There are three quite different ways to support lymphatic drainage, and they are frequently discussed as if they were interchangeable. They are not. Manual lymphatic drainage is performed by hand. Compression therapy uses a garment that inflates in sequence. LPG Endermologie uses a mechanical device applying roll and suction to the skin.
Each works differently, suits different situations, and has a different evidence position. Most clinics offer one and present it as the answer. This guide explains what each actually does so you can judge which is appropriate for you.
Manual lymphatic drainage (MLD)
What it is: a very light, slow, rhythmic hands-on technique following the natural drainage pathways toward the lymph nodes.
How it works: gentle directional pressure applied to the superficial tissue, where the lymphatic vessels sit just beneath the skin. Pressure is deliberately light, because heavier pressure compresses those vessels and works against the intended effect.
Where it is strongest: MLD is a recognised component of Complete Decongestive Therapy, the established approach to managing lymphoedema. It is also widely used for post-surgical swelling and for general fluid retention.
Its particular advantage is adaptability. A trained therapist works around scar tissue, adjusts to where drainage is actually compromised, redirects around blocked pathways, and responds to what the tissue is doing that day. No machine does this.
Best suited to: lymphoedema management, post-surgical recovery, anywhere the anatomy is altered or complicated, and treatment of the face, neck and other areas a garment cannot address.
Compression therapy (Body Ballancer)
What it is: you wear a garment, typically covering the legs, lower body or arms, divided into chambers that inflate and deflate in a programmed sequence.
How it works: sequential compression, usually beginning furthest from the trunk and moving inward, applying external pressure that encourages fluid movement in the intended direction.
Its particular advantages are consistency and coverage. The pressure is identical every time and across the whole treated area, and the session requires nothing of the practitioner during treatment. It is also comfortable and passive.
Its limitation is that it cannot adapt. It applies the same programmed sequence regardless of what the tissue needs, and it cannot work around scarring or altered anatomy.
Best suited to: general fluid retention and heaviness in the legs, recovery after training, people who stand or sit for long periods, and maintenance between hands-on sessions.
LPG Endermologie
What it is: a mechanical device with a treatment head that lifts and rolls the skin using controlled suction.
How it works: mechanical stimulation of the skin and underlying tissue, with effects on local circulation and tissue mobility.
An important distinction: Endermologie is primarily a body contouring and skin texture treatment that has effects on fluid, rather than a lymphatic treatment in the clinical sense. It is not part of established lymphoedema management in the way MLD is.
Best suited to: appearance-focused goals around skin texture and body contouring, where a reduction in fluid is part of what you are after rather than the clinical objective.
Choosing between them
If you have diagnosed lymphoedema
MLD, within a properly structured programme including compression, skin care and exercise, and with medical oversight. This is the evidence-based pathway. Machines may complement it but should not replace it.
If you are recovering from surgery
MLD, and only with your surgeon's agreement on timing. Hands-on treatment can work around healing tissue and scarring in a way no machine can. Compression may be introduced later.
If you have general leg heaviness or fluid retention
Compression therapy is often the practical choice, and it suits regular use well. MLD may be preferable if you want assessment and a tailored approach.
If your concern is facial puffiness
MLD. Compression garments do not treat the face.
If your goals are contouring and skin texture
LPG Endermologie is aimed at this. Be clear with yourself that this is a cosmetic objective rather than a clinical one.
If you are recovering from training
Compression therapy is convenient and repeatable.
Do they work well together?
Often, yes, and this is where having all three available genuinely matters.
A common structure is hands-on MLD to address the specific problem and clear the drainage pathway, with compression therapy for maintenance between sessions. Where appearance is also a goal, Endermologie may run alongside.
The important principle is sequencing. Clearing the route before pushing fluid toward it is the logic behind starting MLD near the trunk, and it applies when combining modalities too. Any clinic offering several should be able to explain why they are combining them in a particular order, rather than simply selling more sessions.
Claims to be wary of, whichever you choose
- Detoxification. Your liver and kidneys do this. None of these treatments removes toxins.
- Weight loss. Fluid shift is not fat loss, and the scale change is temporary.
- Permanent inch loss. Circumference reduction after treatment is real and measurable, but it reflects fluid redistribution.
- Immune boosting. No good evidence supports this in healthy people.
- Cellulite removal. Appearance may temporarily improve through reduced fluid. The cellulite remains.
Who should take medical advice first
All three require screening. Speak to a clinician before treatment if you have acute infection or cellulitis, untreated or unstable heart failure, deep vein thrombosis or a history of clots, kidney failure, active untreated cancer, or acute inflammation of unknown cause.
Compression therapy has additional considerations where there is peripheral arterial disease or significant neuropathy. A responsible clinic will screen for all of this. If nobody asks, that is a warning sign.
Frequently asked questions
Is the machine better because it is more powerful?
No. Lymphatic vessels are superficial and respond to light pressure. More force is not more effective, and can be counterproductive.
Can compression therapy replace MLD?
Not for lymphoedema or post-surgical work, where adaptability matters. For general leg heaviness it is often a reasonable choice on its own.
How many sessions will I need?
Depends entirely on the reason. General fluid retention often responds within one or two sessions. Lymphoedema and post-surgical recovery need structured courses. A clinic should set out a plan rather than sell an open-ended package.
Which is most relaxing?
Most people find MLD the most relaxing, because it is slow, rhythmic and hands-on. Compression is passive and comfortable but less soothing.
Can I have more than one on the same day?
Sometimes, in a considered order. Ask your practitioner to explain the sequence.
Lymphatic treatment in Chiswick
We offer manual lymphatic drainage, compression therapy using Body Ballancer, and LPG Endermologie at Omnia Lifestyle in Chiswick, W4, close to Gunnersbury station with parking on site. Having all three means we can recommend what actually suits your situation rather than the one thing we happen to offer, and say when a combination is unnecessary.
Learn more about manual lymphatic drainage, compression therapy and LPG Endermologie, or book a consultation.
This article is general information, not medical advice. If you have diagnosed lymphoedema or are recovering from surgery, treatment should be coordinated with your medical team.
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