How to massage fibrosis after liposuction or cellulite surgery

Liposuction often leads to fibrosis: how to massage it away, by hand or with ultrasound

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• Fibrosis massage (by hand or with ultrasound) after lipo / cellulite surgery

• How to self-massage at home after liposuction in order to get rid of fibrosis, in 7 simple steps

• Fibrosis post-lipo massage, Step 1: First apply a little oil on the area - Not too much, not too little

• Fibrosis massage after lipo, Step 2: Proceed with long, firm pressure strokes, up and down the area

• Fibrosis massage, Step 3: Now start kneading the hard lumps, as you would knead dough

• Post-lipo fibrosis massage, Step 4: Now massage the scar tissue with your knuckles

• Post-lipo massage, Step 5: Add more oil and massage upwards with long, medium-pressure strokes

• Fibrosis lipo massage, Step 6: Apply some ice for 10-20 minutes, to help with inflammation

• Anti-fibrotic massage, Step 7: Apply a good cream with multiple relevant actives in high concentrations

• Important notes

• Ultrasound massage for fibrosis after lipo: the perfect companion to hand (manual) massage

• What is best to break down fibrosis after lipo: manual massage or ultrasound massage?

• What about radiofrequency or RF microneedling for post-liposuction fibrosis? My surgeon said that this is what I need to do to break down the fibrosis.

• Be patient, fibrosis needs time to break down and fast results are not going to happen

• Excessively strong treatments will lead to inflammation and more fibrosis, not less

• Very frequent / daily treatments will also lead to inflammation and more fibrosis

• Have a skin tightening/cellulite treatment in London with the experts

• Advanced, infrared / blue / red light therapy treatments in London at LipoTherapeia

• The Cellulite School™: Get advanced training in cellulite reduction and skin tightening

Fibrosis massage (by hand or with ultrasound) after lipo / cellulite surgery

In a previous article we analysed everything to do with fibrosis after liposuction/cellulite surgery, including what causes it.

On that article we presented a timetable of different actions you can take and treatments you can have from Day 2 to Day 56 to prevent/breakdown fibrosis after:

• ‘Lipo’ surgery, which may leave behind a lot of fibrosis:

  • Plain liposuction (lipoplasty)

  • Vaser (ultrasound-assisted lipoplasty)

  • Laser lipo/smart lipo (laser-assisted lipoplasty)

  • BodyTite (radiofrequency-assisted lipoplasty)

  • Tummy tuck (abdominoplasty)

  • Thigh lift (thighplasty)

• Cellulite surgery, which may leave behind a lot of fibrosis, sometimes looking worse than cellulite itself:

  • Subcision

  • Cellfina (laser-assisted subcision)

  • Cellulaze

How to self-massage at home after liposuction in order to get rid of fibrosis, in 7 simple steps

Fibrosis prevention and reduction ‘macro-massage' (by hand) is quite straightforward and you can perform it effectively and safely if you follow some simple advice, either as a patient or as professional.

(‘Micro-massage’ with ultrasound is equally effective and complementary to ‘macro-massage’ by hand, but it must be done by a professional to ensure safety and effectiveness. You can read more on ultrasound massage for fibrosis further down on this article. To ensure safety and effectiveness, ultrasound massage should only start from Day 56 after surgery.)

Below is a simple yet effective, 7-step method to help you prevent / minimise / remove fibrotic hard lumps after liposuction and related surgery.

*** This massage can be performed from the 21st day after surgery ***

Before the 21st day you can have some professional lymphatic massage to help with swelling; or simply practise just Step 5 below.

Fibrosis post-lipo massage, Step 1: First apply a little oil on the area - Not too much, not too little

For fibrosis massage, skin should be neither too slippery, nor too dry.

It should allow some “drag”, but not too much, as we want to focus on dermis, hypodermis and subcutaneous tissue:

• Too much oil / too slippery skin will focus the massage too deep, i.e. muscles

• Too little oil / too dry skin will focus the massage too deep, i.e. epidermis

You also want an oil which is not too ‘dry’ (such as coconut oil), not too thick (such as cocoa butter) and not too thin (such as grape seed oil or soya oil) either.

Almond oil, apricot oil, plum oil, olive oil or high oleic acid sunflower oil are the perfect massage oils, as they are hydrating and of the right consistency.

If you don’t have any of the above oils, it’s not a problem. You can always use any oil - it’s just that the above oils suggested have the optimum drag for a good fibrosis massage.

In all cases, what you don’t want to do is pay £35 for those ripoff 30ml bottles of facial oils that come with a dropper.

Contrary to the marketing blurb, expensive vegetable oils (e.g argan oil or anything overhyped) does not have magical properties and will not miraculously take away the hard lumps or the inflammation if it costs a fortune.

And no, rose hip oil, for example, does not have enough vitamin C to make a difference. And if it had, not much would penetrate the skin. This is because oils, in contrast to creams, do not penetrate anywhere below the epidermis.

If you wish though, you may add 2 drops of essential oil (lemon, mint, eucalyptus etc) in 5ml of oil (that is roughly 2% - that’s more than enough).

While you perform the massage, make sure you reapply a bit of oil from time to time, to ensure a balance between slip and drag.

Fibrosis massage after lipo, Step 2: Proceed with long, firm pressure strokes, up and down the area

It doesn’t matter if these strokes are upwards or downwards.

We are not doing lymphatic drainage at this stage, we are breaking the fibrotic lumps (you will have a chance to do more upward strokes later).

In fact, and contrary to the half-knowledge parroted on the internet, you DO need to massage on both directions to more efficiently break down the fibrotic lumps and the skin adhesions.

Apply differing pressure, sometimes lighter and sometimes firmer. Feel the tissue and what it needs and what it can take.

*** If the tissues are still sensitive (weeks 3-6 after surgery), be gentle. From weeks 6-8 you can apply much more pressure, but always below the pain threshold. ***

In all cases do NOT overdo it. This is a marathon, not a sprint. If you do it too lightly you will have a chance to do it stronger the day after (always leave a day inbetween).

But if you overdo it, your skin will be sore and potentially inflamed the next day, actually making the situation worse and setting you back by a few days. In that case, apply some ice 2-3 times a day and leave a 2-3 day gap before your next session.

Fibrosis massage, Step 3: Now start kneading the hard lumps, as you would knead dough

Again apply lighter and firmer pressure at times, checking what the tissues can take. Do that for several minutes and make sure you are just below the pain threshold.

If the tissues are still sensitive (weeks 3-6 after surgery), be gentle. From weeks 6-8 you can apply much more pressure, but always below the pain threshold.

If you overdo it, follow the advice on Step 3.

Post-lipo fibrosis massage, Step 4: Now massage the scar tissue with your knuckles

Again use varying pressure and again and massage with the knuckles in different directions for a few minutes and do not overdo it.

Post-lipo massage, Step 5: Add more oil and massage upwards with long, medium-pressure strokes

Do that for a few minutes to increase blood circulation and lymphatic drainage and thereby help bring nutrients to the area and remove excess fluid waste products.

The extra oil is to make skin more slippery and allow the hand to glide over the skin.

Fibrosis massage, Step 6: Apply some ice for 10-20 minutes, to help with inflammation

Always apply ice though a thin cloth to avoid ice burns.

Never overdo it - more is not better with icing. Just apply the ice for 10-20 minutes or remove earlier if it feels too cold / uncomfortable etc. Moderation is key with icing. You can carefully apply ice a couple of times a day.

*** In all cases, don’t burn yourself with the ice ***

Anti-Fibrotic massage, Step 7: Apply a good cream with multiple relevant actives in high concentrations

Good actives known for their anti-fibrotic and healing properties are centella asiatica, EGCG and curcumin, among others.

Always make sure you avoid applying the cream on any open wounds.

Important notes (again)

• Start from Day 21. Initially start gently and gradually increase pressure - but always practise moderation. Excess, premature intensity will cause pain and inflammation and therefore will be counterproductive, so always be conservative. Be moderate, don’t be aggressive.

• For days 1-21 you need a lymphatic drainage massage, which can simply be Step 5 on its own, with very light pressure in the first few days after surgery and gradually firmer - but not too firm - pressure as the days go by. If you want a full-on lymphatic drainage massage, that cannot be taught in a few paragraphs and you need to go to an expert.

Ultrasound massage for fibrosis after lipo: the perfect companion to manual massage (hand massage)

The massage applied with your hands is a macro-massage, i.e. it acts on the macroscopic level and affects larger connective tissue structures.

Ultrasound has been used in physiotherapy to break down scar tissue / fibrosis for decades. Ultrasound provides a micro-massage, i.e. it affects smaller connective tissue structures at the microscopic level.

Both hand (manual) massage and ultrasound are great for fibrosis reduction and you can combine them for faster results.

What is best to break down fibrosis after lipo: manual massage or ultrasound massage?

Ultrasound massage is definitely more effective than manual (hand) massage but both are needed and they complement each other.

On the other hand, although hand massage may be less effective / slower acting but you can do it yourself at home. Also, manual massage is the only option from Day 1 to Day 56.

Ultrasound massage is much more effective from Day 56 but strong manual massage still has a lot of utility from Day 56+ too.

Furthermore, you should NOT do ultrasound massage to break down fibrosis yourself. For safety reasons, we do not recommend ultrasound treatment at home on your own: you can easily overdo it (and most people do overdo it) and cause damage.

For ultrasound to work, it has to be of the exact intensity. If you do too little, not much will happen. if you do too much it can either increase fibrosis or cause damage. And unfortunately post-lipo patients don’t have this experience or knowledge, plus they are very emotional/impatient and that makes things worse.

Furthermore, the ultrasound machines people buy on the internet can be of very dubious specifications, quality of manufacture and safety standards. Of course, people who inject their own fillers will also buy their own ultrasound machine, put it on max and use it for hours a week. And for them all I have to say is: good luck, you will need it.

Of course, you can also overdo it with massage, but with ultrasound you can cause damage much more easily.

So the best advice is: for areas of your body that you have access to with your hands (e.g. stomach, front thighs, inner thighs, outer thighs etc), do the hand massage yourself, if you do have the inclination and the energy.

For areas you do not have access to (e.g. buttocks, back of thighs, back etc) or if you find it too much of manual labour, go to a professional.

And for ultrasound massage, always go to a professional.

You can do massage at home 1-3 times a week. And you can also do ultrasound at a clinic that specialises in this service, 1-2 times a week.

What about radiofrequency or RF microneedling for post-liposuction fibrosis? My surgeon said that this is what I need to do to break down the fibrosis.

This is a very common question at the clinic and I have to say that this shows utter ignorance, which is quite unacceptable from a surgeon.

Cosmetic surgeons may be amazing with cosmetic surgery but some are literally clueless about energy-based technologies and just blindly believe the equipment manufacturers’ marketing spiel. Sorry guys, but that’s the truth.

The fact is that radiofrequency, especially the extreme intensity, static RF touted by most surgeons, will make fibrosis worse.

Even worse: RF microneedling and HIFU are based on creating connective tissue fibrosis to harden the skin, by first literally burning it 60-90ºC. If you have post-lipo fibrosis, the last thing you need is more fibrosis.

So my advice to you is to ignore this irresponsible / stupid recommendation. And my advice to surgeons is: stop recommending HIFU, RF microneedling or even plain RF for fibrosis and start recommending massage and ultrasound instead.

Of course, if you don’t have fibrosis (or perhaps if you have very little) and you want to tighten your skin, then deep-acting, high-power radiofrequency is indeed the treatment you need - after Day 56. But skin tightening is definitely the exact opposite of fibrosis breakdown.

Furthermore, you should still not do RF microneedling or HIFU for skin tightening after surgery, because they are less effective and safe than proper, deep-acting, high-power radiofrequency.

(Check here the safety record of RF microneedling and make up your own mind.)

For cellulite reduction after lipo, both deep-acting, high-power radiofrequency and deep-acting, high-power ultrasound cavitation are effective, from Day 56 after surgery.

Be patient, fibrosis needs time to break down and results are not going to occur overnight

In any of these two cases, don’t expect fast, dramatic results. When it comes to breaking down fibrosis three elements are necessary:

• Lots and lots of patience

• Lots and lots of time: we are talking weeks and months with treatment or even years without treatment - not days

• And lots and lots of sessions: have in mind 5 (minimum), 10 (typical), even 20 sessions (in the worst cases), not the “you only need 3” that many clinics and therapists misleadingly claim

Sounds boring, slow and costly but that’s how it is. Your body does not care if you are impatient or if you have already spent thousands of ££££ on surgeons and do not want to spend hundreds more £££ on therapists.

Neither the body cares if you indeed have thousands of ££££ to spend on “You only need one” or “You only need 3” (extortionately priced) miracle treatments. Miracle treatments never work as advertised and are usually unsafe too.

Excessively strong treatments will lead to inflammation and more fibrosis, not less

Fibrosis does not break down faster if you do stronger massages or stronger intensity ultrasound. You will just cause inflammation, which will delay improvement, not accelerate it.

You will not be better with 1-3 sessions, even if they are very strong (very strong treatments will actually make the situation worse). It ain’t gonna happen, no matter what different doctors and therapists promise you.

You will need many, many sessions of average intensity massage and/or medium intensity, low frequency ultrasound. As mentioned in the previous paragraph above, think of 5, 10 or even 20 sessions of massage, ultrasound or, ideally, both.

These are the facts on the ground and the lived experience of thousands of post-lipo fibrosis sufferers. Be patient, allocate a lot of time and have lots of not-too-strong massage and/or ultrasound sessions.

Very frequent / daily treatments will also lead to inflammation and more fibrosis

Furthermore, fibrosis will not break down faster if you have manual massages / ultrasound massages more frequently, e.g. every day or twice a day.

You always need to allow time to recover between sessions, which is 1-7 days, depending on each case.

You will not be fibrosis-free in 4 weeks, even if you have treatment every day (especially NOT if you have treatment every day). Think of several weeks and - most probably - months.

Of course, there is always the option of going to one of those cowboys who will promise you fast results with 1-3 sessions of HIFU, RF microneedling, extreme intensity, static RF or even vaser surgery (yes, fibrosis-producing surgery to break down fibrosis. I know, it’s mad but surgeons need to make a living, right?)

These are totally the wrong techniques and they will make the situation worse - not better.

Building more scar tissue collagen (i.e. fibrotic collagen), which HIFU, RF microneedling, extreme intensity, static RF and vaser are designed to do, is obviously the exact opposite of breaking scar tissue collagen. We have seen so many clients at the clinic the past few years who underwent the above procedures to “break down fibrosis” only to develop more fibrosis.

Don’t be a victim. To break fibrosis down you need many, many medium intensity treatments, spaced out over a period of time - not 1-3 super-strong, fibrosis-producing “miracle” treatments or “You will be ‘cured’ in two weeks” - that ain’t gonna happen…

Again, these are the facts on the ground and the lived experience of thousands of post-lipo fibrosis sufferers. Be patient, allocate a lot of time and have lots of massages properly spaced out, either self-massages at home or professional manual massages and ultrasound massages at a good clinic.

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