Your Questions About Post-Surgical Recovery & MLD — Answered

Manual Lymphatic Drainage is a specialized, light-touch technique that manually supports lymphatic flow as part of individualized postoperative care, when appropriate for your procedure and surgeon's protocol. It is performed by certified therapists using gentle, rhythmic movements — not deep tissue pressure. At TheraFlow Health, all MLD is performed by a Certified Lymphedema Therapist (CLT) and Certified Plastic Surgery Therapist (CPST).

Yes — when performed by a certified therapist with proper post-surgical training. Eva Tutic holds CLT and CPST credentials and has over a decade of experience in plastic surgery recovery care. She adapts every session to your specific procedure, stage of healing, and surgeon guidelines.

MLD is a medical-grade technique — not a relaxation service. The pressure is far lighter than Swedish or deep tissue massage. The sequencing follows the precise anatomy of the lymphatic system, not muscle groups. A massage marketed as "lymphatic" but performed with typical massage pressure will not produce clinical results.

MLD may begin as early as 48 hours post-operatively — with documented surgeon clearance received at least 24 hours before your appointment. Earlier intervention allows care to be individualized to your specific procedure and stage of healing from the start.

Active surgical drains are not a contraindication. You may begin MLD with drains still in place. Eva works around drain sites and adapts the protocol accordingly.

Fat transfer procedures (BBL, breast fat transfer, facial fat grafting): MLD over grafted areas is deferred for approximately 2 weeks to allow fat cell viability and early angiogenesis to establish. However, MLD can begin in non-grafted areas during that deferral period — there is no reason to delay full treatment.

It is never too late to begin, but the earlier the better. Consistent early intervention is associated with better tissue outcomes.

Every patient heals differently, and Eva bases session recommendations on objective measurements and photographs — not a fixed calendar.

As a clinical guideline, Eva looks for a cumulative reduction of 18–20 cm across all measured areas after 3 sessions. This is an overall reduction across the body, not necessarily in any single area. If we reach that benchmark, recovery is progressing well. If not, additional sessions are typically recommended.

A minimum of 3 sessions is the initial clinical framework. Most post-surgical patients benefit from 5 or more sessions during Stage 1, particularly after body contouring, BBL, or abdominoplasty. Rhinoplasty and facial procedures may require fewer sessions concentrated in the first two weeks.

Your session plan is reassessed at every visit based on tissue response, measurements, and photos. Eva will always give you an honest, evidence-based recommendation — not a package upsell.

Yes, always. Eva works with your surgeon's post-operative instructions and defers to your surgical team on all clinical decisions. Bring any protocols or restrictions from your surgeon to your first session.

Fibrosis is the formation of excess fibrous connective tissue — essentially hardened scar tissue — that forms when inflammatory fluid is not properly cleared during recovery. It can feel like lumps or unevenness under the skin. MLD is one part of individualized postoperative care that may be incorporated during the window when inflammatory fluid is present, based on your procedure and surgeon's protocol.

Yes. TheraFlow Health works with medical-grade compression from Juzo, Thuasne, SIGVARIS, L&R, Marena, and Isavela. Every garment has a manufacturer-stated mmHg rating, FDA Class I medical device listing, and is sized from your actual body measurements.

Juzo, Thuasne, SIGVARIS, and L&R are used for medical compression needs such as lymphedema, lipedema, venous disease, and chronic edema. Marena and Isavela are used primarily for medical postoperative compression and surgical recovery — not every Marena or Isavela garment is equivalent to a graduated-compression garment selected for established lymphedema, and the two categories are not interchangeable.

TheraFlow Health does not select garments by brand name alone. Your garment is chosen based on your diagnosis, surgical procedure, treatment phase, swelling pattern, tissue characteristics, anatomy, compression requirements, and clinical presentation — not every brand, textile, compression class, or garment style is suitable for every patient.

If a specific garment or size is not in stock at the time of your fitting, Eva will ship it directly to your home at no additional handling fee. You will never be sent home without a plan.

A FREE compression garment fitting is included with every garment purchase. A $75 measurement-only fitting is available if you are not purchasing through TheraFlow Health.

Eva also carries medical-grade foam (Lipo Foam, Gray Foam Pad, Komprex), Lymphoderm skincare, silicone scar tape, female urinals, and third-party tested CBD oil for Stage 2 scar management.

ERAPS — Enhanced Recovery After Plastic Surgery — is a patient-centered recovery framework co-developed by Eva Tutic and her husband, a board-certified plastic surgeon, drawing directly from their combined clinical experience in plastic surgery practice.

ERAPS was adapted from ERAS® (Enhanced Recovery After Surgery), an evidence-based protocol already widely used by surgical teams in hospitals to reduce complications and improve outcomes. Eva recognized that ERAS was clinically excellent but not designed with the patient's recovery journey in mind. ERAPS reframes that clinical structure around the patient — adding compassionate education, empowerment, and individualized recovery support.

ERAPS is not just about MLD. It is a comprehensive 8-pillar recovery philosophy: preoperative education and counseling, risk assessment and mitigation, perioperative nutrition, anesthesia management, pain management, lymphatic and compression therapy, early mobilization, and postoperative follow-up care.

Eva also uses the proprietary Edema Risk Assessment (ERA) tool — developed within the ERAPS framework — to evaluate each patient's individual swelling risk profile and proactively plan session frequency, rather than reacting to problems after they arise.

Yes. Compression is essential after most body contouring and reconstructive procedures. The right garment worn correctly supports fluid drainage, may help support swelling management, and helps tissue conform to its new contour. Eva provides expert compression guidance as part of every post-surgical recovery plan.

Yes. Manual Lymphatic Drainage is a medically guided modality. Eva conducts a clinical intake assessment at every session. The following are general guidelines — your specific situation will be assessed individually.

Absolute Contraindications (MLD cannot proceed):

• Acute, uncontrolled congestive heart failure (CHF)
• Active deep vein thrombosis (DVT) or pulmonary embolism
• Acute infection with systemic fever
• Active cellulitis at the treatment site
• Active malignancy without oncologist clearance

Local Contraindications (treatment avoided in specific areas):

• Open wounds or unhealed incisions
• Active hematoma or seroma (refer to surgeon)
• Active radiation treatment site
• Areas with compromised skin integrity

Relative Contraindications (proceed with caution, modification, and clearance):

• Thyroid conditions — avoid anterior neck without physician guidance
• First trimester of pregnancy
• Asthma or bronchospasm history — positioning modifications required
• Renal insufficiency — reduced session intensity
• Recent cardiac procedures

If you have a complex medical history, please contact TheraFlow Health before booking so Eva can review your situation and advise appropriately. Completion of a booking does not guarantee eligibility for treatment.

4656 Haygood Rd, Suite C, Virginia Beach, VA 23455 · Mon–Fri 8:30am–4pm · We serve all of Hampton Roads including Norfolk, Chesapeake, Suffolk, and Portsmouth, as well as patients traveling from Northeastern North Carolina.

Yes. While most patients are local to Virginia Beach and greater Hampton Roads, we regularly see patients who travel from Northeastern North Carolina for post-surgical MLD, lipedema and lymphedema care, and scar and tissue therapy. If you're planning to travel for care, contact us and we can help plan your visit — including scheduling sessions close together if you're coming from a distance.

• Completed intake paperwork (sent in advance — please complete before arrival)
• Surgeon clearance documentation (must be received 24 hours prior)
• Any post-operative instructions or surgical protocols from your surgeon
• Your compression garments (do not wear them to the appointment — bring them in a bag)
• Loose, comfortable clothing
• A list of current medications and supplements
• BBL patients: arrive wearing a thong or no undergarment for proper access to treatment areas

Please arrive with clean, dry skin. Do not apply oils, lotions, creams, or makeup to the treatment area on the day of your appointment.

We do not accept insurance directly. However, many HSA and FSA plans cover Manual Lymphatic Drainage and post-surgical recovery services when recommended by a physician. Ask about our payment plan options if you need flexible scheduling.

In most post-surgical cases, one MLD treatment is not enough to fully address swelling. Manual Lymphatic Drainage helps move excess fluid out of congested areas, but your body is still healing and may continue producing inflammation and fluid after surgery.

I often explain it using a faucet analogy: think of post-surgical swelling like a sink with the faucet turned on. MLD helps the body drain the water out — but if the faucet is still running because your tissues are inflamed and healing, fluid can continue to refill the area. That is why one treatment may help, but it may not be enough to keep swelling down long term. The number of sessions needed depends on the refill rate — meaning how quickly your body is continuing to produce and hold fluid after treatment.

In some cases, clients may even feel or appear more swollen after the first session. This can be normal and does not mean treatment made things worse. It happens because MLD begins to mobilize stagnant fluid, moving it from congested areas into pathways where the body can process and eliminate it. During that transition, swelling may temporarily seem more noticeable before the body has had time to fully clear it.

This is one reason I recommend treatment as a series rather than a one-time session, especially after surgery. Each session builds on the last, helping the body gradually reduce fluid, improve circulation, and support a more efficient recovery.

No. TheraFlow Health does not accept tips — and this is a deliberate policy.

Eva made a considered choice not to accept gratuity because the care you receive at TheraFlow Health is a clinical service. Your session price reflects training, experience, time, clinical supplies, documentation, and the full responsibility of caring for your body during a vulnerable stage of recovery. She does not underprice and hope for tips to make up the difference.

You paid for your care. That is enough. Your thank you is enough.

Note: the 3% merchant processing surcharge on credit card payments is not a tip. It is the cost of processing a card payment, disclosed separately. It is not gratuity, and it does not affect your care in any way.

If you would like to support TheraFlow Health, the most meaningful things you can do are leave an honest review, refer a friend or fellow patient, or share Eva's work with someone who needs it.

Because this work is healthcare-adjacent — not a hospitality transaction. Eva provides Manual Lymphatic Drainage, post-operative recovery care, lymphedema support, scar and tissue therapy, and clinical recovery guidance. Patients arrive during swelling, vulnerability, discomfort, and uncertainty.

The end of a session should feel calm and clinical — not like a checkout prompt. Eva does not want patients leaving an appointment calculating 20% or wondering whether they were generous enough. The price is the price, and your care is never contingent on gratuity.