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Lymphedema is a severe debilitating disease characterized by the accumulation of excessive protein-rich fluid in the interstitial space. Given the severe morbidity associated with this disease process, various surgical and non-surgical treatment modalities have been developed to attempt to reduce the incidence and symptoms associated with lymphedema. Manual lymphatic drainage (MLD), a component of complete decongestive therapy (CDT) on-surgical treatment which has demonstrated benefit in reducing the development of lymphedema following surgery. Here we provide a review of literature on MLD and its potential mechanism of action. This paper aims to educate patients, physicians, and surgeons about MLD regarding its efficacy and utility in the treatment paradigm for lymphedema and to translate concepts from the treatment of lymphedema to cosmetic procedures.

Background There are many functional and aesthetic benefits to lipoabdominoplasty (combination liposuction with abdominoplasty), including increase in core strength, reduction in urinary incontinence, and improvement in lower back pain. However, patients are still hesitant to undergo surgery due to the perceived fears of post-surgical drains, and post-operative pain. Objectives Propose a standardized multimodal pain protocol for patients undergoing lipoabdominoplasty procedures that aims to improve post-operative pain control. Methods A total of 80 patients operated on between July 2020 and December 2021 were evaluated in this study. Patients all underwent lipoabdominoplasty and were administered a standardized pre-, intra-, and post-operative pain regimen. Pain scores were measured across all patients in the immediate post-operative period, and post-operative days 1, 7, 28, and 90. Results Mean pain scores in the post-anesthesia recovery unit were 0.46/10 (+/- 0.18). Subsequent reassessment in the post-op recovery suite yielded mean pain scores of 0.34 (+/- 0.15). Mean pain scores on POD1 were 1.23 (+/- 0.15), and consistent through to postoperative day 7 (POD7) at 1.24 (+/- 0.11) with patients taking an average of 6.65 total Percocet 5mg during the week. After POD7, 95% (76/80) of patients were only taking nonsteroidal anti-inflammatory medications medications. A total of 75/80 patients (93.75%) reported zero pain at 4-6 weeks after surgery (mean pain score 0.10 +/- 0.08). Conclusions The multimodal analgesia protocol consisting of preoperative or immediate induction IV Tylenol, precut local analgesia with marcaine and lidocaine, and intraoperative use of liposomal bupivacaine, can improve perioperative pain control in patients undergoing lipoabdominoplasty.