Beyond Swelling: A Review of Postoperative Lymphedema in Aesthetic Surgery

Abstract

Postoperative edema is a nearly universal consequence of aesthetic surgery, yet its clinical implications and potential progression to lymphedema remain underexplored. This review examines the prevalence, pathophysiology, diagnostic criteria, and management strategies for edema and lymphedema following aesthetic procedures. A comprehensive search of PubMed, Embase, and Cochrane databases identified studies involving adult patients undergoing aesthetic surgeries with documented postoperative edema or lymphedema. The review found that while edema is expected postoperatively and is generally self-limiting, persistent or disproportionate swelling may indicate early lymphedema. Risk factors include extensive liposuction, body contouring, and procedures involving lymphatic disruption. Despite its significance, lymphedema remains underdiagnosed due to a lack of standardized diagnostic criteria and low clinical suspicion. Emerging imaging modalities, such as indocyanine green lymphography, enhance early detection, while conservative treatments, such as manual lymphatic drainage, compression, and physical therapy, remain first-line interventions. Increased awareness among surgeons and incorporation of lymphatic-preserving techniques are vital to reducing morbidity. This review underscores the importance of distinguishing transient edema from chronic lymphedema and calls for further research to establish evidence-based guidelines for diagnosis, prevention, and management of postoperative lymphedema in aesthetic surgery.

1. Introduction

The lymphatic system plays a vital role in homeostasis, immunity, and tissue repair, mainly by clearing solute-rich fluid from the interstitial spaces and returning it to the venous circulation [1,2,3]. When lymphatic drainage is disrupted, fluid accumulates and may progress to chronic lymphedema, which is characterized by prolonged swelling, inflammation, and fibro-adipose tissue deposition [4,5]. While lymphedema is well-documented in oncologic procedures that involve lymph node biopsy or excision, it is increasingly recognized that aesthetic interventions may compromise superficial lymphatic channels and lead to sustained edema [6,7].

Secondary lymphedema arises when a previously intact lymphatic system is damaged [5]. Within aesthetic surgery, mechanical disruption of subdermal vessels, repeated surgical passes, and extensive flap elevation have been implicated in postoperative lymphatic compromise. In most cases, aesthetic surgeries induce a degree of postoperative edema that is transient, peaking in the first few days to weeks after surgery and slowly resolving over a few weeks or months with supportive care [8]. However, a subset of patients may develop swelling that persists beyond the normal postoperative healing period or manifests later as a new swelling, which may represent chronic lymphedema rather than transient edema [8]. Factors such as obesity, advanced age, smoking, and prior infection or surgery in the same area may further predispose patients to prolonged, chronic edema.

Aesthetic surgeries encompass a wide range of procedures on the face and body (rhinoplasty, blepharoplasty, liposuction, abdominoplasty, thighplasty, brachioplasty, etc.), each with unique patterns of tissue disruption and healing. This review examines the current literature on postoperative edema and lymphedema in aesthetic surgery. We synthesize data on incidence rates by procedure, risk factors for developing chronic edema, surgical technique modifications to preserve lymphatics, methods for early detection of lymphatic compromise, and strategies for prevention and management. By differentiating normal transient edema from pathological lymphedema and understanding contributory factors, plastic surgeons can better anticipate, identify, and treat lymphatic complications following aesthetic procedures.

2. Lymphedema Incidence in Aesthetic Surgery

True secondary lymphedema is relatively uncommon after aesthetic procedures, but its incidence varies by the type of surgery. Transient postoperative edema is highly common after aesthetic surgeries, whereas chronic lymphedema is reported in very few cases. In an article that followed a series of 600 liposuction patients, 1.7% developed significant persistent edema beyond 6 weeks postoperatively [8]. These patients had required extended management such as compression garments and massaging, and in refractory cases, the authors suggested repeat liposuction was necessary. In a literature review of brachioplasty complications with 1065 patients, the combined incidence of seroma or lymphocele was 6.94% [9]. A cohort of 205 brachioplasty patients reported 1.5% of patients experienced postoperative distal edema that resolved with compression dressings over time [10]. Isolating lymphedema specifically, a retrospective study of 144 weight loss patients undergoing either brachioplasty alone or brachioplasty with concomitant arm liposuction reported arm lymphedema, defined as prolonged upper extremity edema, at a rate of 1.3% and 3.2%, respectively [11]. Table 1 provides an overview of this section’s findings, highlighting findings and risk factors associated with postoperative edema after aesthetic surgery.

2.1. Body Contouring Procedures

Body contouring procedures, particularly in patients with massive weight loss, may pose an increased risk for postoperative lymphedema due to the proximity of surgical dissection to critical lymphatic channels.

Thighplasty: In a cohort of 97 massive weight loss patients undergoing thigh lift, the overall incidence of clinically diagnosed postoperative lymphedema, diagnosed by physical exam indication of calf swelling and patient complaint, was 8.2%, with all cases resolving within two months using conservative measures such as compression garments and leg elevation. Notably, lymphedema was more frequently associated with vertical thigh lift techniques (OR = 28.7, p = 0.016), hypothyroidism (OR = 22.6, p = 0.041), and male gender, while a higher BMI showed a negative association with lymphedema (OR = 0.62, p = 0.025) [12].

Brachioplasty: Brachioplasty, a removal of excess skin and adipose tissue of the arm, has demonstrated more favorable lymphatic outcomes when lymph-sparing techniques are used. In a prospective study of 22 patients undergoing bilateral lipobrachiopexy, a modified brachioplasty technique utilizing circumferential liposuction and fascial suspension, lymphatic preservation was examined using serial indocyanine green (ICG) lymphography. At one-year follow-up, all patients demonstrated intact physiological linear lymphatic drainage patterns consistent with preoperative imaging. Although minor tracer extravasation was observed in two patients at the one-month postoperative mark, these findings resolved by one year without clinical lymphedema [13].

Abdominoplasty: The impact of body contouring procedures on abdominal lymphatic drainage has also been investigated. In a study by Bassolobre et al. [14], 20 women undergoing abdominoplasty underwent pre- and postoperative lymphoscintigraphy to evaluate superficial infraumbilical lymphatic drainage patterns. Preoperatively, all patients exhibited drainage to the inguinal lymph nodes. Postoperatively, however, only 15% retained this drainage route. The majority (65%) developed a new lymphatic drainage pathway toward the axillary nodes, while 10% exhibited dual drainage to both axillary and inguinal regions, and another 10% showed indeterminate patterns. These alterations remained stable between one and six months postoperatively, suggesting a long-term redirection of superficial abdominal lymph flow following abdominoplasty [14].

Case reports have further highlighted the risk of lymphatic complications in patients undergoing multiple body contouring procedures. Bellini et al. [15] described a 47-year-old woman who developed abdominal swelling consistent with acquired cutaneous lymphangiectasia (ACL) approximately eight weeks after breast reduction surgery. Her prior surgical history included abdominoplasty and cesarean sections, suggesting that cumulative disruption to superficial lymphatic channels may have predisposed her to the condition [15]. A second case reported by Bellini et al. [15] involved a 74-year-old woman who developed persistent pruritic plaques and papules over the upper abdomen six months after breast reduction. Histologic evaluation confirmed extensive dermal lymphangiectasia with positive podoplanin (D2-40) staining, supporting a diagnosis of ACL [15]. These cases underscore the importance of recognizing cumulative surgical trauma as a potential risk factor for abdominal lymphatic compromise, particularly in patients with a history of multiple abdominal procedures.

2.2. Facial Procedures

Postoperative edema remains a common sequela following facial aesthetic surgery, and growing evidence suggests that individual lymphatic anatomy, surgical technique, and procedure extent all play critical roles in postoperative recovery. Recent investigations have begun to clarify the impact of facial procedures on lymphatic function and the potential for lymphatic regeneration in both aesthetic and reconstructive contexts.

Blepharoplasty: A recent study by Nishioka et al. [16] examined the relationship between lymphatic vessel density and postoperative healing outcomes following upper eyelid blepharoplasty. In this cohort of 40 eyelids from 21 patients, the lymphatic area was quantified using immunohistochemical staining, and findings were correlated with clinical recovery parameters, including edema and scar maturation scores based on the Vancouver Scar Scale. The authors found that greater lymphatic vessel density, particularly in the medial upper eyelid, was significantly associated with improved healing outcomes at two weeks and one month postoperatively, independent of patient age. Moreover, lymphatic density declined with increasing age, suggesting an anatomical basis for delayed postoperative recovery in older individuals. These findings support the importance of preserving superficial lymphatic structures during blepharoplasty and underscore the potential utility of additional therapies aimed at enhancing lymphatic function in patients with inherently low baseline vessel density [16].

Facelift Surgery: Dr. Aldo Mottura conducted a descriptive study to understand the mechanisms underlying facial edema following rhytidectomy. Using lymphoscintigraphy and venous pressure monitoring, he demonstrated that surgical elevation of facial flaps redirects lymphatic flow medially. When concurrent medial facial procedures, such as rhinoplasty or blepharoplasty, are performed, this redirection may exacerbate lymphatic congestion, leading to severe and prolonged edema. In one case, lymphoscintigraphy performed preoperatively and again seven days postoperatively revealed a complete absence of radiotracer uptake in the surgical field, indicating lymphatic disruption [17].

Intraoperative monitoring further revealed that platysma plication increased peripheral venous pressure from 12 mmHg to 15 mmHg, with additional elevations observed after the application of compressive bandages. Wide flap dissections, temporal pedicle transection, and the addition of medial procedures all compounded lymphatic and venous compromise. Prolonged swelling was more common in patients with pre-existing comorbidities or age-related lymphatic atrophy. Based on these findings, the author advocates for tailored postoperative protocols such as early manual lymphatic drainage, avoidance of excessive compression, and muscle activation therapy to reduce edema and improve recovery [17].

More recently, Kriet et al. [18] conducted a prospective case series on extended deep plane rhytidectomy, using standardized measurements at POD 1, 7, 14, 30, 56, and 84. They stated that edema peaked at POD 7 (+2.8%, p = 0.0025) and mostly resolved by one month, with modest residual swelling by three months. Early postoperative swelling temporarily accentuated the “Ogee curve” (the S-shaped midfacial contour defined by malar prominence and submalar hollowing) before the facelift’s structural repositioning produced a lasting restoration of this contour [18]. Restoration of the Ogee curve is a major aesthetic goal in facelift surgeries, as this convex curve reflects a youthful facial feature. The authors concluded that while edema follows a predictable trajectory, future research should assess whether adjunctive lymphedema therapy might enhance recovery and optimize outcomes [18].

Table 1. Reported Findings and Risk Factors for Postoperative Lymphatic Sequelae in Aesthetic Surgery.

Procedure	Reported Findings/Outcomes	Risk Factors/Notes
Body Contouring
Liposuction	1.7% persistent edema > 6 weeks [8]	Resolved conservatively in most cases
Brachioplasty	- 6.9% combined seroma/lymphocele [9] - 1.5% distal edema resolving with compression [10] - 1.3% (brachioplasty alone) vs. 3.2% (brachioplasty + liposuction) with persistent edema/lymphedema [11]	Lymph-sparing lipobrachiopexy preserved physiological lymphatic drainage on ICG lymphography at 1 year [13]
Thighplasty	8.2% postoperative lymphedema (resolved < 2 months) [12]	- Risk increased with vertical thigh lift, hypothyroidism, and male sex - Higher BMI showed a negative association
Abdominoplasty	85% with altered drainage on lymphoscintigraphy: 65% rerouted to axillary nodes, 10% dual drainage, 10% indeterminate [14].	Stable rerouting persisted at 1–6 months, indicating durable long-term change [14]
Facial Procedures
Blepharoplasty	Increased lymphatic vessel density correlated with faster edema resolution and scar maturation [16]	Older patients had lower density leading to delayed recovery
Facelift	Edema is predictable: peaks at POD 7 (+2.8%, p = 0.0025), mostly resolved by 1 month [18]	Wide flaps, platysma plication, medial procedures, tight compression led to increased edema [17]
Multiple Surgeries	Case reports: ACL after breast reduction in women with prior abdominoplasty/cesarean (47-yr-old, 74-yr-old) [15]	Suggests cumulative trauma predisposes to delayed complications

ICG: Indocyanine Green; BMI: Body Mass Index; POD: Post Operative Day; ACL: acquired cutaneous lymphangiectasia.

Table 1. Reported Findings and Risk Factors for Postoperative Lymphatic Sequelae in Aesthetic Surgery.

Procedure	Reported Findings/Outcomes	Risk Factors/Notes
Body Contouring
Liposuction	1.7% persistent edema > 6 weeks [8]	Resolved conservatively in most cases
Brachioplasty	- 6.9% combined seroma/lymphocele [9] - 1.5% distal edema resolving with compression [10] - 1.3% (brachioplasty alone) vs. 3.2% (brachioplasty + liposuction) with persistent edema/lymphedema [11]	Lymph-sparing lipobrachiopexy preserved physiological lymphatic drainage on ICG lymphography at 1 year [13]
Thighplasty	8.2% postoperative lymphedema (resolved < 2 months) [12]	- Risk increased with vertical thigh lift, hypothyroidism, and male sex - Higher BMI showed a negative association
Abdominoplasty	85% with altered drainage on lymphoscintigraphy: 65% rerouted to axillary nodes, 10% dual drainage, 10% indeterminate [14].	Stable rerouting persisted at 1–6 months, indicating durable long-term change [14]
Facial Procedures
Blepharoplasty	Increased lymphatic vessel density correlated with faster edema resolution and scar maturation [16]	Older patients had lower density leading to delayed recovery
Facelift	Edema is predictable: peaks at POD 7 (+2.8%, p = 0.0025), mostly resolved by 1 month [18]	Wide flaps, platysma plication, medial procedures, tight compression led to increased edema [17]
Multiple Surgeries	Case reports: ACL after breast reduction in women with prior abdominoplasty/cesarean (47-yr-old, 74-yr-old) [15]	Suggests cumulative trauma predisposes to delayed complications

ICG: Indocyanine Green; BMI: Body Mass Index; POD: Post Operative Day; ACL: acquired cutaneous lymphangiectasia.

3. Imaging for Early Lymphatic Compromise

Early identification of lymphatic compromise allows timely intervention before extensive lymphedema develops. Several imaging and diagnostic modalities have been utilized to evaluate lymphatic function after surgery. Table 2 provides an overview of imaging modalities used in the assessment of postoperative lymphedema.

• Lymphoscintigraphy: This is a functional imaging gold standard for lymphatics. It involves injecting a small amount of radioactive tracer into an area and using a camera to track its uptake and transport through lymphatic vessels and nodes. Bassalobre et al. employed lymphoscintigraphy to map abdominal drainage before and after abdominoplasty [14]. The study highlights lymphoscintigraphy as an effective, noninvasive method for visualizing and tracking changes in superficial lymphatic drainage patterns following abdominoplasty. Specifically, intradermal injections of technetium-99m-labeled dextran (dextran 500–^99mTc) allowed for dynamic and static imaging of lymphatic flow from standardized points on the infraumbilical abdomen. Using a gamma camera, the research team was able to map lymphatic drainage at three key time points—preoperatively and at 1 and 6 months postoperatively. Using this technique, the study revealed that while all patients had inguinal drainage preoperatively, 65% rerouted to axillary nodes after surgery, with only 15% maintaining their original drainage. These changes remained consistent between 1 and 6 months, demonstrating lymphoscintigraphy’s utility in capturing long-term lymphatic remodeling [14].
• Indocyanine Green (ICG) Lymphography: ICG lymphography is a dynamic, high-resolution imaging technique that involves intradermal injection of ICG dye, which binds to plasma proteins and is taken up by lymphatic vessels. Using near-infrared light, the dye fluoresces, allowing real-time visualization of lymphatic flow and structure. In the study by Bianchi et al., ICG lymphography was used to assess lymphatic function in patients undergoing lipobrachiopexy [13]. Patients received intradermal ICG injections, and lymphatic flow was imaged preoperatively and at 1, 6, and 12 months postoperatively. The authors found that lymphatic drainage patterns remained physiologic in all cases, with preserved linear tracer progression and no clinical evidence of lymphedema at one-year follow-up. ICG lymphography also detected minor tracer extravasation in two patients at one month, which resolved by one year, underscoring the sensitivity of this technique in identifying early, subclinical lymphatic disruption [13].

4. Management Strategies and Interventions

Management of postoperative edema and lymphedema in aesthetic surgery patients involves a multi-step approach. Strategies range from standard conservative measures to surgical interventions. Table 2 provides an overview of management strategies for postoperative lymphedema.

• Conservative management: The mainstay for treating edema or mild lymphedema is Complete Decongestive Therapy (CDT), which consists of manual lymphatic drainage, compression therapy, exercise, and skin care. In the aesthetic surgery setting, surgeons implement many of these principles as part of standard postoperative care. Postoperative compression garments are commonly used in aesthetic and reconstructive procedures, including abdominoplasty, breast surgery, and facelifts. Current evidence primarily supports their benefit in reducing edema and ecchymosis after rhinoplasty and in decreasing postoperative pain following breast and abdominal surgery [19]. For example, liposuction patients wear graded compression garments on treated areas for weeks. Compression helps prevent fluid re-accumulation and encourages lymphatic and venous return [8].
• Manual Lymphatic Drainage (MLD): Manual lymphatic drainage (MLD) is a cornerstone of nonsurgical lymphedema management and is gaining prominence as a supportive therapy in plastic and reconstructive surgery. MLD is a specialized massage technique that employs slow, rhythmic hand movements to stimulate lymphatic flow and reroute lymph through functioning channels, particularly after surgical disruption. It is a key component of CDT, used alongside compression, exercise, and skin care [20]. The physiological mechanisms of MLD are still under investigation, but several theories suggest that MLD enhances lymphatic drainage by increasing intrinsic vessel contractility, reducing distal lymphatic pressure, and improving interstitial reabsorption through elevated interstitial pressure [20]. In aesthetic surgery, MLD has been increasingly applied in the postoperative setting to manage swelling, promote healing, and optimize aesthetic outcomes. Marxen et al. [20] emphasizes its utility following high-risk procedures such as liposuction, abdominoplasty, and brachioplasty, where lymphatic disruption is common. For example, abdominoplasty can shift drainage from the inguinal to axillary nodes, creating a mismatch in flow that may contribute to seroma or edema. MLD may help address this mismatch, particularly during the critical 3–6 month recovery window when edema and fibrosis are most pronounced [20].

Table 2. Imaging and Management of Postoperative Lymphatic Dysfunction in Aesthetic Surgery.

Section	Approach/Modality	Summary	Representative Findings/Application
Imaging for Early Lymphatic Compromise	Lymphoscintigraphy	Functional nuclear medicine study using intradermal 99mTc-dextran; maps superficial drainage pathways	Bassalobre et al.: after abdominoplasty, 65% rerouted to axillary nodes, 15% retained inguinal drainage, 10% dual drainage, 10% indeterminate; patterns stable from 1–6 months [14].
	Indocyanine Green (ICG) lymphography	Near-infrared fluorescence technique after intradermal ICG injection; dynamic, high-resolution visualization of superficial lymphatic flow	Bianchi et al.: after lipobrachiopexy, physiologic linear drainage preserved at 1 year; minor tracer extravasation in 2 pts at 1 month resolved spontaneously [13].
Management Strategies: Complete Decongestive Therapy	Compression therapy	Use of graded garments to limit fluid re-accumulation and encourage venous/lymphatic return	Ormseth et al.: Broadly used after aesthetic procedures; strongest evidence for reducing edema/ecchymosis after rhinoplasty and postoperative pain after breast and abdominal surgery [19]
	Manual Lymphatic Drainage (MLD)	Gentle, rhythmic massage to enhance lymphatic flow and reroute fluid through intact channels	Marxen et al.: highlighted utility after abdominoplasty, brachioplasty, and liposuction, where lymphatic disruption is common [20].

^99mTc: Technetium-99m; ICG: Indocyanine Green; MLD: Manual Lymphatic Drainage.

Table 2. Imaging and Management of Postoperative Lymphatic Dysfunction in Aesthetic Surgery.

Section	Approach/Modality	Summary	Representative Findings/Application
Imaging for Early Lymphatic Compromise	Lymphoscintigraphy	Functional nuclear medicine study using intradermal 99mTc-dextran; maps superficial drainage pathways	Bassalobre et al.: after abdominoplasty, 65% rerouted to axillary nodes, 15% retained inguinal drainage, 10% dual drainage, 10% indeterminate; patterns stable from 1–6 months [14].
	Indocyanine Green (ICG) lymphography	Near-infrared fluorescence technique after intradermal ICG injection; dynamic, high-resolution visualization of superficial lymphatic flow	Bianchi et al.: after lipobrachiopexy, physiologic linear drainage preserved at 1 year; minor tracer extravasation in 2 pts at 1 month resolved spontaneously [13].
Management Strategies: Complete Decongestive Therapy	Compression therapy	Use of graded garments to limit fluid re-accumulation and encourage venous/lymphatic return	Ormseth et al.: Broadly used after aesthetic procedures; strongest evidence for reducing edema/ecchymosis after rhinoplasty and postoperative pain after breast and abdominal surgery [19]
	Manual Lymphatic Drainage (MLD)	Gentle, rhythmic massage to enhance lymphatic flow and reroute fluid through intact channels	Marxen et al.: highlighted utility after abdominoplasty, brachioplasty, and liposuction, where lymphatic disruption is common [20].

^99mTc: Technetium-99m; ICG: Indocyanine Green; MLD: Manual Lymphatic Drainage.

5. Discussion

Although chronic lymphedema following aesthetic procedures remains rare, the present review underscores that there remains a risk for lymphatic disruption. The frequency of transient postoperative edema across nearly all procedures is well established, but the evolution to persistent lymphedema, though infrequent, may be underdiagnosed due to its often subclinical presentation and the limited long-term follow-up.

Surgical Technique and Anatomical Vulnerability: Body contouring procedures, especially in massive weight loss patients, appear to have a higher documented incidence of postoperative lymphatic sequelae. This may reflect both the anatomical location of dissection and the pre-existing lymphatic fragility in these patients. Massive weight loss patients often have attenuated lymphatic vessels due to chronic mechanical overload and fibrotic remodeling, making them more susceptible to lymphatic injury during aggressive excisional procedures [12]. Moreover, techniques that use vertical incisions, as in vertical thighplasty, may traverse critical collecting lymphatic trunks, explaining the markedly higher odds ratio for postoperative lymphedema in these patients [12].

Procedures like lipobrachiopexy that incorporate lymph-sparing principles, such as limited flap elevation and tumescent-assisted liposuction, may offer a blueprint for reducing lymphatic compromise. The study by Bianchi et al. demonstrating preserved lymphatic flow on serial ICG lymphography suggests that careful manipulation of superficial lymphatics can yield favorable outcomes without compromising aesthetic goals [13].

Redistribution vs. Destruction of Lymphatic Flow: An emerging concept in aesthetic lymphatic science is not just whether drainage is lost but how it is re-routed. The Bassolobre study provides compelling evidence that after abdominoplasty, lymphatic flow is often redirected rather than obliterated, with a shift from inguinal to axillary drainage [14]. While patients may remain asymptomatic, this redirection could contribute to persistent suprapubic edema or seroma formation. These findings raise the possibility that persistent postoperative fluid retention may partly represent low-grade lymphatic dysfunction, a diagnosis that requires a shift in clinical perspective and utilization of diagnostic imaging.

Cumulative Trauma and Iatrogenic Risk: Another insight is the cumulative effect of multiple surgeries on lymphatic health. The cases of acquired cutaneous lymphangiectasia following breast reduction in patients with prior abdominoplasty or cesarean deliveries suggest that repeated injury to superficial lymphatic networks can produce delayed complications, even when individual procedures were well tolerated [15]. Surgeons should consider prior operative history, especially in the abdomen, groin, or axilla, when planning new contouring procedures, and perhaps employ more conservative dissection strategies or postoperative lymphatic support (e.g., early manual drainage) in patients nearing this threshold.

Facial Procedures and Lymphatic Preservation: While less frequently associated with extensive lymphedema, facial aesthetic procedures pose a subtler risk to lymphatic integrity. The correlation between eyelid lymphatic density and postoperative healing reported by Nishioka et al. provides early evidence that even at small scales, individual lymphatics help aid in recovery from postoperative edema [16]. This highlights the importance of preserving delicate lymphatic networks in facial surgery, as minor disruption may contribute to prolonged edema or delayed wound healing. Techniques that minimize lymphatic injury could therefore improve both functional and aesthetic outcomes.

Mottura’s study’s data after facelift also reveal the interplay between lymphatic and venous systems, suggesting that simultaneous compression of both, via platysma plication and tight dressings, may synergistically impair fluid clearance and worsen edema [17]. This reinforces that edema in facial surgery is an aesthetic hindrance and may reflect deeper lymphatic dysfunction requiring targeted intervention.

Kriet et al. [18] quantified edema progression after extended deep plane rhytidectomy and reported a predictable trajectory, with swelling peaking at postoperative day 7 and resolving by one month. They observed that early edema temporarily enhanced the youthful Ogee curve by creating uniform midfacial fullness, but this effect subsided as swelling resolved and the true structural repositioning of deep tissues became visible. The authors proposed that future studies should explore whether lymphatic-directed therapies could further accelerate edema resolution and optimize aesthetic recovery [18].

Clinical Application and Future Directions: From a clinical standpoint, these findings support a tiered risk stratification model for postoperative lymphatic dysfunction in aesthetic surgery. Patients undergoing procedures with high lymphatic disruption potential (e.g., vertical thighplasty, circumferential abdominoplasty), those with prior surgeries, or those with known lymphedema risk factors (e.g., obesity, hypothyroidism, older age) should be counseled preoperatively and considered for closer surveillance or prehabilitation strategies, including early MLD. Moreover, the integration of lymphatic imaging, such as ICG lymphography, in preoperative planning or intraoperative mapping may become standard in high-risk cases. Its role in detecting subclinical disruption, as seen in the Bianchi study, offers the potential for real-time feedback and tailored surgical adaptation [13].

Overall, this review underscores the importance of acknowledging lymphatic integrity as a relevant factor in aesthetic surgery outcomes. While current preoperative planning typically emphasizes vascular anatomy and skin quality, future studies may evaluate whether identifiable features, such as prior surgical history, procedure type, or patient-specific risk factors, correlate with postoperative lymphatic complications. Although routine preoperative lymphatic imaging is not currently standard practice, its role in selected high-risk cases may merit further investigation. A better understanding of procedure-specific lymphatic disruption and recovery patterns can help refine surgical technique, guide postoperative care, and reduce the incidence of persistent edema or delayed wound healing.

6. Conclusions

Postoperative edema is an expected and typically self-limited consequence of aesthetic surgery, but in select cases, it may signal underlying lymphatic disruption with the potential to evolve into chronic lymphedema. This review highlights that while the overall incidence of secondary lymphedema after aesthetic procedures remains low, it is not negligible, particularly in body contouring procedures performed on patients with risk factors such as massive weight loss or prior surgeries. Facial procedures, though less likely to cause overt lymphedema, can still compromise both superficial and deep lymphatic channels, influencing recovery and aesthetic outcomes. Diagnostic tools like ICG lymphography and lymphoscintigraphy, along with early postoperative interventions such as manual lymphatic drainage, may help identify and manage subclinical dysfunction. Future research should focus on refining surgical techniques to preserve lymphatic pathways, better characterizing patient-specific risk factors, and validating the role of imaging in risk stratification and postoperative monitoring. By integrating lymphatic considerations into the broader framework of aesthetic surgical planning and care, surgeons may reduce complications, improve outcomes, and better support long-term patient satisfaction.