SPA SERVICES: Lymphatic Drainage—A Moving Experience

Give your spa menu a wellness component with lymphatic drainage services.

Spa services often focus on the skin, but treating the lymph system can be equally important to your clients’ overall wellbeing. Understanding how the lymph system works and its importance to overall health can help you improve existing spa services, and add new ones.

“Lymph is formed when plasma from blood vessels mixes with fluids around the cells,” says Victor Maine, Ph.D., Onyx Medical. “It carries nutrients—for cellular activity, blood cells and the waste discharged from cells—along predetermined pathways to hundreds of filtering stations called lymph nodes, which cleanse the lymph, removing waste as well as undesired molecules or organisms, and excess water.”

This continuous cleansing is an important part of the body’s immune system. Keeping the lymph flowing is essential to good health. Blood is kept moving by the beating of the heart, but the lymphatic system has no pump of its own. Pulsing arteries, respiration and muscle movement are usually enough to keep the lymph moving, but that can be slowed or blocked by poor health habits, trauma or illness, all of which allow fluids and toxins to accumulate and overwhelm the immune system.

In 1936, a Paris-based physician, Dr. Emil Vodder, introduced a set of precise hand movements designed to facilitate the movement of lymph. Manual lymphatic drainage (MLD), his gentle massage system, has been studied and refined now for nearly a century.

“More than 30 years of research documents the therapeutic effects of MLD,” says Linda-Anne Kahn, president and founder of Beauty Kliniek Aromatherapy Day Spa & Wellness Center, and director of Lymphatic Therapy Services of San Diego. “It is widely prescribed by physicians in the U.S. and Canada, and the West German National Health Insurance Administration recognized MLD as a covered preventive healthcare therapy in 1972.

“Within the spa you can offer lymph drainage for problems as diverse as cellulite, acne, rosacea, sinusitis and stress,” continues Kahn. “Wellness services include detoxification; post-surgical treatment, especially pre- and post-surgical liposuction; as support for patients with autoimmune disorders and neurological diseases such as multiple sclerosis, Parkinson’s and migraines; and for lymphedema, Lyme disease and more,” adds Kahn.

In the medical world, MLD is most often performed to treat lymphedema, or lymph fluid accumulation that causes swelling, which results when lymph nodes are damaged or removed (after breast cancer surgery, for example). According to many in the medical establishment, lymphedema is the only legitimate reason for MLD.

Training and Spa Services

MLD is very different from other types of massage therapy. Instead of kneading the muscles, the therapist uses a feathery touch—usually around an ounce of pressure per square centimeter, or about as much as would be applied by placing a nickel or dime on a particular spot. The pressure can be slightly lighter or heavier depending on whether you’re working on a client’s chest or her legs, and whether you’re treating lymphedema or some other problem. When properly performed, MLD should always be a pleasant experience for the client.

Licensed professionals such as massage therapists, physical therapists and registered nurses can earn MLD certification from the Chikly Health Institute or Dr. Vodder School. Graduates of the Vodder School complete courses in anatomy, effects of MLD, contraindications, special techniques and lymphedema treatment. Graduates of the Chikly Institute complete classes in lymphatic drainage for organs, whole body, joints and nerves. The main difference between the Vodder technique and the Chikly method is that with the Vodder technique, therapists use circular motions to move the lymph along the most likely path, whereas Chikly practitioners feel for the lymph flow, and then either stimulate or re-route it.

“Both methods have merit,” says Kahn. “I prefer the Vodder method overall, but as I’m working, I also feel for the flow and sometimes recognize the need to continue working on one area for longer.”

The Dr. Vodder School offers classes throughout the U.S. and Canada. There are four levels of certification: Basic, Therapy 1, Therapy 2 and Therapy 3. To take the classes, massage therapists must have a minimum of 500 hours of training. Estheticians can take specialized face and neck classes, as well as the basic whole-body class, but their esthetics license limits them to working on the face and neck.

“Spa treatments, which can be done by therapists with basic training in the Vodder method, are most often recommended for cellulite, general detoxification, soreness from extreme exercise, headaches (including migraine), stress reactions (including depression and sleep problems), and some forms of chronic pain,” says Kahn.

“Postoperatively, MLD is used to accelerate tissue healing and resolve bruising, while reducing inflammation, pain and edema (swelling),” says Tino Lerma, global corporate trainer, Pevonia International. “Properly trained MLD therapists started affiliating with medical practitioners in the 1990s, mostly for the benefits they provided in postoperative recovery. MLD is known to improve bruising, hastening the transition from the initial blue-red discoloration to the healing yellow-green stage, while producing a measurable reduction in inflammation and swelling. All of these benefits allow patients to look and feel healthier sooner.”

Finding certified therapists for your spa can be difficult. “MLD is such a delicate technique that massage therapists and estheticians can sometimes think they know how to do it when they don’t,” says Bella Schneider, CEO of 5 Star Formulators and founder of LaBelle Day Spas & Salons in the San Francisco Bay Area. “It’s important to ask what kind of training they’ve had, and where and how they’ve used MLD in the past.”

Schools are a good place to start. Kahn, who is certified as a lymphedema specialist and manual drainage therapist, hosts Dr. Vodder classes at Beauty Kliniek several times a year. The Lymphology Association of North America ( has established training guidelines and does certification testing for lymphedema specialists.

Lymph Drainage Devices

There are a number of lymphatic drainage devices used in hospitals and spas, and for in-home care. These vary from simple vibration or pressure devices to complex machines that make use of multiple technologies to attack specific areas of lymphatic drainage, as well as other problems.

“There can be differences in the machines used for lymphatic drainage in the two settings,” Schneider notes. “Machines used in medical settings can be more elaborate and, perhaps, more powerful. In the medical setting, lymphatic drainage is more often used post-surgery, while in the spa, the emphasis more often revolves around detoxification and slimming.”

Here’s a quick rundown of the types of devices available, and some of the brands typically marketed to spas:

Compression pumps
consist of pneumatic cuffs connected to a pump. They employ compressed air pressure to force excess lymph fluid in a particular direction. These include simple, single-chamber devices that apply uniform pressure, as well as complex, computer-programmed machines with a dozen or more chambers that can be inflated sequentially with gradient pressure.

The Ballancer Pro from 5 Star Formulators is a computerized, sequential compression therapy system designed for use by spa professionals. “Most other compression systems in the marketplace are designed to drain only one or two body parts, such as the legs or arms,” says Schneider. “The Ballancer covers the whole body. We usually start the treatment with the upper body jacket to drain the face and neck; we then lay the client down and do the rest of the body.”

Additional compression devices include the BTL LymphastimPresso-therapy units and the Onyx Medical Press-O-Therapy 8.

ELDT (electro-lymphatic drainage therapy), which employs acoustic vibration transmitted through an electro-static energy field, has a long, and somewhat controversial, history. Still, devices like the Arcturus Star Products Lymphstar Pro and the Therapeutic BioSystems Lymph Drainage XP are used in many alternative healing settings.

Vacuum systems assist but do not replace the therapist. The therapist slides the vacuum tubes along the lymphatic channels following the direction of the lymph, performing lymph drainage efficiently and without stress. The procedure is not only painless but very relaxing.

“When it comes to lymphatic drainage, the simpler the device, the better,” says Onyx Medical’s Maine, whose company’s Prestige Vac is designed for lymphatic drainage and body contouring. “The device should let you see the area you are working on and afford enough superficial vacuum to address the conjunctive tissue.”

Combination units blend the above techniques. “Most equipment used by professionals in the beauty and wellness industries involves either vibration or vacuum to accomplish a cosmetic effect, in addition to increasing lymphatic drainage,” says Kenneth Callison, director, Allied Health Association. “Our Tri-Phasic Resonator device uses heat, vibration and electrical force to sculpt muscles, break down fat and cellulite, and remove the resulting toxins and fat through lymphatic drainage.”

Another multi-tasker, the Belleza & Beauty Lymphatic Drainage unit, utilizes vacuum, microcurrent, vibration and red light energy to give the therapist maximum control over treatments.

Anticellulite machines often include a mixture of mechanical massage and/or suction with a heat source. The new Silhouet-Tone PR Cell 2G, for example, combines mechanical massage skin fold techniques with modulated suction to reduce the dimpled appearance of cellulite. It can also be adjusted to treat poor leg circulation and post-liposuction edema.

Onyx Medical offers the Prestige LDT, which combines lymphatic drainage with low-frequency ultrasound. Each function can be employed separately or combined. Low frequency ultrasound destroys fat tissue, and improves the look of cellulite using lymphatic drainage and vacuum therapy to remove the cell debris and open clogged lymphatic vessels.

“We use the Cynosure Triactive Laser, which is FDA-cleared for cellulite reduction,” says Beauty Kliniek’s Kahn. “It effectively moves the lymph and can be used as an addition to MLD, post-liposuction.”

Building Spa Services
In day spas and wellness centers, lymphatic drainage services vary in price much like massage services, based on the time and materials involved. Electro Lymphatic Drainage & Mini Natural Face Lift Healthy Being Wellness Center in St. Petersburg, Florida, for example, advertises a $70 Lymph Plus Package designed to maximize lymph flow, alleviate congestion and detoxify the body in one session. Clients can also opt for the Cellulite Release Mini Package, two 60-minute sessions for $150, or the Mini Face Lift Package, three 30-minute sessions for $125. Here are some additional possibilities:

• Estheticians can use manual lymphatic drainage to improve dark under-eye circles and bags. Many massage therapists are now offering what they call “face-lift” massage, which begins with MLD and progresses to incorporate firming and toning techniques.

• Some spas emphasize the lymphatic drainage component of microcurrent facials on their menus. As the microcurrent contracts the facial muscles, it naturally stimulates lymph drainage.

• MLD massage relieves the fluid retention many experience as a result of travel, menstruation or pregnancy.

• “MLD has a great effect on skin conditions that compromise the lymphatic and immune systems, such as acne, rosacea and sensitive skin,” stresses Tino Lerma, Pevonia International.

• At LaBelle Day Spas & Salons, therapists use machine lymphatic drainage not only for slimming and detoxification treatments but also to enhance facials, body wraps and other massage treatments. “Lymphatic drainage is such a comfortable service, it helps relax clients during the facial extraction process. In our medical spa we even use it to help clients relax during botulinum toxin and filler injections. Unlike a massage therapist, a machine never gets tired, so it can work all day for you. It is an added benefit that helps spas to effectively compete with discount massage and facial services,” says Bella Schneider, 5 Star Formulators CEO and founder of LaBelle Day Spas & Salons.

Cautions and Contraindications

Therapists should not attempt manual or mechanical lymphatic drainage on clients with the following contraindications:

• Any active infection, often indicated by a fever
• Serious circulatory or cardiac problems such as thrombosis or phlebitis
• Any sign of hemorrhage (bleeding)
• Active-cancer patients, including those with any undiagnosed lumps

Linda W. Lewis is an editorial consultant and a regular contributor to DAYSPA.