Preparing for Leg Lengthening Surgery (A Comprehensive Checklist)

It can be overwhelming trying to factor in cost estimations, physical or mental impact, and whether to disclose the surgery and to whom, among countless other decisions that must be made while preparing for limb lengthening surgery. For those contemplating cosmetic leg lengthening surgery, these types of questions are very common. 

Skip to the bottom if you want to see a list of nearly every aspect that should be taken into consideration or, continue reading to see why these factors are so important. 

Reasons to Choose Leg Lengthening Surgery

Today, there are three main reasons someone undergoes this surgery: a congenital defect, trauma accidents or height dysphoria, a condition where an individual is concerned about their height to the point where their dissatisfaction is affecting their day to day lives. People facing these issues frequently see view their short stature as a disadvantage in various aspects of their life. Of course, there are people who may just want to be taller to reap the social and physical benefits, but there’s usually some level of discontent. 

If it’s due to a dissatisfaction, it’s vital to observe your thought patterns and understand WHY exactly you’re dissatisfied and if becoming taller will truly help your specific case. 

If patients opt for the surgery, it’s important they do it for intrinsic reasons since height increasing surgery doesn’t always cure height dysphoria or stop the discrimination (this is very subjective and depends on the individuals past and present experiences, in addition to their initial and final height).

It is also important to address common issues when dealing with height dysphoria connected to gender. Both men, women, and transsexuals can have insecurities about their height or suffer from a lack of confidence, but some men fear that they are being skipped for potential raises or romantic dates, simply because they are shorter than other men around them. Women sometimes think that their short stature causes them to be treated like children. Some surgeons will provide a consultation to be sure that this surgery is being sought for appropriate reasons.

Risks vs. Reward

Of course, this surgery does not come without risk, but are the rewards worth it? The average height gained by this surgery is 3 inches, but it is possible to gain up to 6.3 inches. However, there are risks of potential nerve damage, damage to the muscle and tendons near the surgery site, atrophy, a very long and painful recovery, and potential complications after surgery. [2] [3]

When someone opts for this surgery for cosmetic reasons, it is even more important to weigh the risks against the potential reward. For most people with severe height dysphoria or Body Dysmorphic Disorder, some surgeons will not sign off on this surgery, as it is suspected that simply changing the patient’s height will not address the problem and is not worth the risks. However, those with minor dissatisfaction or BDD report an increase in happiness and content. 

Choose the Right Limb Lengthening Surgeon

For those who have decided to have this surgery done, it is extremely important to be mindful when choosing a surgeon. Surgeons such as Dr. Paley have performed over 20,000 surgeries and remains one of the most experienced limb lengthening surgeons in the world. But of course, not all surgeons have equal skills or experience. This is a relatively new procedure, so it’s important to consider both the physician’s experience and ultimately, one’s own safety.

A few tips to find the right surgeon are:

1. Be sure the surgeon performs limb lengthening to trauma patients and congenital deformities. This provides more experience and is partially indicative that they’re not only in the field for money. 
2. See if the surgeon has research in orthopedics or lengthening to determine how active they are in the world of academia and if they’re upkeeping their education.
3. Read others stories about particular doctors in hopes to gauge the surgeons demeanor, abilities, track record and more. Forums are a great place to read anecdotal information.
4. Prioritize safety first, cost second, location third. 

Choose the Best Lengthening Methods & Devices Possible

There are two basic ways to perform this surgery: with an external fixator or with an internal leg lengthening nail. Sometimes, the surgeon will suggest their preferred method, although most surgeons are beginning to opt for internal nails like Precice or Stryde because they have fewer risks and a faster recovery time associated with them. 

However, small boned women, or children, may need to utilize external fixators – as their bones are simply too small to use most internal leg lengthening nails. [4]

Patients will need to discuss their options with their surgeon since there are several options available depending on which bones are to be lengthened, the fixation devices available, and how many times surgery will be performed.

Height Surgery Options: Tibias, Femurs, or Both

During preparation, the patient and surgeon will usually collaborate to choose one of five lengthening, or segment options for height enhancement surgery: 

1. Femur lengthening (bilateral): Can increase height up to 3.25 inches
2. Tibia lengthening (bilateral): Can increase height up to 2 inches
3. Combined tibia and femur lengthening, separated by 3 weeks (quadrilateral): Can increase height by 4 inches
4. Femur lengthening followed by tibia lengthening, separated by one year: Can increase height by 5.25 inches
5. Combined femur lengthening and tibia lengthening, separated by 3 weeks; followed by rebreak of femur and tibia and re-lengthening one year (or more) later: can increase height up to 6.3 inches 

The first two options are most often chosen but combining bones can lead to more height gained. Of course, the more complex the surgery is, the more breaks needed. Generally, more surgeries can increase risks and operating on tibias has higher rates of complications. 

Financial Considerations

The surgery is expensive and if it is performed for cosmetic reasons, it is not covered by health insurance. While costs vary, especially based on what type of surgery is needed (procedures with more bones that need to be lengthened, and the procedures that require more than one surgery are more expensive), the average general cost estimate is between $70,000 and $150,000, but it can be as low as $10,000 – $20,000 in other countries [5]. 

It’s also important to consider other financial burdens associated with this surgery – lost wages from taking time off work, medication, physical therapy, and transportation to and from the surgeon’s city. [5]

Just in case, it’s recommended to have at least $30,000 reserved for potential complications and the initial costs of the surgery are due up front in one payment before the procedure. 

Allocating Time Off Work

It’s best to discuss time off with a supervisor or request PTO well in advance. Looking into medical leave could be a potential option as well. 

In some cases, patients may own a business, which certainly makes getting time off more attainable. However, this poses its own challenges, as someone needs to be trusted with the running of the business as the patient recovers.  

Privacy – To Disclose or Not Disclose

Most people decide to air on the side of privacy when it comes to this type of surgery – usually there is little to no benefit from disclosing having this surgery to anyone who doesn’t immediately need to know (caretakers, family, bosses or staff if necessary). Most people choose not to disclose their decision to their larger circle of contacts, simply because they fear being judged. 

Yet, there are many patients on YouTube (Cyborg 4 Life or Victor Egonu) and in the media who are proud they’ve gained a few extra inches. At the end of the day, the decision is personal. 

Recovery Timeline

Everyone’s recovery will look slightly different depending on which type of surgery they had, the reason for their surgery (whether it was cosmetic or to fix a congenital defect), the number of bones lengthened and by how many inches. In general, patients can expect to spend 2-4 days in the hospital. Their physical therapy will begin a few days after the procedure to give the best chances for a full recovery. [1] 

Remember, it can take 6-12+ months to return to one’s “normal” life – so be patient and trust in the process. 

Comprehensive Checklist and Overall Considerations

All in all, there are multiple factors to consider before deciding whether or not to pursue surgery. Each point on this checklist should be weighed carefully and thoroughly while preparing for height surgery:

1. Choose a doctor carefully
2. Consider the reasons behind the surgery
3. The pros and cons of leg lengthening given an individual’s circumstances (risks vs reward)
4. Lengthening technique or devices used
5. Desired height, surgery options, and which bones to lengthen
6. Research pain medication (Painkillers prescribed are sometimes opioids – consider potential risks of these medications as well as benefits)
7. Potential sacrifice of athletic abilities
8. To Disclose or Not Disclose
9. Proportions (femur-tibia, wingspan-height (ape index) etc.)
10. Financial considerations
    1. Time off work
    2. Caretakers or home aids for the first few weeks
    3. Lodging or hotel costs
    4. The surgery, hospital, & consultation fees
    5. Medicine
    6. Physical therapy
    7. Physical therapy equipment (i.e. slant board, dynasplints, mattress cover etc.)
    8. Transportation from hotel-hospital and vice versa
    9. Airfare
    10. Loans if needed
    11. Complication fees
    12. Supplements
    13. Food
    14. Nail Removal
    15. Scar removal (optional)
11. Recovery timeline

We hope this article provides food for thought surrounding all aspects involved in preparing for cosmetic limb lengthening. As always, discuss these matters with a physician to be sure everyone is on the same page. 

If anyone has any questions, feel free to get a hold of us by filling out the contact form and we’re happy to provide additional resources or further insight. 

Resources

[1] Hospital for Special Surgery, Limb Lengthening. https://www.hss.edu/condition-list_limb-lengthening-deformity.asp

[2] Gamal A. Hosny, Limb lengthening history, evolution, complications and current concepts. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7058770/

[3] Yousef Marwan, Dan Cohen, Mohammed Alotaibi, Abdullah Addar, Mitchell Bernstein, Reggie Hamdy, Cosmetic stature lengthening: systematic review of outcomes and complications. https://online.boneandjoint.org.uk/doi/full/10.1302/2046-3758.97.BJR-2019-0379.R1

[4] S. M. Dubowy, Limb lengthening surgery: External Fixator (for parents) – nemours kidshealth. KidsHealth. https://kidshealth.org/en/parents/limb-lengthen-fixator.html