Efficacy of Manual Lymphatic Drainage in Reducing Postoperative Complications After Cosmetic Plastic Surgery: A Systematic Review

Cosmetic plastic surgical procedures, such as liposuction and abdominoplasty, often disrupt the lymphatic system, leading to complications, including swelling, pain, fibrosis, and seromas. Manual lymphatic drainage (MLD) is commonly recommended postoperatively to enhance lymphatic flow and accelerate healing. However, evidence regarding its efficacy remains inconsistent, particularly in cosmetic procedures. This study aims to evaluate the effectiveness of MLD in reducing postoperative swelling, pain, fibrosis, seromas, and recovery time compared with standard care following cosmetic procedures and assess secondary outcomes, including bruising, patient satisfaction, and adverse effects.

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed/MEDLINE, the Cochrane Library, Embase, CINAHL, Web of Science, and Scopus were searched from inception to September 2025 for studies involving adults undergoing cosmetic surgery. Eligible studies included randomized controlled trials (RCTs), cohort studies, and case series. Risk of bias was assessed using Cochrane RoB 2.0 and ROBINS-I tools. Owing to heterogeneity among the studies, findings were narratively synthesized.

Seven studies were included, primarily RCTs and prospective trials involving cosmetic procedures such as liposuction and abdominoplasty. MLD, alone or with other therapies, reduced swelling, showed variable pain relief, and indicated potential fibrosis mitigation. Efficacy varied by procedure, with better outcomes when initiated early (days 2-5) and delivered in 6-12 sessions. Adverse events were minimal.

MLD provides moderate benefits for postoperative swelling reduction after cosmetic surgery, with inconsistent effects on pain and fibrosis. High-quality RCTs are needed to refine protocols and confirm long-term efficacy.