Abstract <p>Lymphedema is a common, debilitating condition that challenges treatment efforts. The primary aim of treatment is to debulk the affected areas, providing relief without further damaging tissues or causing undesirable cosmetic outcomes. Liposuction has become a popular treatment for end-stage extremity lymphedema, yet there is no consensus on the most effective technique. Current practices include a range of methods such as dry, wet, superwet, laser-assisted, water-assisted, and power-assisted liposuction. Dry liposuction has sparked controversy, primarily due to concerns that it might be less gentle, and therefore potentially more harmful, than wet liposuction. Contrary to this, we posit that dry liposuction is a viable, low-risk alternative that minimizes the risk of tissue and lymph vessel damage while providing excellent and durable outcomes. This assertion is supported by current literature. In this video article, we present our systematic, step-by-step approach to performing dry liposuction for end-stage lymphedema, illustrating its efficacy and safety. Our personal experience is that patients experience significant reductions in limb volume and report high satisfaction rates, demonstrating that dry liposuction is both effective and reliable for the long-term management of end-stage lymphedema.</p> Level of Evidence V <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors &#xa0;<a href="http://www.springer.com/00266">www.springer.com/00266</a></p>