Leg Lengthening Surgery: What is it & what to expect?
Written by Joshua Leaf | Updated on August 31, 2021
Written by Joshua Leaf | Updated on August 31, 2021
Leg lengthening surgery is a new groundbreaking medical procedure where adults can permanently increase their height if they desire. Limb lengthening surgery, its other common name, is a surgery that works by making a cut in the bone, stretching apart the leg a fraction of a millimeter at a time, and allowing the bone to heal or consolidate.
While lengthening originated from congenital deformities or trauma, today, many people are undergoing surgery to simply get taller.
While it may seem like a crazy question, in the year 2021 and beyond, it’s not: more and more people are getting cosmetic leg lengthening every single year. As the procedure becomes even more well-known, it’s sure to grow in popularity.
In fact, many cosmetic limb lengthening height surgeries allow adults (defined as someone with closed growth plates) to grow 3 inches or more. But before asking how to grow 5 inches (which requires femur lengthening and tibiae lengthening, sometimes called calf lengthening or shin lengthening), it’s essential to know what exactly is involved in the surgery process.
Because the cold hard truth is you can’t become taller in one day. The entire height surgery process takes many weeks from start to finish. And the more height you desire, the longer the process takes.
Well, not quite. It is actually banned in some parts of the world like China.
With that said, as long as you can pay the high up-front costs and take time off (you cannot work full-time for up to 4 weeks after surgery and up to 12 weeks or longer for some patients), you can get it.
There are a few main requirements that any top surgeon will need to confirm:
The last one is easily the most controversial.
Who should be allowed to get surgery, and who should be denied?
Should it be reserved for men and women of a certain height threshold? While everyone has their own opinion on this, keep in mind that the top doctors in the field do not have a height threshold: they will operate on anyone as long as they meet the criteria above.
The “right reasons” for surgery will be different for everyone. However, the piece that is critical for everyone is a healthy sense of self-worth and life outlook in almost every other area of life.
In other words, if you are otherwise successful and fulfilled in your career, social life, relationships, and all of the essential aspects of Maslow’s Hierarchy of needs, but this one thing just keeps nagging at you…
And that one thing is your short stature (the medical term for the dislike of one’s height)…
Then limb lengthening surgery may be perfect for you.
In fact, it is one of the very few cosmetic procedures with a near 100% success rate. 1In other words, every single person that gets height enhancement surgery has a chance to free themselves of height neurosis (height neurosis is the term legendary leg surgeon Dr. Dror Paley of Florida came up with).
The very first decision you will need to make if you want to move forward with surgery is whether to lengthen your femurs or your tibia.
There are pros and cons of both options.
For most, the easy choice is femurs. You can gain more height, the rehab is easier, and consolidation (bone growth) is faster due to the larger muscle mass on the upper leg.
However, there are reasons why femur lengthening is not always ideal…
Of course, if you are looking to get the maximum benefit out of leg lengthening you will need to undergo both surgeries. This can be done simultaneously (really, 3 weeks apart to give your body some rest in between), but only by the top surgeons.
But, going from 5’6 to the glorious 6 foot mark might be worth it, and is worth it for the handful of patients who lengthen both. Yes, you can gain a total of 6 inches in a perfect scenario (arm lengthening is another story).2
In the past, the limb lengthening process had a much, much harder patient experience. In fact, the surgery was invented in Russia when Dr. Gavriil Ilizarov discovered that new bone will begin to form in the gap by pulling apart the leg bones very slowly. In the medical and leg lengthening community, this is known as the Ilizarov apparatus method. 3
But the entire process was a nightmare. You had to wear metal frames around your legs for months and even years to gain 2 inches or more.
Fortunately, getting taller in 2021 is much easier.
Instead of bulky external appliances like the Ilizarov device, the top limb lengthening surgeons use an internal device that is “installed” inside your existing leg bones.
The main issue with internal lengthening devices is that they cannot be used to treat moderate or severe misalignment issues such as bow legs or knock knees. While an expert surgeon can use additional blocking screws to fix slight alignment issues, it is unsuitable for those with more severe pre-existing misalignment issues.
Keep in mind just because you have never had pain does not mean you have perfect alignment. Some patients who undergo leg lengthening are troubled to learn that they have bow legs that can’t be corrected unless they undergo additional surgery. This will not apply to most, but be sure to ask your surgeon about your existing leg bone alignment.
Leg lengthening has gone mainstream in the past months, thanks to doctors like Debiparshad alerting the press and news segments like Insider.
But that doesn’t mean internal limb lengthening hasn’t been around for long. In fact, the first breakthrough internal devices (the precice nail versions one and two) have been in use for several years now.
However, these Nuvasive Precice devices were almost exclusively used for lower limb discrepancy surgery (and congenital cases)–people who have one leg shorter than the other: otherwise known as a leg length discrepancy.
Many doctors still debate the ethics of increasing the height of an otherwise healthy person through bilateral limb lengthening (both legs increased in height). But the leading surgeons in the field like Dr. Paley and Dr. Rozbruch are both helping to pave the way for future acceptance by the larger medical community.
Fortunately, you don’t have to wait until the world catches up: you just have to go to a surgeon that actually performs it bilaterally and for cosmetic purposes.
Once you find the doctor who will perform the surgery, it’s time to begin phase 0 – the preparation phase. By preparing for surgery, you will ultimately set yourself up for success and be more likely to reach your desired height.
Many people pass the qualifiers above but then have to delay their surgery because their vitamin D or calcium levels are deficient or they weigh too much for the normally ‘full weight bearing’ STRYDE nail. If the doctor has to partially restrict weight-bearing, the recovery time will subsequently be longer.
Lastly, most patients wind up cutting their lengthening short because their muscles get too tight or waste away (atrophy), which can cause complications. Therefore, it’s beneficial to stretch and exercise your entire lower body before surgery, but more specifically, your calves and hamstrings. Toe touches, slant board stretches, yoga and running before surgery are just a few ways to prepare physically. Let’s recap some of the more important preparation tips:
Please note, this is not an exhaustive list but serves as a starting point for physical preparations. Many other things must be considered such as work, finances, family, housing accommodations and more.
Leg lengthening is broken down into 4 phases: surgery day, distraction, consolidation, and removal.
Distraction is the process of slowly making your leg longer through “height stretching”–which is really bone lengthening. The scientific name is the osteogenesis process.
The human body is fascinatingly good at creating new bone and muscle as long as enough stimulus is applied for a long enough time. In fact, this is exactly how dental braces work: the bone in your teeth and jaw are remodeled slowly over time through constant pressure applied.
The final phase of rod removal (getting your STRYDE or precice intramedullary limb lengthening system removed from the inside of your leg bones) is considered optional by most doctors but highly recommended.
Plus, some patients claim they don’t truly feel 100% recovered until they have the intramedullary rods removed.
While the day of surgery is incredibly nerve-wracking, it isn’t too bad for most patients. Anesthesia does an excellent job of controlling most pain. The latest and greatest internal lengthening devices are fully hidden inside your leg, allowing for an extremely improved experience compared to when patients had to wear giant metal frames around their entire leg!
There isn’t much to know about this phase of height increasing surgery, other than it lasts about 7 days.
This is known as the “latency period”. It’s a short period of time that allows your body to recover from the trauma of surgery some before beginning distraction, which obviously causes inflammation by the sheer fact of stretching your legs apart!
The second phase is distraction, which is also known as the lengthening phase.
This is the core of what height surgery really is: slowly using the lengthening device to pull apart, or distract, your leg bones.
There are many types of devices, but the primary one that is considered safe and reasonable for most cosmetic patients is an intramedullary rod. This simply means a rod that goes in the inside of your bone canal where bone marrow normally is.
How long this phase takes depends on many factors, but mainly on whether you undergo femur lengthening height surgery or tibia lengthening height surgery.
The tibia bones take longer to lengthen. This is because the soft tissues–muscle, tendons, ligaments–of the lower legs are much smaller and thus become much tighter when lengthened.
This means two things:
Femur lengthening is normally 1 millimeter per day, while tibia lengthening is normally .75 or even just .5 millimeters per day.
For example, if someone wants to get the maximum amount of height increase which is 8cm (a little over 3 inches) it will take 80 days to lengthen for the femurs.
But this assumes there are no complications. And one thing is for sure–you should expect complications from undergoing surgery to get taller.
Luckily, complications are very mild for most (extreme muscle stiffness and weakness), but they are still limb lengthening surgery side effects to be aware of nonetheless.
Tibia on the other hand, can only be lengthened 4 to 5 centimeters, with 6 centimeters as the upper limit. Most doctors consider this the “safe range” for lengthening of the shin bones. By doing a full 8cm in the tibia it can take years of rehab to fully recover from surgery. And in some cases, a full recovery is not even possible.
So stay safe and pick a doctor that knows not just how to perform the height increase surgery but is an expert at handling the many complex complications that can arise without proper surgeon knowledge and experience.
The third stage in the process is almost like “limb lengthening without surgery”–you slowly forget you ever did anything to your legs. But it happens very slowly, getting slightly better every single day.
This is known as consolidation: the body’s healing process of filling in the newly extended gap in your leg bone.
As a general rule of thumb, you can expect 1 month of consolidation needed for every 1 month of femur lengthening and 1.5 to 2 months of consolidation needed for every month of tibia lengthening.
Please note that these consolidation times correspond to a fully weight-bearing nail; currently, there is only one approved full weight-bearing nail–the STRYDE device (which is currently recalled to further test biological safety). 4
If you have leg lengthening done without STRYDE, you can expect consolidation times to be double the rule of thumb above.
Now for the good part: the consolidation phase is so much easier than the lengthening phase.
You did it! Almost.
Now you just need to take it easy, eat the correct nutrients needed to grow bone, stimulate bone remodeling by walking, and sleep as much as possible.
During the consolidation phase, you will be sending monthly x-rays to your doctor for review to make sure the bone gap is healing, and you haven’t fractured your callous or damaged your internal nail or hardware (screws).
You can expect to “feel normal” about 3 weeks after stopping lengthening. This simply means you will no longer have the constant “pulling sensation” of the soft tissues in your legs being constantly stretched apart. While lying still in bed, it becomes hard to tell anything ever happened.
But being able to walk properly will take several months and even years to return to sports if you don’t use the proper performance physical therapy approach to constantly modify and adjust what rehab exercises and stretches you are doing daily.
Whether you have tibia rods or femur rods, it’s recommended to get them removed.
The official statement from doctors is that we simply don’t know enough about the materials, and specifically the rare earth magnet, to leave it in the body for a lifetime.
Over time it is thought that metals and other parts of the nail could theoretically leak into the bloodstream. That’s why most top doctors in the USA highly recommend removing the rods as soon as possible following full consolidation.
While removing the rods too soon before the bone is fully healed is unsafe, leaving them in for multiple years will make it very difficult for a surgeon to remove the internal device. This is because over time your leg bone will begin to grow over and around the screws and other hardware holding the internal nail in place.
You can avoid this by just getting them removed.
Of course, but it’s going to cost you.
P.S. Some doctors can help utilize your medical insurance to pay for at least part of the removal, but only some in the United States do this.
Besides pain, probably the number one question most people have when it comes to leg lengthening is how long does it take to recover back to 100%?
It’s a bit of a loaded question because everyone’s experience will be different.
How much you prepare with stretching and exercises before surgery, your age and pre-existing flexibility, your chosen limb to lengthen, and many other uncontrollable factors will all play a role in your ultimate recovery.
However, most patients fall into the following date ranges:
Keep in mind the above timeline is a rough estimate and your individual recovery may be better or worse depending on the variables listed above.
But really, it will come down to your own effort that you apply day in and day out to your stretching and exercises. Truly, they must be completed every day if you expect a healthy, expedient, and full recovery.
Now you should have a solid understanding of what goes into leg lengthening surgery and what will be required of you if you truly want to get height surgery. As we always suggest, please go with the best doctor you can afford and do your own due diligence when it comes to your health.
1Robbins, C., & Paley, D. (2020, September). Stryde Weight-bearing Internal Lengthening Nail. Paley Orthopedic & Spine Institute. https://paleyinstitute.org/wp-content/uploads/Stryde-Weight-bearing-Internal-Lengthening-Nail.pdf. <https://paleyinstitute.org/wp-content/uploads/Stryde-Weight-bearing-Internal-Lengthening-Nail.pdf>
2Paley, D. (n.d.). Cosmetic Stature Lengthening Frequently Asked Questions (FAQ’s). Paley Orthopedic & Spine Institute . https://paleyinstitute.org/wp-content/uploads/Cosmetic-Stature-Lengthening-FAQs15.pdf. <https://paleyinstitute.org/wp-content/uploads/Cosmetic-Stature-Lengthening-FAQs15.pdf>
3Wikimedia Foundation. (2021, January 14). Ilizarov apparatus. Wikipedia. <https://en.wikipedia.org/wiki/Ilizarov_apparatus>
4Collins, M. (2021, February 20). URGENT RECALL NOTIFICATION PRECICE STRYDE, PRECICE PLATE AND PRECICE BONE TRANSPORT. Nuvasive. https://www.nuvasive.com/wp-content/uploads/2021/02/NSO-Precice-FSN-United-States-Biodur.pdf. <https://www.nuvasive.com/wp-content/uploads/2021/02/NSO-Precice-FSN-United-States-Biodur.pdf>
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