The conventional approach for fluid predominant lymphedema , even when advanced, involves a physiologic procedure such as lymphaticovenular anastomosis (LVA) or lymph node transfer (VLNT) to address lymphatic stasis, while disregarding concurrent fat deposits.

Subsequent liposuction then requires a conservative and LVA sparing approach. Our consistent observation of improved lymph low in post liposuction Indocyanine green lymphography (ICGL) prompted us to formulate the ‘hybrid’-debulk first and bypass later surgical sequence.