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It’s when you fuck one of Santas elf and enjoy it and somehow stay on the nice list
Bob: What are you doing for the holidays?
Joe: I’m elf fucking tonight
A sick fuck elf is one nasty little cunt. Usually can be used along with the term Asshat. Derived from the "Warhammer" series and made popular by James Buddy.
"Man that guy is a sick fuck elf"
"What a bunch of sick fuck elves"