Can I Get Limb Lengthening Surgery Two or Three Times?

Are you worried you might not be satisfied with your height after just one limb lengthening surgery? Many patients feel one surgery won’t resolve their anxiety over their height as they’ll still be too short to be satisfied.

These patients might ask themselves, “Can I get limb lengthening surgery twice or three times?” The answer is yes, but the costs and risks increase exponentially with each subsequent surgery so it’s not always that easy. Consider the following information if you’re wanting to get multiple height increasing surgeries…

Getting Limb Lengthening Surgery Twice is Possible and Common

Usually, when patients get a second leg lengthening surgery, they get femur surgery first. If they’re not satisfied with their height or proportions, they can then bring up tibia surgery.

While only a maximum of 8 cm (about 3 inches) of height gain is possible with one surgery,[1] this can extend up to 13 cm (about 5 inches) with a second one.[2] Surgeons usually perform these two surgeries at least a year apart.

If time is limited, another option is to get quadrilateral limb lengthening, where the tibia and the femur are elongated simultaneously. In this case, surgeons carry out this procedure in two sessions. Surgeons recommend operating on the tibias first to give them a head start in healing. The femur surgery occurs three weeks later, so the body has time to recuperate from the first procedure.[2]

Double Limb Lengthening Factors and Considerations

It’s important to consider everything from costs, recovery time, and risk of complications when debating or preparing for multiple surgeries. Many people opt for one surgery at first once they realize multiple surgeries are far more intensive in every aspect, but the choice is ultimately up to the individual. Consider the following if you want to lengthen both tibias and femurs or just one segment lengthened twice…

Higher Cost

Logically, the cost of surgery will nearly double. At the Paley Institute:

• Bilateral femur lengthening – lengthening both femurs at once costs $97,500.
• Bilateral tibia lengthening – lengthening both tibias at once costs $109,000.
• Quadrilateral femur and tibia lengthening – lengthening both tibias and femurs at once, with tibia surgery performed three weeks after femur surgery costs $196,000.
• Lengthening femur first, followed by tibia lengthening after one year, costs $206,500.[2]

Longer Recovery

Tibia recovery takes almost twice as long as the femur, and for each centimeter of length gained in the femur, recovery takes one month. In contrast, 1 cm of height gain requires 1.5-2 months of recovery for the tibias.[3]

This difference means that recovery time will be nearly doubled, especially with quadrilateral lengthening. Patients, therefore, need to pay more in rehabilitation or physical therapy costs, larger accommodation costs on top of taking more time off work.

If they’re getting Precice 2.2 surgery and not STRYDE, they also won’t be able to walk unassisted until their legs have fully healed (unless the patient weight less than 150 pounds)

Risks & Potential Complications

While doing the two surgeries a year apart carries the general risk of muscle stiffness, the tightness is even more with quadrilateral lengthening. All the posterior leg muscles stretch together and this affects muscles in the back.

Below are some general risks associated with getting the surgery twice, but this is not a comprehensive list:

• Drop foot – Tibia lengthening carries with it the risk of drop foot (ballerina foot). This condition occurs when the peroneal nerve is damaged, and patients can’t flex their foot up as a result. Since the second surgery is typically on the tibias, patients should be aware of this risk.
• Anterior Pelvic Tilt – Lengthening all four bones at once also increases the likelihood of anterior pelvic tilt (APT). The quadriceps, specifically the hip flexors, become tight while the extensors in the back of the thigh get looser, tilting the spine backward and causing the rear to protrude outward.[4]
• Contractures – There’s also a higher risk of muscle contractures, where the muscles adjoining the knee become so stiff that they prevent the joint from moving which makes it difficult to walk.

How Can I Get the Best Results?

The best way to prevent these conditions is to follow an intensive stretching routine under medical supervision at least two weeks before the surgery and keep up with regular stretches, exercises, and physical therapy afterward.

Patients should also make sure they go to a physical therapist recommended by their surgeon, as most therapists won’t have experience working with leg lengthening patients.

You Can Even Get Leg Lengthening Surgery Three Times to Maximize Height

If patients believe they need to gain more than 5 inches of height, they may consider a third leg lengthening surgery. Here, both the femur and the tibia extend up to 4 cm with quadrilateral lengthening. A year or more later, a third procedure elongates both femur and the tibia by 4 cm again, leading to a maximum height gain of 16 cm (6.3 inches).[2]

Some even say patients can gain more height than this, but top surgeons agree that 6.3 inches is generally the most an individual can safely lengthen.

Triple Leg Lengthening Factors and Considerations

The cost for triple leg lengthening will be much higher. At the Paley Institute, this procedure costs $280,000, including physiotherapy and rod removal.[2] Add to this the increased accommodation and recovery costs, and it becomes quite the exorbitantly priced procedure indeed.

Besides, the risk of complications is also higher since the bones have already been broken once, and the muscles must stretch more than ever. Physical therapy is of paramount importance to prevent long-term effects.

Types of Lengthening Options to Increase Height

Patients can lengthen one leg at a time (unilateral), both legs at a time in one segment (bilateral), or even both legs in both segments (quadrilateral) as discussed above.

Below we’ll discuss bilateral and unilateral options and some things to consider.

Bilateral Limb Lengthening

Most recipients of cosmetic leg lengthening get bilateral lengthening surgery which means one segment on the left and right leg is broken. Bilateral lengthening surgery is most common since it is both safer and cheaper than lengthening the tibias.

The typical tibia to femur ratio is 0.80. with a standard deviation of 0.02. This means that any ratio from 0.78 to 0.82 is considered normal.[5] Though this ratio doesn’t play a significant role in attractiveness unless it is  far out of the norm. [6]

If the ratio is higher than 0.82, the surgeon may recommend tibia lengthening instead. Tibia lengthening is generally only performed first to create more proportionate legs.

Unilateral Limb Lengthening

Very few people get unilateral lengthening for cosmetic purposes, but it is common for trauma and congenital cases.[7] Typically, this method involves inserting pins and wires into the muscles overlying the bones and attached to screws on a fixation device. The patient turns screws or uses a controller to lengthen the bone, generally to correct leg length discrepancies.

Conclusion

Make sure to research and choose a qualified and reputable surgeon if you’re planning to have multiple lengthening surgeries, and always follow the doctor’s word. Consider your finances carefully and provided you keep up a positive mindset throughout, you should be enjoying your new height sooner than later.

References

[1] Guerreschi, F., & Tsibidakis, H. (2016). Cosmetic lengthening: what are the limits?. Journal of children’s orthopaedics, 10(6), 597–604. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5145841/

[2] Paley Orthopedic & Spine Institute. (2018). Costs & Financial Considerations. Paley Orthopedic & Spine Institute. https://paleyinstitute.org/centers-of-excellence/stature-lengthening/costs-financial-considerations/#/

[3] Paley Orthopedic & Spine Institute. (2018). Consolidation Phase. Paley Orthopedic & Spine Institute. https://paleyinstitute.org/centers-of-excellence/stature-lengthening/the-paley-method/consolidation-phase/#/

[4] Six fixes for anterior pelvic tilt. (2017, May 11). Medical News Today. https://www.medicalnewstoday.com/articles/317379#fixes

[5] Paley, D. (2018). Cosmetic Stature Lengthening FAQs [PDF]. Paley Orthopedic & Spine Institute. https://paleyinstitute.org/wp-content/uploads/Cosmetic-Stature-Lengthening-FAQs.pdf

[6] Versluys, T., Foley, R. A., & Skylark, W. J. (2018). The influence of leg-to-body ratio, arm-to-body ratio and intra-limb ratio on male human attractiveness. Royal Society open science, 5(5), 171790. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5990728/

[7] Arenas-Miquelez, A., Arbeloa-Gutierrez, L., Amaya, M., Vázquez, B., & De Pablos Fernández, J. (2021). Upper Limb Lengthening in Achondroplasia Using Unilateral External Fixation. Journal of pediatric orthopedics, 41(4), e328–e336. https://pubmed.ncbi.nlm.nih.gov/33560708/