Manual Lymphatic Drainage

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Facial Anatomy

Manual Lymphatic Drainage (MLD) is a light massage technique used to reduce a build-up of fluid in the tissues, for example edema (or oedema). It was created by Dr Emil Vodder, a Danish physical therapist, and his wife, Estrid, in the 1930s.

As well as the circulation system that courses blood through our veins and arteries, we also have the lymphatic system that sends white blood cells (lymph fluid) throughout the body and sweeps bacteria and toxins into the blood stream and away to the organs of elimination. Although the blood circulation system is powered by the heart, the lymphatic system has no motor and lymph is propelled through special channels by muscle contraction or by movements of blood through adjacent veins and arteries.

When lymph fluid stops draining properly, swelling or edema results. In MLD, the tissues are gently stroked to assist the flow of lymph away from the areas of swelling and out through the lymph nodes. One popular technique is Skin Brushing, where a brush with natural bristles is used to encourage healthy lymph flow, often in conjunction with hot or very cold showers.

Since lymph flows through the body in a one-way direction, with valves preventing fluid from going the wrong way, the tissues must always be slowly and gently 'pumped' in the same direction as the local flow pattern. This is done in reverse order, clearing the node through which the lymph will drain, then working back towards the problem area. MLD should not be used near an open wound or if the patient has a fever, an infection or one of several heart or kidney problems. It is recommended that MLD should only be carried out by someone with a recognized qualification.

If facial lymph nodes are damaged, lymph fluid may pool, leading to areas of puffiness and edema, for example under the eyes and low in the cheeks. MLD can be used, but only with the lightest touch of the fingertips, to avoid any risk of stretching skin that may have already started to become baggy. Since facial lymph all drains into the neck, the nodes in the neck need to be tackled first. MLD cannot reverse telangiectasia or rhinophyma, but might help reverse areas of fibrosis, where the tissue seems hard and immobile. If properly carried out, MLD will not irritate the skin or increase blood flow.

For maintenance, people generally need to be treated every 4 to 6 weeks. The good news is that you can perform MLD on your own face, but preferably after you've been shown how by an expert. (Pay careful attention and write up your notes the moment you leave.) Alternatively, here is a brief note about performing MLD on oneself, submitted by Gavrielle, November 2002:

"If facial swelling is caused by the lymphatic system being unable to drain extra fluid from the face, it may be beneficial to use your fingertips to lightly stroke the lymphatic nodes under your chin in a downward direction. (You can feel these nodes on either side of the midline of the throat, tucked up under the jaw.) This has an immediate effect of draining off fluid and often cools down a flush. You can actually feel the extra fluid in your neck immediately afterwards, but this will dissipate. It might not drain all the fluid, but can sometimes make a marked improvement. "

Link for drainage systems charts:

Link for general notes on massage technique:

Link for general background information on lymphatic drainage massage: