrectly referred to in the article as “lymphatic drainage massages”).
The Miami Herald reports: “Ms. Diaz [the therapist in question] willfully abused her position as a massage therapist to advertise and engage in dangerous practices outside of the scope of her license,” the emergency restriction order states. “She subjected herself, her patients, the public and an undetermined number of associates to needless risk of infection…Ms. Diaz’s actions demonstrate that she poses a significant danger to patients as long as she continues to improperly perform post-surgical drainage massages.”
My reposting of this information is not to shame Ms. Diaz in particular. The type of incisional drainage that she is accused of performing happens every day in Miami, and is performed by likely hundreds of people. It is illegal, and it is dangerous. End of story.
Know How to Assess Your Therapist
Licensure and Education
At first you may not think that licensure is important, but let’s think about this for a second.
For a person to be a licensed massage therapist, they must have a minimal level of schooling – usually no less than 500 hours in most states, and up to 1,000 hours in others.
This education teaches the therapist how to work on the human body safely, because it is possible for them to cause harm – and that is just doing regular simple spa-style, feel-good massage. People whose education has stopped at this level have not learned enough to work on people undergoing plastic surgery recovery.
In almost every state, it is required that a massage license be posted at the place of business.
Just finding a licensed massage therapist
doesn’t mean that person is qualified to work on you after surgery.
You can be a licensed massage therapist, but to work with people after surgery, you need special advanced training.
- Does this person have certification in working with medically fragile people – for example, people who have special medical conditions, have training in how to work with people with cancer (in cases of breast reconstruction after mastectomy, or how to work safely around special implanted medical devices (like drains)?
- Do they ALSO have a certification in Manual Lymphatic Drainage, or even better, are they a fully Certified Lymphedema Therapist?
- A CLT (Certified Lymphedema Therapist) has completed 135 hours of extremely intensive training in anatomy and physiology of the lymphatic system, diseases of the lymphatic system, diagnosis of common diseases that cause lymphatic disfunction, compression therapy, fibrosis reduction techniques, and much more.
- Someone who is a CLT-LANA is a CLT who has taken the highest possible exam in the lymphatic profession. It is similar to a doctor who is Board Certified. It is an optional exam, but it means that person really knows their stuff when it comes to the lymphatic system.
- CLT’s are certified through special schools that offer training for Lymphatic Therapy only. You cannot get certified in Manual Lymphatic Drainage or become a Certified Lymphedema Therapist without attending one of these schools. There are only a few of these schools in the United States and Canada. If someone is claiming to be “certified” they should be able to produce a certificate from either Klose Training, Academy of Lymphatic Studies, Norton, or the Vodder School. Massage schools do not certify people in Manual Lymphatic Drainage. Here is more info on this subject:
Ask your potential therapist:
- How often they work on people with plastic surgery. If there is a long pause, that’s a hint.
- What training they have in plastic surgery recovery
- Are their certifications available online so you can view them?
Is Their Business Legitimate?
A reputable therapist will likely have a city business license as well as a tax registration available on their wall. (I have worked in cities that don’t require a city license, so if you don’t see one, call the city and ask if it is required.)
Insurance is another very important thing you should check for in a therapist. Licensed Massaged Therapists (LMT’s) are required to carry liability insurance in case something happens to a client. When interviewing a potential therapist for post-surgical care, ask what insurance company they have. The two biggest ones in the industry are ABMP and AMTA.
REAL Lymphatic Massage Does Not Hurt
Lymphatic work should not be painful. The videos that you see on YouTube and Instagram of women talk about having to take medications in order to bear the pain of “lymphatic massage” did not get true lymphatic massage.
Real lymphatic massage is so relaxing that most people fall asleep on the table. Yes, even right after surgery.
Just Because Someone Says They Do This Work Doesn’t Mean They are Safe!
Real lymphatic massage uses the body’s lymphatic system (a parallel network of vessels to the veins that carry fluid and waste instead of blood) to remove fluid from a swollen area. That fluid is then returned to the bloodstream, and our kidneys help us pee it out.
What is often called “lymphatic massage” is really something called “incisional drainage.” This is where fluid is forced out of your incisions. It hurts.
While there is nothing wrong with fluid coming out of your incisions on its own in the first couple days after surgery, you should NEVER – I mean NEVER have someone re-open these incisions in order to get out the fluid. This puts you at great risk for developing sepsis – an infection of the blood that can kill you in a matter of hours. At the very least, you’d wind up on IV antibiotics from it and enjoy a night or two in the hospital. No joke.
Is Your Therapist Ethical?
This is a really hard thing to assess because there is no certification to look for to find out if your therapist is an ethical business person. Wouldn’t that be nice?
One of the dirty little secrets about the plastic surgery recovery industry is that people who come looking for therapists don’t fully understand the therapies available, and unethical therapists will sell them anything and everything they can to raise the price tag of those visits.
What you need to look out for are people who push services on you right away that are above and beyond lymphatic massage, good compression, and maybe some lymphatic applications of kinesiotape (I don’t mean tape binding here). By this I mean that you call them up and they start selling you immediately on things like wood therapy, cavitation, etc. before they have even seen you.
Several reputable therapists, myself included, offer lots of bells and whistles – sometimes at an additional charge – and there is nothing wrong with that provided that they are suggested on an as-needed basis – AND that the therapist has the proper training.
A good therapist is going to be one who errs on the side of caution and does not try to over-treat. It is a red flag when someone says that “standard treatment must include” things like cavitation ultrasound, radio frequency, wood sculpting, etc. Usually, this comes in the form of a “recipe for getting super snatched” – and the idea that you must get these therapies or your surgery will all have been for nothing are often propagated on Instagram and YouTube.
A good, ethical therapist will look at you after your surgery and make suggestions for x number of massages based on what is common for that surgery. Then, given your age, whether you have had kids and have lots of loose skin, what kind of shape you were in physically prior to surgery, etc. will determine if they think you might benefit from a little lymphatic taping, or some other minor tweak.
If your therapist is talking about doing cavitation on you right off the bat – especially if you are not yet 5 weeks out of surgery, you should start looking elsewhere for a therapist.
A good therapist will want to see first how you respond to lymphatic massage, your properly fitting Stage 2 faja with foams and boards, and possibly a bit of taping before hopping on the bandwagon for other therapies. While everyone wants to look great immediately, slow and steady wins the race when it comes to healing from plastic surgery.
Each person is different. While there might very well be some people who do need cavitation or radio frequency skin tightening, it isn’t everyone. So, if your therapist is being pushy about such services, they may be thinking about their own pocketbook rather than your needs.
You May Get Incorrect Information
From Your Surgeon for Post-Op Care
This one may seem a little far-fetched, but hear me out. It took me a while to believe this, too.
In my own practice, I have had numerous clients over the years insist that their surgeon told them to go for “deep tissue massage” right after surgery. Initially, I was convinced that either the client had misunderstood the surgeon’s post-op instructions because they were still coming out of anesthesia, or that they were just repeating back to me something that they had seen on Instagram or YouTube.
Then, one day I asked if I could actually see the post-op paperwork from one client who was being insistent that I do deep tissue work on her mere days after her surgery. I thought I would prove her wrong.
Much to my astonishment, this young woman had a prescription that ordered not only deep tissue massage, but ultrasound cavitation to boot! I remember just staring at the paper unable to speak.
No wonder she was having such a hard time believing what I was saying. She thought that if she didn’t get what the surgeon ordered that her surgery results would look terrible.
And, frankly, who could blame her?
Over the years I have lost count of how many of these prescriptions for inappropriate post-op care that I have seen.
Don’t get me wrong – there are plenty of good surgeons who make good post-op recommendations.
Also, there are some absolute things that you MUST follow that your surgeon says to do post-op, like don’t sit on your BBL for a minimum of 6-8 weeks, and keep your incisions clean and dry.
But, as much as I hate to say it, surgeons are not always 100% right with their post-op directions. These prescriptions for post-op deep tissue massages only serve to perpetuate the myth that you must suffer after your surgery.
I would never presume to tell a surgeon how to do a surgery. Surgeons receive years of training to learn their craft. While I know a good deal about what they do, I’m not a surgeon. Likewise, generally speaking, surgeons do not have training in lymphatic work. For that matter, most doctors (I’m not kidding) get maybe a whole hour or two of lecture about the lymphatic system in their entire medical school training. Don’t believe me? Find someone who knows a doctor and ask them. I have – many of them.
So, when it comes to lymphatic massage after plastic surgery, it is important that you find someone whose training is specifically in lymphatic therapy. The best option are Certified Lymphedema Therapists if one is available to you. They not only are trained in lymphatic massage (properly called “Manual Lymphatic Drainage [not to be confused with incisional drainage where fluid is pushed out of incisions]), but they also are highly trained in compression which is a critical part of post-operative care.