The procedure can cost £80 000 – but increasing numbers of people are putting themselves through painful leg lengthening surgery, with the demand for “stature lengthening” on the rise worldwide, particularly among young men.
Thanks to technological advances, changing attitudes to cosmetic procedures, and a growing entrepreneurialism among orthopaedic surgeons, clinics around the globe are competing for patients. Yet there is also concern about this growth industry, reports The Guardian, and the motivations of the surgeons offering it.
“What’s driving it, sadly, is cash,” says Dr Dror Paley, a pioneering orthopaedic surgeon in Florida and one of the world’s most experienced limb lengthening specialists. He now gets half a dozen inquiries from new patients daily, up from one a day only five years ago.
“For the first time, orthopaedic surgeons have a piece of the plastic surgery business, but that doesn’t mean it’s being done well,” he says. “In fact, patients are being preyed upon and are coming to me with horrible complications.”
The operation is a remarkable feat of medical engineering – and not for the squeamish. Techniques and devices vary. Paley’s version uses nails or rods similar to those employed to stabilise bad fractures. But when he drills out the marrow cavity and drives in the nail, he also intentionally breaks the bone in half.
The clever bit comes after the operation itself. A handheld device positioned against the leg at home creates a magnetic field. This activates a magnetic screwing mechanism inside the nail, which is telescopic. At a typical rate of a millimetre per day, spread across three or four activations of a few minutes each, the nail pulls the two sections of bone apart. The body makes new bone tissue to bridge the growing gap.
This extension process lasts several weeks and involves a period of relative immobility, sometimes necessitating time in a wheelchair, and months of physiotherapy to help the muscles adapt. Once the lengthening is complete, the nail can be removed.
Patients typically extend both femurs (thigh bones) by up to 8cm. The pain apparently comes not from the magnetic activation, but from the overall effects of surgery and a double leg fracture. It is also possible to extend the tibias, or shin bones, by up to 5cm.
Paley, who operates on around a dozen UK patients annually, charges £83 000 for both femurs, and up to £240 000 for a two-year package extending all four leg bones for a height gain of up to 16cm. A handful of UK surgeons offer leg lengthening procedures, charging between £50 000 and £70 000 for both femurs. Prices can drop to around half that, depending on the device used, in “cosmetic tourism” hotspots like Turkey and India.
What concerns Paley is not growing international competition, but that generalist orthopaedists are increasingly marketing themselves as specialists without the right experience, infrastructure or awareness of complications.
These can include infections, blood clots, joint dislocation and a sometimes fatal condition in which fat expelled by the rod ends up in the lungs. “You have the potential to handicap a patient – it has to be taken extremely seriously,” Paley says. He points out that China outlawed stature lengthening in 2006 after a reported spate of botched operations.
Hamish Simpson, a surgeon and professor of orthopaedics and trauma at the University of Edinburgh, does not offer cosmetic lengthening, but increasingly gets inquiries from shorter men. “I nearly always try to talk them out of it,” he says. He estimates that, even in the best hands, the risk of complications is twice that of, for example, a knee replacement.
Limb lengthening was never intended as a cosmetic fix. Modern techniques emerged in the early 1950s when a Soviet physician called Gavriil Ilizarov invented an external fixator system for injured soldiers. Extendable, halo-like frames supported pins fixed straight through the leg. Ilizarov achieved national fame in 1967 after treating the champion Soviet high jumper Valeriy Brumel, but he was isolated behind the Iron Curtain until an Italian surgeon discovered his work.
In 1983, Paley, then an ambitious young registrar in his native Canada, heard about the method. “This was a brand new orthopaedic field, being ignored,” he says. He studied the technique in Italy and Russia, and began practising in Canada in 1987, later moving to the US.
The apparatus, which was first used in the UK in 1989, was unwieldy, unsightly, painful – and revolutionary. Bone lost in accidents or to infection could be grown back as if by magic, saving limbs from amputation. Children born with deformities or leg-length discrepancies could escape a life of stigma and pain.
People with height insecurity also showed an early interest. “My first cosmetic patient was in 1988,” Paley says. “The market always existed.” But it stayed small. Paley, who values the transformation his cosmetic patients report in their confidence and well-being, performed around 10 stature lengthenings annually for the next two decades. The first telescopic nails arrived in the 1990s. They worked mechanically: patients twisted the limb to activate a ratcheting mechanism in the nail.
The big change came in 2011 with the launch of the magnetic Precice nail, which Paley helped develop, and which is now owned by NuVasive, a US medical tech firm. In 2018, NuVasive launched the Precice Stryde nail, which allowed patients to bear weight on their still-elongating legs soon after surgery. With each new development, leg lengthening looked more like a futuristic body hack than medieval torture.
Even a recall of the Precice Stryde nail in 2021 due to “biocompatibility” issues – which Nuvasive says are still being investigated – has failed to reduce demand. Paley now uses the Precice 2.2 nail, and is also developing a new, smartphone-linked device.
While the pandemic shut down clinics and tourism for months, surgeons say it only created pent-up demand, as people had more time to contemplate their perceived imperfections. Paley says inquiries for stature lengthening have gone from one a month in 2013 to 40 a month in 2017 – and 200 a month today. He now performs 100 cosmetic procedures a year: 84% of his patients are men.
As surgeons market themselves via social media and Google search results, shorter people are discovering a brave new world – and a minefield.
Victor Egonu, a health clinic manager in Baltimore, has emerged as a lightning rod for their questions. The amateur bodybuilder had a leg lengthened in 2012 to correct a two-inch discrepancy caused by a childhood roller-skating crash. Since early 2020, he has interviewed dozens of surgeons and patients for his Cyborg 4 Life YouTube channel, which has had more than 1m views. He now gets up to 30 messages a day from prospective patients, almost all young men.
While nobody counts the total number of procedures performed worldwide, Egonu estimates it is in the thousands every year, and rising fast. He says men account for 95% of his views, and that women who get the surgery start proportionally smaller – he recently had a message from a woman in her 20s who is 140cm tall and fed up with being treated like a child.
Egonu wants patients to be better informed. He also wants to tackle a secondary stigma confronting people trying to escape height prejudice. “People say breaking your legs to get taller is barbaric and you should never do it,” he says. “But when you hear about the unhappiness patients wake up with every day, you understand.”
Surgeons themselves are navigating the ethics of limb lengthening. When I contact Ian Bacarese-Hamilton, the UK’s best-known limb-lengthening specialist (he trained with Paley), the surgeon initially agrees to talk before cancelling and referring me to the Schoen Clinic, where he works, near Harley Street in London.
The clinic tells me it has never carried out cosmetic limb lengthening, despite having previously marketed it, and has even stopped lengthening for medical reasons. Neither the surgeon nor the clinic responds when asked why they appear to be distancing themselves from stature lengthening.
Matija Krkovic, a consultant orthopaedic surgeon and limb-reconstruction specialist in Cambridge, says he always had “severe reservations” about the practice. “The risks, while low in frequency, can be substantial,” he says. But that hasn’t stopped a flood of recent inquiries – and a change of heart. “I realised that people will do this, and that I’m well suited to it because I know how to deal with complications.”
Krkovic is now waiting for a handful of prospective patients to have psychological assessments before carrying out his first cosmetic leg-lengthening operations. He’s ready to disappoint people if he thinks surgery won’t solve their problems.
Dimitrios Giotikas, a Greek surgeon and specialist operating in Athens and Cambridge, says “no” to about one in 15 patients if assessment reveals body dysmorphia, a psychological condition that can be treated with therapy and antidepressants. “I make sure that I’m doing the right thing for the right person,” he says.
See more from MedicalBrief archives:
Australia put the brakes on cosmetic surgery ‘cowboys’
Brazilian butt lift: Behind the world’s most dangerous cosmetic surgery
Demand for cosmetic surgery continues to grow