To see the Pre-Class Document PDF, please click or tap here.
Thank you for signing up for the FREE Intro to Plastic Surgery Recovery Massage preclass!
Watch This Video:
What can you expect to learn? If you open and read the links and watch all the videos, you will be able to:
List and describe three popular plastic surgery procedures
Describe what happens in the liposuction procedure
Describe why people may seek liposuction
List a few modalities that may be useful in the treatment of edema and fibrosis after plastic surgery
Describe the difference between Stage 1 and Stage 2 compression garments.
List the different types of foam that may be used after plastic surgery and their benefits
Describe why a client should wear compression after plastic surgery procedures like abdominoplasty or liposuction
Why is this so important to learn?
Reviewing these materials will help us to discuss what our clients are experiencing after each operation and apply the modalities we already use at the office as well as other interventions to reduce their symptoms, promote mobility and function and increase quality of life.
What if you are interested to learn more?
In November 2019 I will be teaching a more robust class (Update: This Class has SOLD OUT!) that will build upon the information in the Intro Preclass. The in-person Plastic Surgery Recovery Massage class will familiarize students with applications of massage and bodywork therapy for specific needs of the post-plastic surgery client.
Objectives covered in the in-person class include:
How to market massage and bodywork therapy practices focused on serving the post-plastic surgery client.
Side effects of plastic surgery that clients may feel during the recovery process
Stages of wound healing
Massage modalities that can reduce swelling, fibrosis and other side effects of surgery
Client self-care actions that can reduce swelling, fibrosis and other side effects of surgery
Contraindications to post-surgery massage
Post-recovery exercise and movement options you can suggest to clients
Continuing education options for therapists
Resources that you can pass on to clients
Put what you learned to work by analyzing post-operative signs and symptoms in a case study client and offering potential interventions to the client.
I will provide more details on future in-person classes in 2020.
Intro to Plastic Surgery Recovery Massage – Section 1
Let’s start by taking a look at different types of plastic surgery. Hold on to your sandwiches, because some of the videos are show and tell.
You are reading this because you a massage therapist, or physical therapist interested in helping clients recover after plastic surgery. Most of the techniques also apply after orthopedic surgery, but let’s stick to plastic surgery for now.
First things first – what type of surgeries are plastic surgery? What should clients know before their surgery? Let’s take a look.
The American Society of Plastic Surgeons (ASPS) shares a list of the most popular plastic surgery procedures in the United States: https://www.plasticsurgery.org/news/press-releases/new-statistics-reveal-the-shape-of-plastic-surgery
Check out these Plastic Surgery Statistics https://www.plasticsurgery.org/news/plastic-surgery-statistics
The ASAPS has a great online Plastic Surgery Planning Toolkit full of resources https://www.smartbeautyguide.com/planning-toolkit/
The ASAPS also has a list of Questions to Ask Yourself Before Plastic Surgery for potential plastic surgery clients. https://www.smartbeautyguide.com/news/all-news/ask-12-questions-before-plastic-surgery/#.XO4F_LzYrnF
Now that we have an idea of what plastic surgery is, let’s learn more about some of the most popular operations. Watch these informative videos of the top procedures:
Brazilian Butt Lift –
Facelifts have several different possible incisions https://www.plasticsurgery.org/cosmetic-procedures/facelift/procedure
Male Plastic Surgery –
Next we’ll focus on liposuction!
Intro to Plastic Surgery Recovery Massage – Section 2
Today is all about liposuction. This surgery is the heart of my practice, but there is more to it than meets the eye. It is done several different ways and for different purposes.
Liposuction is the surgery I see the most. Let’s learn more about liposuction:
The article ‘A journey through liposuction and liposculpture: Review’ published in the Annals of medicine and surgery’ provides a great overview: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5681335/
Learn about Liposuction zones of adherence https://journals.lww.com/plasreconsurg/Documents/Updates_in_Aesthetic_Surgery_0512_Article.14.pdf
Analysis of postoperative complications for superficial liposuction: a review of 2398 cases. https://www.researchgate.net/publication/49802564_Analysis_of_Postoperative_Complications_for_Superficial_Liposuction_A_Review_of_2398_Cases
Contour Irregularities : Management of Contour Irregularities following Superficial Liposuction https://journals.lww.com/plasreconsurg/FullText/2011/08000/Management_of_Contour_Irregularities_following.58.aspx
Liposuction research on treatment of swelling and lumps / fibrosis https://youtu.be/XhRcnCUyuS0
Many different clients receive liposuction. Here are a few:
Male liposuction (Dr. Hall also talks through what the surgeon’s markings mean and where incisions are placed).
A Nonbinary Trans Person Talking about Midsection Lipo
Nonbinary Transition: 1 Year Post-Op for Midsection Lipo, 5.5 months for Top Surgery
Bobbi Dare’s experience with liposuction and Brazilian Butt Lift
Liposuction for Lipoedema patient stories
Some reconstruction surgeries after breast cancer involve liposuction to harvest fat as well as removing skin on the abdomen. We can use our post-plastic surgery skills to help these clients as well.
Breast reconstruction with a TRAM flap –
Breast reconstruction with liposuction –
Next we’ll focus on edema and learn about swelling
Intro to Plastic Surgery Recovery Massage – Section 3
If you have Foldi’s Textbook of Lymphology, review chapters on:
- Manual Lymphatic Drainage
- Decongestive Movement Therapy, decongestive breathing therapy, rehabilitation exercise and other physical therapy techniques
- Compression Therapy
Let’s talk edema (swelling). What did we learn when we were young? Edema happens when we injure our bodies. Wound care is important, and then we used RICE (rest, ice, compression, elevation).
Edema basics – https://www.woundsource.com/patientcondition/edema
Evaluate information you find online with the Craap test https://libguides.okanagan.bc.ca/c.php?g=400553&p=2905312
Next we’ll focus on modalities we can use after plastic surgery.
Intro to Plastic Surgery Recovery Massage – Section 4
What types of modalities are used after surgery? Here is some basic information on the modalities we will discuss.
- Manual Lymphatic Drainage (MLD)
- Can Manual Lymphatic Drainage massage help reduce swelling after a facelift?
- IASTM / Graston Technique https://youtu.be/9Kl7lMCtBUI and https://youtu.be/MM7nBqp6yk0
- Massage Cupping https://youtu.be/477Ycy0dInA
- One school’s massage cupping cleaning protocol – https://www.studycupping.com/disinfection-download
- ABMP Massage Cupping class https://www.abmp.com/members/continuing-education/online-learning/courses/webinar-introduction-massage-cupping-and-vacuum-manual-therapy
- Mechanically Assisted Negative Pressure Therapy (Lymphatouch) webinar – https://www.performancehealthacademy.com/education/webinars/considerations-and-clinical-applications-of-mechanically-assisted-negative-pressure-therapy-for-orthopedic-and-oncologic-populations.html
- Hivamat https://youtu.be/fO_3KXJEhfs and MLDUK Conference 2018: Dr. Jens Reinhold Presentation https://youtu.be/-6m3SH9e0Is
- Manual lymphatic drainage and therapeutic ultrasound in liposuction and lipoabdominoplasty post-operative period https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4075221/
- Rhythmic Deep Tissue Massage Technique https://youtu.be/olXf-i5ro1k
- Pneumatic compression. Karen ashforth states “Evidence proves that higher pressures are required to effectively decongest and remodel hardened fibrotic tissue. Current research points to pressure up to 60 mmHg” and “Using quilted compression pads and garments underneath pneumatic compression yields powerful results by giving a “dual massage”.” https://lymphaticnetwork.org/news-events/understanding-lower-extremity-phlebolymphedema-fibrosis
- Tissue fluid pressure and flow in the subcutaneous tissue in lymphedema https://pdfs.semanticscholar.org/21be/bf938eac988b0545857f5029fdb20bd7854f.pdf
- Karen Ashforth is an innovator in treating lymphedema-related fibrosis and inflammation – read her “Understanding Fibrosis” series here:
- Scar treatments https://aestheticsjournal.com/feature/treating-scars-2
Scar Management https://www.woundsource.com/patientcondition/scar-management
Next we’ll focus on nutrition and wound healing
Intro to Plastic Surgery Recovery Massage – Section 5
Out of our Scope of Practice, but still important to know. If the client has questions, refer them to their surgeon for assistance.
Nutrition and Wound Healing
Nutrition in Wound Care Management
Nutrition in Surgery Podcast Series
8 Signs of Infection
Surgical Site Infections
More Surgical Site Infections https://www.woundsource.com/blog/assessment-surgical-wound-infections
Reasons why a Wound Will Not Heal https://www.woundsource.com/blog/wound-healing-reasons-wounds-will-not-heal
Knowing the difference between a scab and eschar https://www.woundsource.com/blog/knowing-difference-between-scabs-and-eschar
Slough Versus Purulence
Wound Healing informational resources – Should I refer what I am seeing to a wound care specialist? https://www.woundsource.com/webinars
“Surgical Wounds and Surgical Site Infections: When Acute Healing Goes Wrong”. https://event.on24.com/wcc/r/1837452/F98959A2A8B9ECA33187C50DD72FAAF1
Incision Management Class
Next we’ll focus on how to help our clients recover
Intro to Plastic Surgery Recovery Massage – Section 6
How to Help Clients Recover
Frustrated over noncompliance? This may help. I learned this in my personal training classes, and it applies to massage clients as well! Why is it crucial? Compression, nutrition, movement, self-care are critical to recovery.
Is your advice really being heard? Know what stage they are in. https://www.psychologytoday.com/us/blog/happiness-in-world/200910/5-steps-changing-any-behavior
Motivational Interviewing https://youtu.be/s3MCJZ7OGRk
Understanding Reflective Judgement Stages – http://umich.edu/~refjudg/reflectivejudgmentstages.html
Where are we at? Where are our client’s at?
Another perspective – Emotional First Aid and inner thoughts https://youtu.be/F2hc2FLOdhI
Next we’ll talk compression
Intro to Plastic Surgery Recovery Massage – Section 7
VIdeo: What is a Plastic Surgery Compression Garment?
Compression garments are often called fajas or fajas columbianas, which is Spanish for ‘girdle.’
Most compression garments used for post-plastic surgery are not graduated compression.
Many patients will have their faja altered by a non-medical seamstress, which may or may not change the original even level of compression in the garment.
Some plastic surgeons may recommend their patients wear antiembolism stockings after surgery to reduce the risk of deep vein thrombosis.
Brazilian butt lift garments have no compression over the gluteal area. The butt may be either closed or open.
Some garments are custom made to the patient’s measurements, others are purchased ready made. Sizing is not the same as clothing sizing and is based on arm, underbust, waist, hip and thigh measurements.
What do we know from our lymphedema therapy training about compression? Foldi & Foldi advise that “pressure generated by compression should be high enough to be effective, but should not cause pain or restrict circulation (especially at rest)” (Foldi & Foldi, 2012 p. 533) “Every unnecessary crease in the compression material blocks lymph drainage; thus, creases act like scars. This obstruction can be avoided by applying adequate underpadding” (Foldi & Foldi, 2012 p. 535)
Postsurgical Compression Garments have 2 or 3 stages.
Most Stage 1 garments are provided to the patient by the plastic surgeon and are to be worn 23 hrs. per day for the first week or two (possibly for up to a month). They feature soft fabric and either zippers or hook and eye closures. Due to postsurgical edema, the garment will be difficult to don. Stage 1 garments often have an open crotch to aid in toileting.
Some people will recommend that the patient places ‘lipo foam’ inside of their garment for more even compression. There is no universal agreement by plastic surgeons on the prescription of ‘lipo foam’ or the use of abdominal boards or BBL lumbar board.
Stage 2 garments are usually purchased by the savvy patient once their first stage garment feels loose. They are often slip on garments, with no hook and eye closures. They may or may not have an open crotch. If compression is not controlling edema, I suggest wearing a micromassage garment instead of a tank top under the stage 2 garment.
Stage 3 garments are for ongoing daily wear or nonsurgical use and feature a lighter level of compression. I suggest that a client can also consider wearing a micromassage garment as a stage 3 garment.
Deep Dive into Compression – https://www.magonlinelibrary.com/pb-assets/JOWC/JWC%20STRIDE%20Supplement.pdf
Next we’ll talk about foam!
Intro to Plastic Surgery Recovery Massage – Section 8
Foam pieces for liposuction are usually rectangular shaped and can be either plain or with an adhesive added to enable it to stick to the skin. Most brands are 8 x 11 and ½ inch thick. Many brands are available and can be found on Amazon. M&D makes a smaller sized foam with a fabric cover they call a ‘lateral protector.’ and made of polystyrene with a hypoallergenic cotton lining.
Several pieces are needed to fully compress the torso, but some clients only purchase one for the anterior abdominal area. I have found that incomplete foam coverage can result in indentions in the uncompressed areas of the torso.
What do we know from our lymphedema training? Foldi & Foldi recommend “using foam that is .5 to 1.5 cm thick, with a relatively high bulk density (e.g. 25-35 kg/m).” (Foldi & Foldi, 2012 p. 531)
Foldi & Foldi state that “pieces with an “uneven surface” have proven to be especially useful for softening fibrosis … prefabricated padding materials with uneven surfaces are also offered in various versions by a few manufacturers” (Foldi & Foldi, 2012 p. 531).
Foam pieces I use:
Komprex foam rubber shapes for patches of swelling not covered by foam padding (xiphoid process or pubis)
Medi lymphpads on my client’s fibrosis. Learn more about uneven foam in the video ‘Liposuction fibrosis – foam can help!’
Next we’ll talk about wearing fajas!
Intro to Plastic Surgery Recovery Massage – Day 9
How do don a post-liposuction compression garment
I have chosen several videos from compression manufacturers. The advice for donning is far different that we were taught in lymphedema therapy class:
Curvy Gyals- How To Put On Our St. Azar Traditional Faja
My FAJA doesn’t fit!?!?!
How To Put Your Faja (Body Shaper) On Properly
Liposuction Swelling Tips –
How can we reinforce the importance of wearing compression after surgery? Let’s start by figuring out what our clients may be thinking. I have heard many of the same frustrations experienced by patients with a lymphedema diagnosis have around compression during CDT.
Let’s borrow the questions from John Holland’s (Vice President of Absolute Medical) Klose 2019 conference presentation:
What is it?
Compression garments and padding work together to reduce edema and fibrosis after surgery.
What’s in it for me?
According to Foldi & Foldi, “compression therapy prevents reflux of fluid that has been shifted as the result of MLD or postural positioning … preserves the successful results of treatment” and “when foam passing material is placed under compression bandages, lymphostatic fibrosis can be softened. It is known that scar tissue also softens (especially after burns) when sustained compression is applied” (Foldi & Foldi, 2012 p. 505).
Foldi & Foldi state that “padding is divided into smooth or uneven padding groups, depending on its function and structure. For smooth padding, the emphasis is on even pressure distribution. “Uneven” or “active” padding achieves a micromassage effect when the patient moves.” (Foldi & Foldi, 2012 p. 529).
Can you prove it?
Each person heals from surgery differently, so no one-size-fits-all plan applies. The easiest way to “prove” if the compression is needed is to take measurements of the compressed area then remove the compression for a few hours or a day and observe the results. How do you feel? What are your measurements after not wearing your compression?
Will it be worth it?
Proper compression therapy will help your body heal faster, reducing the heavy, tight feeling that comes with swelling. How quickly do you want to get back to your daily life? How good do you need your result to look? Did you undergo surgery to look good in clothes or both in clothes and unclothed?
Can I justify the purchase?
Ask the client to share their final goal of surgery with you. What do they want to do once their are completely recovered?
Do I really need it now?
Are you experiencing a plateau in your healing? Are you feeling fibrosis starting to form? Is your older garment still doing a good job of compressing?
Next we’ll talk about ongoing education and self-care
Intro to Plastic Surgery Recovery Massage – Section 10
Therapist ongoing education and self-care
Carole Osborne: Addressing Body Mechanics While in the Side Lying Position https://youtu.be/qfkDmg2flSo
Body Dysmorphic Disorder https://www.mayoclinic.org/diseases-conditions/body-dysmorphic-disorder/symptoms-causes/syc-20353938
Katharine Phillips MD | Body Dysmorphic Disorder (BDD) Conference 2015, London
Optional deep dive into the topic – https://adaa.org/webinar/professional/body-dysmorphic-disorder-disease-self-perceived-ugliness-and-its-relationship
To keep up to date on the latest research, follow these accounts on Instagram: