Tissue-reducing procedures have been performed universally since the introduction of liposuction, which has its roots in cosmetic surgery. As with all surgical treatments, an unequivocal diagnosis must be made before the procedure. This is particularly required for resections of tissue in lymphoedema and Lipohyperplasia dolorosa. The history of the “Charles Procedure” resection probably underlies the often still present critical attitude towards surgical methods of lymphological therapies in general. However, such an undifferentiated assessment of surgical procedures needs to be revised to consider the successes and the significant therapeutic value of modern resecting and derivative, reconstructive, and combined procedures available since the 1990s of the last millennium. In the procedure of Lymphological Liposculpture, lymphoedema arms are operated on simultaneously; lymphoedema legs are operated on in two stages (one-sided or both sides, then symmetrically) at intervals of not less than 4 weeks. After completing the first session, which consists of surgery and AMLD, the next operation follows with the same post-operative lymph vessel training program. Early detection of lymphoedema in those at higher risk and advances in imaging will improve the ability to detect locally functioning lymph vessels accurately. Reconstructive lymph surgery will thus become more accurate and predictable. Technical advances in the devices used in this surgery should make it possible to operate on lymph vessels, significantly improving the results of lymphedema surgery. The development of higher stages of the disease, which must then be treated with resecting methods, should be slowed down or even cease. All surgical procedures, especially the resecting ones, are now possible without damaging the lymph vessels and should be offered to patients without reservation if the two goals—reduction in circumference and renunciation of lifelong CPE—cannot be achieved in any other way.