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Lower extremity lymphedema is an important clinical condition causing morbidity and is frequently encountered by the phlebologists. Elephantiasis Nostra is the status characterized with the extraordinary massive swelling of one or both legs with subsequent thickening and fibrosis of the overlying skin. It is an exaggerated manifestation of a longstanding chronic lymphedema. Etiologically, secondary lymphedema is caused by an external effect such as a chronic lymphangitis, removal of the lymph nodes, trauma, mechanical obstruction, radiotherapy, venous insufficiency, obesity, heart failure, bacterial or helminthic infection (Lymphatic Filariasis), in contrary to the primary lymphedema in which an inherent malfunction of lymphatic channels exists. A morbidly obese female patient with a bilateral Elephantiasis Nostra and our effort on setting the etiological definition and the treatment approach is presented.