As the old saying goes: if something seems too good to be true, it probably is. The current manifestation of this wisdom is the bourgeoning medical segment urging men to become taller through cosmetic limb lengthening surgery.
Leg lengthening surgery — most recently championed in an edition of Gentleman’s Quarterly — is sold as minimal discomfort outweighed by gigantic leaps in confidence. But look a little deeper at lengthening surgery, and a minefield of possible tragedies appears.
“This is a bad idea and can’t be compared to cosmetic surgeries,” says noted plastic surgeon Dr. Sepideh Saber, MD, FACS. “With a limb lengthening procedure, one must break the tibia and fibula on both sides. These are our weight-bearing bones. Potential complications could be nonunion (bones don’t heal), malunion (bones heal in poor position/slightly off), re-fracture, and osteomyelitis (an infection in the bone).”
Leg lengthening surgery to compensate for short stature is performed by orthopedic surgeons and is a multi-hour, traumatic operation involving breaking a bone in two places.
Limb lengthening is medically valid to preserve a child’s limb function and mobility. Limb length discrepancies — one leg shorter than the other — can occur for several reasons. First, a child may be born with a leg length discrepancy that causes one limb to grow slower. Second, a leg may stop growing after a complex fracture or a fracture that heals incorrectly. Third, some children have birth defects and dwarfism or may require a deformity correction.
During cosmetic height surgery, the lengthening device — an expandable rod — is inserted after the tibia (shin) is cut. One commonly used lengthening rod is a Precice nail. X-rays guide the surgeon as they move the internal device into position. The rod is later lengthened with a magnetic controller outside the limb.
An older method of leg lengthening used the Ilizarov unit — an external fixator. The external device attaches around the lower leg and slowly stretches the bone to lengthen it.
In the weeks after surgery, the two parts of the bone are slowly (with a rate of around 1 mm per day) pushed away from each other by the internal lengthening device. New bone tissue — identical to healthy tissue — gradually forms in the developing gap. The procedure is essentially growing new bone using the body’s natural healing response.
In some subsequent surgeries, the femur is broken to add two additional inches.
The surgical procedure is done under general anesthesia, epidural anesthesia, or a combination of both. After the osteotomy (cutting of the bone), the bone is held in place with orthopedic implants or devices that provide stability for the patient.
Even uneventful leg surgeries take at least a year to even out. Depending on the patient, the first 24-48 hours following surgery can be quite painful. Most people stay in the hospital for about three days after surgery. Then, have a friend or family member take them home.
Using a remote control, the leg bones must be pulled apart slowly each day of the lengthening process to allow the muscles, tendons, and bone enough time to grow. Most doctors advise patients to forgo working for at least three months after surgery — or not undergo the surgery.
While new bone growth expands at a rate of more than 1 mm per day, the soft tissues of the legs (muscles, tendons, ligaments, nerves) cannot grow as quickly. For this reason, if the leg muscles become too tight, the surgeon may not allow you to lengthen at the maximum daily expansion rate.
Daily physical therapy is a crucial component for healing and maintaining a range of motion. You will also have to go in for multiple follow-up appointments so your healthcare provider can monitor your growth and healing.
One day, the bone formation will reach the desired length and your doctor will remove the rods. Rod removal is an outpatient procedure that should be done within 1-2 years of the last surgery. Most patients can walk out of the hospital but may need assistance such as a walker or cane for about a week afterward.
The screw holes take around 10-12 weeks to heal. Patients should not do any heavy lifting until the holes are healed.
Patients can begin light sports anywhere from 6-18 months after the last surgery or about three to six months after rod removal.
The short-term side effect of surgery is that patients must spend 8-12 weeks in bed until they have healed enough to walk.
According to the University of Florida Health Department, the most common risks of this surgery include:
Leg lengthening surgery should not be pursued for strictly cosmetic reasons. While many people (commonly men) have insecurities about their height, self-confidence can be improved in other ways — ideally ways that don’t risk permanent disability.
Cosmetic surgery has been growing among men in recent years. Body contouring, facelifts, and rhinoplasty have all helped patients feel more self-confident without putting their ability to walk at risk.
The possible complications of leg lengthening are too severe for it to be recommended as a cosmetic, elective procedure.
The following are serious complications that can occur from leg-lengthening surgery:
Patients who feel pain on the top of their foot or find themselves frequently needing a foot massage may have entrapment of the tibia’s peroneal nerve. The trapped nerve can lead to increased sensitivity (hyperesthesia) or lessened sensitivity (hypoesthesia).
In some cases, the immediate post-surgical nerve pain following leg lengthening surgery can reach an 8/10 or above on the pain scale.
A fat embolism (FE) is the scariest risk associated with leg lengthening.
Before inserting the lengthening pin into your leg, they must first cut the bone. Reaming involves cutting bone with a rotational cutting tool (a reamer). This process builds up pressure in the bone and causes bone marrow to be compressed.
This compression creates a possibility for fat from the bone marrow to make its way into your bloodstream. These chunks of fat can block blood flow and cause major complications. A pulmonary embolism can occur if the fat clot travels all the way into the lungs.
Large amounts of fat can lead to:
Deep vein thrombosis (DVT) can occur after orthopedic surgery or bone damage, such as a fracture. It occurs when a blood clot (thrombus) occurs in one of your body’s deep veins (such as in the legs). These blood clots can form as a side effect of surgery, or if you go a long time without moving — for example, while on bed rest after surgery.
During leg lengthening surgery, a rod is only inserted into one of your lower leg bones — the tibia, not the fibula. The fibula bone is too thin to place an internal nail.
The tibia and the fibula must therefore be screwed together so that when one is lengthened, the other is as well. If not, the tibia will extend more than the fibula, causing a severe bone misalignment.
The consequences can be disastrous as the fibula can dislocate at the top or end up smaller than the tibia. Unevenness in these bones can lead to ankle arthritis and the inability to fully flex the knee.
Dr. Sepideh Saber, MD, FACS, offers a more sensitive, female perspective for patients of all ages, genders, and orientations. With training in cosmetic and reconstructive surgery — including the highly delicate field of hand surgery — Dr. Saber is a skilled expert in the field.
Whether you know what procedure you want, or are just exploring your cosmetic options, Dr. Saber can help. After evaluating your goals and lifestyle, she can recommend the best procedure for you (even if the best option is not to go forward with surgery).
To request a free consultation, call (877) 205-4100 or schedule a consultation online.
Dr. Saber takes her patients’ safety very seriously. Her facility’s Covid-19 patient safety procedures exceed all CDC and World Health Organization recommendations. Masks are required in our office at all times during the coronavirus pandemic.
The practice of Dr. Saber is located in Encino, CA for patients throughout the Los Angeles area. We are also convenient to Encino, Woodland Hills, Sherman Oaks, Calabasas, Burbank, Glendale, Hidden Hills, Agoura Hills, Northridge, North Hollywood, Malibu, Topanga, Canoga Park, Reseda, Valley Glen, Chatsworth, West Hills, Winnetka, Universal City, Bel Air, Beverly Hills, Downtown Los Angeles, Silverlake, and Echo Park.