Elbe was the primary model and muse for her spouse, Gerda Wegener. Together, they explored the themes of love, sex, gender, and mystery in both life and art. Elbe also had success as a painter, primarily under the name Einar Wegener. She is known for her Impressionistic landscapes, many of which depict Parisian scenes. As the first woman to undergo gender confirmation surgery, she became a critical figure in the LGBTQ community. After her successful transition in 1930, she changed her legal name to Lili Ilse Elvenes and stopped painting. Unfortunately, as the methods were largely untested and the surgery was dangerous, she passed away from complications of her fourth surgery. In 2000, a novel loosely based on her life was published and was turned into a feature-length film, The Danish Girl, in 2015.