The Pros & Cons of Limb Lengthening Surgery – A Comprehensive Guide

The pros and cons of limb lengthening surgery should be carefully considered when deciding if surgery is appropriate for you. The most important, including mental health, social life, risks, and costs are addressed in this comprehensive guide,

With this knowledge, you should be able to make an informed decision and determine if limb lengthening surgery is worth it for you!

Is It Worth It?

The question that everyone who has ever considered limb lengthening surgery asks: Is it worth it? It would be great to give a unanimous, clear-cut ‘yes’ or ‘no,’ but the reality is that it depends. 

When it comes to personal health and happiness, value is subjective. What may be worthwhile to one person, may not be to another. Therefore, the answer to “is it worth it?” is completely dependent on the individual. Is the desire for limb lengthening surgery due to physical impairments, a deeply-rooted dissatisfaction in life, or merely a desire to gain a competitive advantage in life?

Differentiating between deep, intrinsic motivations and shallow, extrinsic motivations is important to properly value the risks and rewards of surgery. This is important, because the benefits of limb lengthening surgery cannot be obtained without the associated costs and risks. 

When It May Be Worth It

For many people, limb lengthening surgery is definitely worth the investment. Limb lengthening surgery offers the potential to drastically improve an individual’s life, especially for people suffering from a congenital defect, trauma accidents, or height dysphoria. A strong dissatisfaction with height and quality of life is a primary motivation for the surgery. In addition to overcoming physical and mental ailments, the benefits of being taller cannot be understated. 

If limb lengthening surgery can overcome physical and mental ailments to significantly improve one’s quality of life, and they have the intrinsic motivation to fully commit to the process, the benefits can be life-changing.

When It May Not Be Worth It

However, limb lengthening surgery still requires a significant investment of time and money, and there are associated risks with the surgery. Understandably, for some people, it may not be worth it, particularly if they do not have deep-rooted intrinsic motivations. 

Examples of this could be an individual that simply wants to be able to reach the top shelf easier, improve their pick-up basketball game, or catch the attention of someone particular. While these are all real, justifiable advantages of being taller, they are not likely to be derived from an unrelenting desire to deeply improve their life. These are more akin to conveniences than they are necessities for health and happiness.

Each person is subject to unique circumstances and factors influencing their decision. Furthermore, each person has different priorities, intentions, and constraints. Therefore, it is strongly recommended to carefully consider all the pros and cons associated with limb lengthening surgery.

Pros of Limb Lengthening Surgery

Voluntary surgeries would not exist if they did not offer significant enhancements to health and happiness. There is no question that limb lengthening surgery offers benefits that cannot be obtained via other treatment modalities. 

Improved Mental Health

Mental health issues in the form of body dysmorphia and/or dysphoria (gender, height, and limb) are serious impediments to a high quality of life. Extreme levels of dissatisfaction, depression, and anxiety may result from the experience of being shorter in stature. While diagnosis and an evaluation of treatment modalities available should be performed by a medical professional, it is important to be aware of different options available, including surgery. 

Fortunately, limb lengthening surgery is proven to positively improve mental health, happiness, and general life satisfaction. A 2020 study reported that stature lengthening surgery significantly improved patients’ Body Image Quality of Life Inventory (BIQLI), resulting in a reduced impact of height dysphoria in their life (measured by improved Situational Inventory of Body-Image Dysphoria (SIBID) scores) [1]. Essentially, in addition to increasing height, limb lengthening surgery improved psychological heath, body-image, and self-esteem. 

Additional studies on the effectiveness of stature lengthening find that patients report high satisfaction with the procedure, despite the costs, risks, and in some cases, complications [2]. Another study evaluating patients up to 7 years following surgery observed a significant improvement in self-esteem after one year [3]. Although the average satisfaction gradually deteriorated over time, it remained above pro-operative levels 7 years following surgery.

Enhanced Social Life

The influence of height dysphoria and stature on mental health is intricately connected to the quality of an individual’s social life and interpersonal relationships. This can be considered from internal and external perspectives.

Internally, the lack of confidence and self-esteem associated with smaller stature can be detrimental to the fulfillment of personal relationships and a healthy social life. This creates a positive feedback loop that further amplifies dissatisfaction and impairs quality of life. Externally, an individual smaller in stature may be viewed differently by others, very likely being subject to the unfortunate consequences of heightism.

With an increase in height, social life may improve via improved internal and external perceptions. This has been documented in research, including a 2020 paper that reported that 96.7% of patients using the Ilizarov method reported very high self satisfaction and improvements in their level of social activities [4]. Other studies support this notion, finding that self-esteem and self-confidence significantly improve following stature lengthening [2] [3] [5].

Lifestyle Improvements

For many people, the desire to be taller could be traced back to the largely undisputed advantages of being taller. The benefits associated with an increase in height are not frequently discussed in scientific literature, but are experienced anecdotally everyday by millions of people. 

Increased career opportunities and financial success have been correlated with a taller stature, as well as general attractiveness and romantic opportunities. Both genders are subjected to judgment for being short, although it may be more common for short men to be ridiculed than shorter women. 

However, with limb lengthening surgeries, a potential height increase of up to 6 inches may trade some of the disadvantages associated with being shorter for the advantages of being taller. 

Permanent Benefits

One of the most important pros of surgery is the permanency of the height increase. Unlike wearing elevated shoes or improving posture, increases of height obtained through surgery are permanent. The time invested into surgery and recovery will result in a lifetime of increased height.

Not only are the results permanent, but long-term studies show that they are safe. In a study on cosmetic leg lengthening surgeries, “excellent final outcomes were achieved in all patients except one, who required additional surgery,” concluding that a properly performed surgery is safe and effective [5]. 

Another study assessing muscle strength and power post-operation concluded that patients are able to perform everyday functional activities without difficulty following limb lengthening surgery [6]. However, the authors did report a “small residual decrease in muscle strength and power” that may consequently impact performance in specific circumstances, such as athletics [6]. 

Cons of Limb Lengthening Surgery

It should be clear now that there are significant, life-changing benefits of limb lengthening surgery. However, they must be countered by drawbacks of the procedure. This section will cover the most prominent cons associated with surgery.

Associated Risks of Surgery

As with any medical procedure, there are inherent risks with limb lengthening surgery that must be considered. These may take the form of health complications and long term side effects. Further, no surgery can offer a 100% guarantee of successful achieving desired outcomes.

However, it is important to realize that most of these complications can be avoided, or at least minimized, by doing due diligence when finding experienced surgeons and fully committing to all rehabilitation practices.

Health Complications

Due to the nature of the procedure, health complications may arise and vary in severity. Due to this, many wonder whether or not leg lengthening is safe, and with good reason. 

In one review of different studies, complication rates ranged from 12-84% following height enhancement surgery [4]. Among the most common complications, pin track infection is very common when an external fixation device is used, potentially reaching 100% of patients. Other common health complications include poor bone regeneration and axial malalignment, both of which impair bone regeneration and could lead to future health complications.

Most complications are minor and an inevitable outcome of any surgery. These include:

• Muscle pain
• Muscle stiffness
• Muscle weakness
• Swelling
• Insomnia

In some cases, as with all surgeries, alternative issues may arrive. It is important to find a reputable surgeon to ensure that you have experienced medical professionals ready to respond to any issues that may arise, such as:

• Fat embolism
• Deep Vein Thrombosis
• Malunions
• Anterior Pelvic Tilt

These disclaimers are not designed as a fear tactic to keep people from pursuing surgery, but rather, to ensure that people are properly informed of all risks. 

Long Term Side Effects

In addition to the immediate side effects from the surgery, there are some long term side effects. In most cases, these develop due to doctor and patient error, specifically regarding rehabilitation (physical therapy) or an overly aggressive lengthening plan. Short-term effects that are ignored, such as infection and poor regeneration, could potentially evolve into chronic health issues.

First and foremost, scars are a well-documented side effect of limb lengthening surgery. Depending on the surgery performed, the size and location of the scar may vary. In addition to the natural healing process that occurs over time, making scars less pronounced, there are strategies to help reduce the severity of limb lengthening scars. 

Regarding the development and alignment of bones and muscles, the biomechanics of limbs may be altered following limb lengthening surgery. Potential long-term side effects of leg lengthening surgery include, but are not limited to drop foot, knock knees (X Knees), and bow legs (O Knees). For more information 

No Guarantees

No disclaimer would be complete without recognizing that nothing can be guaranteed with a surgical procedure. Whether it is the successful attainment of the intended height increase or a complete recovery without any complications, every surgery comes with risk. However, the success rate of height enhancement surgeries are very high, with an overall success rate of 95% [7].

Costs

People that are highly motivated to increase their height are likely willing to accept the risks of surgery and commit to the rehabilitation required. Perhaps the biggest constraint for most people is the cost of the surgery. Depending on the location, surgeon, type of procedure, and additional requirements (such as complications), total costs vary significantly. 

Direct Costs

Average, total cost estimates for limb lengthening surgery typically range from $70,000 to $150,000, with costs reaching $280,000 for maximum height attainment (performed in the U.S.). However, in other countries, such as France and Russia, costs may be as low as $10,000 to $20,000. 

Considering the risk of complications and lack of a guarantee, it is important to be prepared for additional expenses to manage complications, such as additional surgeries. It is generally recommended to have $15,000 – $30,000 in reserve in case unforeseen and undesired circumstances require additional treatment or modification surgery.

To learn more about the costs of limb lengthening surgery, review our comprehensive overview of the costs for different surgeons, different countries, and different procedures available using the link above.

Indirect Costs

Not to be forgotten, there are numerous indirect costs that add up fast. These must also be carefully considered and planned for prior to committing to limb lengthening surgery. Some of the most prominent include:

• Time off from work
• Physical therapy (including equipment, tools, etc.)
• Medication
• Travel costs (airfare, hotels, food)
• Consultation and hospital fees
• Loan payments
• Scar removal
• Caretakers / home assistants 

Time

Another major investment is time. Recovery is slow and challenging, demanding time allocated to the surgery and rehabilitation before a return to everyday life. Regular tasks, such as returning to work and driving, usually will have to be postponed for 1-3 months after limb lengthening surgery. Even following those guidelines, additional time may be required for an optimal recovery.

In addition to the 1-3 months time off work for the initial recovery, the complete recovery (including physical therapy) and the return to normal will take much longer. Rehabilitation is a long process that often takes 6-12+ months when performed properly.

Surgery: Pros and Cons of Different Methods

There are actually numerous types of limb lengthening surgeries, methods and nails available, each with unique pros and cons. For a comprehensive overview of the primary methods and their advantages and disadvantages, check out this review article. In general, the biggest differentiating factor is the type of device used: External vs internal fixation devices. 

External fixators utilize a support apparatus (like a scaffold) outside of the limb that is connected to the limb via threaded pins and wires. Internal fixators, meanwhile, are inserted into the limb, either inside or adjacent to the bone to be lengthened. The advantage is that they do not require any external support. In some cases, internal and external fixators may be used simultaneously. 

External fixators are generally less expensive, but they have a higher risk of health complications and the process is more painful and uncomfortable. 

Internal fixators are generally more expensive, but their benefits include: lower risk of joint stiffness, infection, and pain; improved comfort; fewer scars; no soft tissue tethering.

While this may help to guide the decision-making process, it must be acknowledged that there are countless factors that are unique to each person. A consultation with an experienced professional is the best way to determine which procedure is most appropriate. Further discussion on the differences between external and internal fixators can be found here.

Preparing for Limb Lengthening Surgery

All major life decisions require significant research, planning, and consideration prior to implementation. Limb lengthening surgery is no different. There are many factors to consider when deciding if surgery is right for you.

With knowledge of the pros and cons of surgery, you are better prepared to make an informed decision and prepare accordingly for limb lengthening surgery, if it is appropriate for you. To help with the preparations, check out the comprehensive height surgery checklist that has everything there is to consider when it comes to leg lengthening.

References

[1] Rozbruch, Sr., Assayag, M., Buksbaum, J., Khabyeh-Hasbani, N., Westrich, E., & Fragomen, A. (2020). Psychological and orthopedic outcomes after stature lengthening surgery using intramedullary nails. Journal of Limb Lengthening and Reconstruction, 6(1), 28). https://doi.org/10.4103/jllr.jllr_4_20

[2] Lee, R. C., Aulisio, M., & Liu, R. W. (2020). Exploring the Ethics of Stature Lengthening as Treatment for Height Dysphoria. Strategies in trauma and limb reconstruction, 15(3), 163–168. https://doi.org/10.5005/jp-journals-10080-1502

[3] Emara, K., Al Kersh, M. A., & Emara, A. K. (2017). Long term self esteem assessment after height increase by lengthening and then nailing. Acta orthopaedica Belgica, 83(1), 40–44. https://pubmed.ncbi.nlm.nih.gov/29322893/

[4] Hosny G. A. (2020). Limb lengthening history, evolution, complications and current concepts. Journal of orthopaedics and traumatology: Official journal of the Italian Society of Orthopaedics and Traumatology, 21(1), 3. https://doi.org/10.1186/s10195-019-0541-3

[5] Elbatrawy, Y., & Ragab, I. M. (2015). Safe Cosmetic Leg Lengthening for Short Stature: Long-term Outcomes. Orthopedics, 38(7), e552–e560. https://doi.org/10.3928/01477447-20150701-51

[6] Barker, K. L., Lamb, S. E., & Simpson, H. R. (2010). Recovery of muscle strength and power after limb-lengthening surgery. Archives of physical medicine and rehabilitation, 91(3), 384–388. https://doi.org/10.1016/j.apmr.2009.11.014

[7] Rozbruch, S. R. (n.d.). Limb lengthening: An overview by S. Robert Rozbruch: HSS. Hospital for Special Surgery. Retrieved from https://www.hss.edu/conditions_limb-lengthening-overview.asp.