【Introduction】

Living with lymphedema while residing overseas can feel isolating and uncertain.

You may be wondering whether traveling to another country for treatment is truly worthwhile, or whether meaningful improvement is still possible for you.

At Lymphedema Clinic Tokyo, we are committed not only to improving your current condition, but also to supporting a future in which lymphedema does not limit your life.

Our goal is to help you stay active, walk independently, and continue an engaged, fulfilling life—now and for many years to come.

This FAQ is written for patients who are considering our clinic and want clear, honest, and compassionate information before making a decision.

1. University of Siena, Italy: Lectures and lymphatic surgery, and guidance (March 2014)
2. University of Oxford, UK: Lectures and lymphatic surgery, and guidance (February 2014)
3. The China-Japan Friendship Hospital, Beijing, China: Lectures and lymphatic surgery, and guidance (November 2013)
4. Right Hospital, Chennai, India: Lymphatic surgery, and guidance (2012)
5. University of Rome, Italy: Lectures and lymphatic surgery, and guidance (January 2013)
6. National University of Singapore: Lectures and lymphatic surgery, and guidance (May 2007)
7. Chiang Mai University, Thailand: Lectures and supermicrosurgery, and guidance (November 2006)
8. Sant Pau Hospital, Barcelona, Spain: Support for lymphatic surgery (November 2011)
   

1. Female patient in her 50s from Spain: Lymphatic venous anastomosis for lymphedema of the lower limb
2. Female patient in her 30s from Singapore: Lymphatic venous anastomosis for idiopathic lymphedema of the lower limb
3. Male patient in his 60s from New Zealand: Lymphatic venous anastomosis for idiopathic lymphedema of the lower limb
4. Female patient in her 60s from Taiwan: Diagnosis of lymphedema of the face and consultation on treatment
5. Female patient in her 50s from Italy: Lymphatic venous anastomosis for lymphedema of the lower limb
6. Male patient in his 40s from Papua New Guinea: Lymphatic venous anastomosis for lymphedema of the lower limb
   
   

Director, Lymphedema Clinic Tokyo (Tokyo, Japan)

My name is Makoto Mihara, MD, and I am a plastic and reconstructive surgeon specializing in the treatment of lymphedema and recurrent cellulitis.

Thank you for taking the time to visit this page.

If you are here, you may be living with lymphedema, struggling with repeated infections, or searching for a place where your condition is truly understood. Many international patients tell me that the most difficult part is not only swelling or fever, but the constant uncertainty and anxiety about the future.

We want you to know that these feelings are fully understood.

【A Career Dedicated to Lymphedema Care】

For many years, my clinical and academic work has focused on lymphedema.

I have been involved in the development and refinement of lymphaticovenular anastomosis (LVA) and have performed a large number of procedures for patients with both upper- and lower-limb lymphedema.

In parallel with clinical care, I have published peer-reviewed scientific papers and collaborated with international researchers to better understand:

・how lymphedema progresses

・why cellulitis recurs

・how surgical and non-surgical treatments can be combined safely and effectively

Research is not separate from my clinical practice—it is something I use every day to guide patient care.

【A Patient-Centered Philosophy】

Every patient’s condition, lifestyle, and goals are different.

For this reason, I do not believe in one-size-fits-all treatment.

My approach is always to:

・listen carefully to each patient’s story

・evaluate lymphatic function in detail

・explain options clearly and honestly

・build a step-by-step treatment plan together

Surgery, including LVA, is not the goal by itself.

The true goal is to help patients regain stability, confidence, and quality of life, whether that means reducing cellulitis, easing daily discomfort, or allowing safe travel and work.

【For International Patients Living Overseas】

Many of my patients travel from outside Japan.

I understand that seeking medical care abroad can feel overwhelming.

At Lymphedema Clinic Tokyo, we support international patients by providing:

・online consultations before travel

・efficient treatment planning for limited stays in Japan

・free email-based follow-up after you return home

・collaboration with local doctors and therapists when needed

Even after you leave Japan, you are not alone in managing your condition.

【A Message to You】

Lymphedema and recurrent cellulitis can affect not only the body, but also independence, work, and emotional well-being.

While outcomes vary from person to person, I firmly believe that careful evaluation, evidence-based treatment, and open communication can lead to meaningful improvement for many patients.

If you are considering visiting Lymphedema Clinic Tokyo, I encourage you to learn, ask questions, and take your time.

We are here to support you, explain your options, and walk with you through each step of care.

【Scientific Background and Further Reading】

For patients who wish to understand the scientific background of our approach, we provide patient-friendly explanations of our research publications and other important international studies on lymphedema:

👉 https://www.english-mominoki-shinryosho.net/research/

Makoto Mihara, MD

Plastic & Reconstructive Surgeon

Director, Lymphedema Clinic Tokyo

Tokyo, Japan

【Frequently Asked Questions（FAQ）】

About Makoto Mihara, MD & Lymphedema Clinic Tokyo

(For International Patients Living Overseas)

Q1. Who is Dr. Makoto Mihara?

Dr. Makoto Mihara is a plastic and reconstructive surgeon and the director of Lymphedema Clinic Tokyo.

He specializes in the comprehensive treatment of lymphedema and recurrent cellulitis, combining conservative care, surgical treatment such as lymphaticovenular anastomosis (LVA), and evidence-based medical management.

Q2. Why does Dr. Mihara focus on lymphedema?

Dr. Mihara has dedicated his clinical and academic career to lymphedema because it is a chronic condition that significantly affects daily life and emotional well-being, yet is often misunderstood or undertreated.

Through years of clinical experience and research, he has focused on improving:

・lymphatic function

・prevention of recurrent cellulitis

・long-term quality of life for patients

Q3. What is Dr. Mihara’s treatment philosophy?

Dr. Mihara believes that there is no single treatment that fits every patient.

His philosophy is to:

・listen carefully to each patient’s history and concerns

・evaluate lymphatic function in detail

・explain treatment options clearly and honestly

・create a step-by-step, individualized treatment plan

Surgery is never the goal by itself—the goal is stability, safety, and improved quality of life.

Q4. Does Dr. Mihara only perform surgery?

No.

While Dr. Mihara is well known for LVA surgery, treatment at Lymphedema Clinic Tokyo is always comprehensive.

Care may include:

・conservative management (skin care, compression guidance)

・surgical treatment when appropriate

・thoughtful, time-limited use of medication

・long-term planning to reduce cellulitis risk

Surgery is recommended only when it is expected to be beneficial.

Q5. Does Dr. Mihara treat international patients?

Yes.

Dr. Mihara regularly treats patients who travel from outside Japan.

He understands the concerns of international patients, such as:

・limited time in Japan

・communication after returning home

・what to do if fever or cellulitis occurs later

Because of this, continuity of care is a key priority at Lymphedema Clinic Tokyo.

Q6. What kind of follow-up is available after I return to my country?

After online consultation or surgery, free email-based follow-up support is provided even after you return home.

If necessary, Dr. Mihara and the clinic team can also:

・communicate with your local doctors

・coordinate care with therapists in your country

You are not expected to manage your condition alone after leaving Japan.

Q7. Is Dr. Mihara involved in research?

Yes.

Dr. Mihara has published peer-reviewed scientific papers on lymphedema, cellulitis prevention, and lymphatic surgery.

He also carefully reviews and recommends important international research, and provides patient-friendly explanations on the clinic’s website so patients can understand the scientific background of their care.

Q8. Where can I read about the scientific evidence behind your approach?

You can find patient-friendly explanations of:

・Dr. Mihara’s published research

・recommended international studies on lymphedema

at the following link:

👉 https://www.english-mominoki-shinryosho.net/research/

Q9. Is LVA surgery guaranteed to work?

No medical treatment can be guaranteed.

While many patients experience meaningful improvement after LVA surgery, outcomes vary depending on:

・disease severity

・lymphatic anatomy

・overall health

・previous treatments

Dr. Mihara always discusses expected benefits and limitations openly before treatment.

Q10. What kind of patients may benefit most from consulting Dr. Mihara?

Patients who may benefit include those who:

・have persistent or progressive lymphedema

・experience recurrent cellulitis or high fever

・feel limited in daily life, work, or travel

・want an evidence-based, individualized approach

An online consultation is the first step to determine suitability.

Q11. What is Dr. Mihara’s message to patients considering visiting the clinic?

Dr. Mihara believes that patients deserve clear information, honest guidance, and compassionate care.

The goal is not only to treat symptoms, but to help patients:

・regain confidence

・reduce fear of infection

・live more freely and safely

Each patient’s journey is different, and care is planned accordingly.

Q12. How can I take the next step?

If you are considering consultation:

・review the information on this website

・read the research explanations

・prepare questions or concerns

Our team will be happy to guide you through the next steps.

Why Running Is Important to Me — and to My Medical Practice

Many international patients have kindly asked me about my personal interests outside of medicine.

I would like to share one aspect of my life that is closely connected to how I think about long-term, safe medical care.

Running, including marathon running, is one of my personal hobbies.

However, for me, running is not about speed, records, or competition.

It is about listening to my body, maintaining physical balance, and continuing steadily without overexertion—the same principles I value in medical treatment.

【Why I Run】

As a physician and surgeon specializing in lymphedema treatment and lymphaticovenular anastomosis (LVA), my work requires:

・sustained concentration

・precise hand movements

・physical endurance during long procedures

・calm decision-making under pressure

For these reasons, I believe it is important to take care of my own physical condition and overall health.

Running helps me maintain:

・cardiovascular fitness

・mental clarity

・emotional balance

・awareness of physical limits

These qualities support my goal of providing stable, consistent, and careful medical care to every patient.

【A Special Reason Why the Honolulu Marathon Matters to Me】

My participation in the Honolulu Marathon was not originally my own idea.

More than ten years ago, one of my patients with lower-limb lymphedema encouraged me to try it someday.

At that time, I was not exercising regularly and did not seriously consider her suggestion.

This patient had been diagnosed with stage III ovarian cancer at the age of 55.

She was told by her oncologist that her long-term prognosis was uncertain and was encouraged to live her life without regrets.

She chose to begin running and challenged herself to complete the Honolulu Marathon.

Through maintaining a healthy lifestyle and continuing at her own pace, she completed the marathon five consecutive times.

Her cancer has not recurred, and more than 15 years later, she continues to visit our clinic in good health.

Her experience left a deep impression on me.

During the COVID-19 pandemic, I began running gradually, and in 2025, I finally participated in the Honolulu Marathon for the first time and completed it safely.

I remain deeply grateful to her for encouraging me many years ago.

【What This Means for My Patients】

I do not believe that everyone should run marathons.

Each person has different physical conditions, medical histories, and life circumstances.

What I do believe is this:

・long-term care requires patience

・safety is more important than speed

・sustainable habits matter more than extreme effort

These principles apply equally to exercise, rehabilitation, and medical treatment.

In my clinical practice, I aim to help each patient find a realistic, safe, and sustainable path—rather than pushing for unrealistic or unsafe goals.

【Looking Ahead】

I plan to continue participating in running events such as the Tokyo Marathon and the Tokyo Legacy Half Marathon, always with careful attention to my health and recovery.

My intention is simple:

to remain physically and mentally well, and to continue providing reliable medical care for many years to come.

Thank you for taking the time to read this message.

I look forward to supporting you on your own journey, with respect for your individual needs and circumstances.

Makoto Mihara

Lymphedema Clinic Tokyo is a medical clinic in Tokyo dedicated exclusively to the diagnosis and treatment of lymphedema.

Many patients who visit us—especially those traveling from overseas—have already tried multiple treatments and are still struggling with swelling, recurrent cellulitis, or uncertainty about their future. We understand how frustrating and exhausting this journey can be.

Our clinic was established to provide focused, evidence-based, and compassionate care for patients living with lymphedema.

【A Comprehensive and Individualized Approach】

At Lymphedema Clinic Tokyo, we do not rely on a single method of treatment.

Instead, we carefully combine:

・conservative management such as skin care and compression guidance

・detailed lymphatic evaluation using appropriate imaging

・surgical treatment, including lymphaticovenular anastomosis (LVA), when indicated

・thoughtful, time-limited use of medication when necessary

Each treatment plan is designed specifically for the individual patient, based on medical findings, lifestyle, and personal goals.

【Supporting Patients from Around the World】

We regularly care for patients who travel from outside Japan.

We understand that international patients often have concerns about:

・traveling for medical care

・limited time available in Japan

・communication after returning home

・managing fever or cellulitis far from their primary clinic

For this reason, we place great importance on continuity of care.

In addition to in-person treatment, we offer:

・online consultations before travel

・efficient scheduling to fit within a limited stay

・free email-based follow-up after you return home

・collaboration with local doctors or therapists when needed

Our goal is to ensure that patients feel supported not only during their stay in Tokyo, but also long after they return home.

【A Clinic That Values Transparency and Education】

We believe that patients deserve clear explanations and access to reliable information.

Lymphedema Clinic Tokyo actively shares:

・explanations of our own peer-reviewed research

・summaries of important international studies on lymphedema

・practical guidance to help patients understand their condition

All information is presented in a patient-friendly manner, so that you can make informed decisions with confidence.

https://www.english-mominoki-shinryosho.net/research/

【Our Commitment to You】

Lymphedema and recurrent cellulitis can affect not only the body, but also independence, work, travel, and emotional well-being.

While outcomes vary from person to person, our commitment is consistent:

・to listen carefully

・to explain honestly

・to treat thoughtfully

and to support you over the long term

At Lymphedema Clinic Tokyo, we aim to be a place where patients feel understood, respected, and supported throughout their journey.

【Frequently Asked Questions（FAQ）

For International Patients Living with Lymphedema

(Who Are Considering Visiting Lymphedema Clinic Tokyo)

Q1. I live overseas and am not sure whether I should visit your clinic. Is this hesitation common?

Yes, it is very common.

Many international patients tell us they hesitate because of distance, language, time, or uncertainty about whether treatment will truly help.

Living with lymphedema often means carrying both physical symptoms and emotional concerns. Feeling unsure before making such an important decision is completely natural.

Q2. What is the main goal of treatment at Lymphedema Clinic Tokyo?

Our goal is not only to improve your current symptoms, but also to support your long-term health and independence.

We aim to:

・reduce swelling and discomfort as much as possible

・prevent recurrent cellulitis and infection

・help you remain active and mobile

・support a life in which lymphedema does not control your future

We believe that patients with lymphedema should be able to walk independently, stay active, and enjoy life even at an advanced age.

Q3. Do you focus only on surgery?

No.

Surgery is only one part of treatment, and it is not suitable for everyone.

At Lymphedema Clinic Tokyo, we use a comprehensive approach, which may include:

・conservative care such as skin care and compression guidance

・detailed evaluation of lymphatic function

・surgical treatment such as lymphaticovenular anastomosis (LVA) when appropriate

・careful, time-limited use of medication if needed

All treatment plans are individualized.

Q4. Can treatment really help me live an active life in the long term?

While outcomes vary between individuals, our approach is designed to support patients so that they can:

・continue walking on their own

・remain physically active

・maintain confidence in daily life

・avoid being limited by fear of swelling or infection

Our long-term vision is to help patients live actively and independently, even into very old age.

Q5. I am worried that my condition is already too advanced. Is it too late?

It is rarely “too late” to seek evaluation.

Even in advanced cases, there may be options to:

・reduce symptoms

・stabilize progression

・prevent further complications such as cellulitis

The first step is understanding your current condition through careful assessment.

Q6. How do you support patients after they return to their home country?

Continuity of care is very important to us.

After online consultation or treatment at our clinic:

・we provide free email-based follow-up support, even after you return home

・we can communicate with your local doctors or therapists when needed

・we help you understand how to manage daily life safely

You are not expected to manage lymphedema alone.

Q7. How long do I need to stay in Japan if I visit your clinic?

In many cases, the stay in Japan is approximately two weeks.

This usually includes evaluation, treatment, and postoperative guidance.

We also provide example schedules on a separate page to help with planning.

Q8. What if I am unsure whether treatment will be worth the effort?

This concern is understandable.

Our role is not to pressure you, but to provide clear, honest information.

Through online consultation, we help you understand:

・your current condition

・possible treatment options

・realistic expectations

This allows you to make a decision that feels right for you.

Q9. Why does your clinic emphasize long-term quality of life?

Lymphedema is a lifelong condition, not a short-term illness.

That is why we think beyond immediate symptom relief.

We focus on helping patients:

・maintain mobility

・prevent complications

・preserve independence

・continue an active lifestyle

Our philosophy is to support patients so that lymphedema does not define the rest of their lives.

Q10. What would you like hesitant patients to know?

You do not need to decide immediately.

It is okay to take time, gather information, and ask questions.

If you are worried about your future with lymphedema, we encourage you to reach out.

Our team is here to listen, explain, and support you—step by step.

【Expertise, Experience, and Compassion Working Together for You】

At Lymphedema Clinic Tokyo, we believe that high-quality lymphedema care can only be achieved through true teamwork.

Our clinic brings together experienced physicians, surgical nurses, certified therapists, psychologists, and administrative staff to provide evidence-based, patient-centered care for people from around the world.

Our goal is not only to treat lymphedema, but to support patients in regaining confidence and pursuing an active and fulfilling life.

【Physicians: Collaborative Expertise in Plastic & Vascular Surgery】

Our physician team consists of four doctors:

Makoto Mihara, MD

Hisako Hara, MD

Yohei Iwanaga, MD

Mari Kawahara, MD

The team includes two male and two female physicians, allowing patients to feel comfortable regardless of personal preference.

Three physicians are board-certified plastic surgeons

One physician is a board-certified vascular surgeon

By combining expertise in plastic surgery and vascular surgery, our doctors work closely together to evaluate each patient’s condition from multiple perspectives.

All online consultations and surgical procedures (including LVA) are personally handled by Dr. Mihara, ensuring continuity and consistency of care.

【Operating Room Nurses: Experience and Emotional Support】

Our operating room nursing team specializes in LVA surgery and supports more than 200 procedures each year.

Beyond technical expertise, our nurses focus on what matters most to patients:

How to reduce anxiety on the day of surgery

How to provide reassurance during local anesthesia

How to create a calm and supportive atmosphere

During surgery, nurses stay close, often holding the patient’s hand, offering verbal reassurance, and carefully monitoring both physical and emotional comfort.

【Lymphedema Therapists: Evidence-Based Conservative Care】

Our conservative treatment is led by dedicated lymphedema therapists with over 10 years of experience.

To personalize treatment, we use advanced tools such as:

Picopress to accurately measure compression pressure

Ultrasound imaging to guide treatment decisions

Rather than relying solely on traditional manual lymph drainage, we take a scientific and comprehensive approach, incorporating:

Exercise prescription

Weight management strategies

Behavioral and lifestyle modification

Together, we determine the most appropriate medical compression garments (stockings or sleeves) and activity levels to support your desired lifestyle.

【Administrative & Support Staff: Seamless International Care】

Our reception and administrative team works closely with

Emergency Assistance Japan Co., Ltd.

to support international patients throughout their journey.

We carefully prepare medical documents required by:

Insurance companies

Assistance organizations

Our staff ensures that medical information is clear, detailed, and accurate, helping facilitate smooth insurance reimbursement and payment processes whenever applicable.

【A Team Guided by Evidence and Continuous Learning】

Our team includes not only physicians and nurses, but also:

Certified psychologists

Therapists

Administrative professionals

All members continuously study the latest scientific literature, ensuring that treatment recommendations are grounded in current medical evidence.

We regularly attend:

National medical conferences in Japan

International conferences worldwide

By integrating the latest LVA techniques with optimized conservative therapy, and by caring for both body and mind, we strive to offer truly individualized treatment plans.

【Our Commitment to You】

Every patient’s condition, lifestyle, and goals are different.

Our mission is to ensure that no concern is left unaddressed, and that each patient receives care tailored specifically to their needs.

At Lymphedema Clinic Tokyo, you are supported not by a single doctor, but by an entire team working together for you.

We look forward to supporting you on your journey toward a more active and confident life.

【Team FAQ – Lymphedema Clinic Tokyo】

Who Will Support Your Care in Japan

Q1. What kind of clinic is Lymphedema Clinic Tokyo?

Lymphedema Clinic Tokyo is a specialized medical clinic dedicated to the diagnosis and treatment of lymphedema.

We provide care through a multidisciplinary team, combining surgery, conservative therapy, nursing care, psychological support, and administrative coordination to support international patients safely and responsibly.

Q2. How many doctors are involved in my care?

Our clinic has four physicians:

Makoto Mihara, MD

Hisako Hara, MD

Yohei Iwanaga, MD

Mari Kawahara, MD

The team includes two male and two female doctors, allowing patients to feel comfortable regardless of gender preference.

Q3. What specialties do your doctors have?

Three physicians are board-certified plastic surgeons

One physician is a board-certified vascular surgeon

By combining expertise from both plastic and vascular surgery, our doctors collaborate closely to evaluate each patient’s condition from multiple medical perspectives.

Q4. Who performs the online consultation and surgery?

All online medical consultations and LVA (lymphaticovenular anastomosis) surgeries are personally performed by Dr. Mihara.

This approach ensures:

Clear communication

Consistency in treatment planning

Continuity from consultation to surgery

Q5. What kind of experience do your nurses have?

Our operating room nurses specialize in LVA surgery and collectively support more than 200 LVA procedures each year.

In addition to technical expertise, they focus on:

Reducing patient anxiety

Providing reassurance during local anesthesia

Creating a calm and supportive surgical environment

Patients are never rushed, and emotional comfort is considered an important part of care.

Q6. Who provides conservative (non-surgical) lymphedema therapy?

Conservative treatment is provided by dedicated lymphedema therapists with over 10 years of experience.

They use evidence-based tools and methods, including:

Picopress for accurate compression pressure measurement

Ultrasound imaging to guide therapy decisions

Q7. How is conservative therapy different from traditional approaches?

Rather than focusing only on manual lymph drainage, our approach integrates:

Exercise prescription

Weight management

Behavioral and lifestyle modification

Based on scientific evidence, we determine:

The most appropriate medical compression garments

Safe and effective activity levels

The goal is to support patients in maintaining an active daily life, tailored to their individual condition.

Q8. How are international patients supported administratively?

Our reception and administrative staff work closely with

Emergency Assistance Japan Co., Ltd.

to support international patients.

This includes:

Appointment coordination

Medical interpretation arrangements

Preparation of detailed medical documents for insurance companies

We make every effort to ensure that insurance-related processes proceed as smoothly as possible.

Q9. Do you support communication with doctors or therapists in my home country?

Yes.

After treatment, we prepare treatment summaries in:

English

And, when possible, translated into your native language

These documents help your doctors and therapists in your home country clearly understand:

What treatment was performed

How postoperative and long-term care should continue

Q10. How does your team stay up to date with medical knowledge?

All members of our team—including doctors, nurses, therapists, psychologists, and administrative staff—continuously study the latest scientific literature.

We regularly attend:

National medical conferences in Japan

International conferences worldwide

This allows us to incorporate current evidence into daily clinical practice.

Q11. How do you individualize treatment for each patient?

Every patient’s condition, lifestyle, and goals are different.

Our team collaborates to:

Review medical findings together

Discuss treatment options carefully

Propose a personalized treatment plan based on evidence and patient needs

We strive to ensure that no concern is left unanswered throughout your care.

Q12. What is the philosophy behind your team-based care?

We believe that effective lymphedema care requires:

Medical expertise

Technical skill

Emotional understanding

Clear communication

By caring for both body and mind, our team aims to support patients in regaining confidence and pursuing an active life—without making unrealistic promises.

【Final Message to International Patients】

At Lymphedema Clinic Tokyo, you are supported not by a single doctor, but by a dedicated team working together for you.

Our commitment is to provide evidence-based, carefully coordinated care, so that you can feel informed, respected, and supported at every step of your journey.

At Lymphedema Clinic Tokyo, we use the world's highest-power surgical microscope, which is made in Japan. We can reliably anastomose lymphatic vessels or veins of 1 mm or less with this microscope. Patients are able to observe the surgical procedure on a large screen in real time.

The condition of the lymphatic vessels can be observed using indocyanine green fluorescence lymphography.

We can now check the condition of lymphatic vessels and veins with an ultrasound device prior to LVA surgery. In 2018, we reported in an international medical journal that observing the condition of lymphosclerosis could improve the outcome of LVA. It has been shown that anastomoses of ten sites performed with the conventional surgical procedure have about the same outcome or efficacy as anastomoses of three sites with the current surgery.