What would you like to change about yourself? Your eyes? Your hair? Your sense of humour? Despite the old adage “never judge a book by its cover”, we all know how important subconscious first impressions can be. Height would also often be included on that list of things people would like to change about themselves. Until recently, your height was a trait gifted to you by your genetics and the idea of changing it being something firmly fixed within the realm impossibility. However, innovative new procedures in cosmetic orthopaedics have made the chance to increase your height a reality: for better or for worse.
Limb lengthening: Where Do We Start?
The idea behind limb lengthening was never meant to be viewed as a cosmetic procedure. Originating from the mind of Gavriil Ilizarov in the 1950s, the first limb-lengthening apparatus, named after its inventor, was made to help heal injured soldiers (1). As interest in this field of orthopaedics grew, the therapeutic possibilities of such a procedure also advanced. The apparatus, first implemented in the UK in 1989, was used to save limbs from amputation and fix congenital deformities in children. One of the greatest advancements to date in this field came in 2011 with NuVasive’s launch of the magnetic “Precice Nail” and ushered in the era of cosmetic orthopaedic surgery(2).
Although the process of breaking one’s bones for a couple of extra inches in height might sound barbaric, the procedure itself is a miracle of medical engineering. Although techniques used vary depending on the orthopaedic surgeon doing the procedure, in general, it involves breaking the bones in the legs and using external fixators to slowly stretch the bones apart, allowing new bone to grow. Using the “Precice Nail”, the surgery involves drilling out the marrow cavity and driving in the nail. The nail is then operated using a handheld device that creates a magnetic field, which activates a telescopic screwing mechanism inside the nail. The nail slowly pulls the two sections of bone apart, allowing the body to make new bone tissue to bridge the gap. After the lengthening process is finished, the patients undergo one final surgery to remove the nail.
This entire process can take several weeks and is followed by a period of relative immobility and months of physiotherapy to help the muscles adapt. For going through with this long, dangerous and extremely painful surgery, patients can expect an increase of up to 8cm in both femurs and up to 5cm increase in tibias, resulting in an overall increase of potentially 13cm in height(2).
Worth the pain?
Despite being medically ingenious, cosmetic leg lengthening, often referred to as stature lengthening, is unsurprisingly not without its complications.
A 2020 systematic review, looking into the outcomes and complications of cosmetic stature lengthening showed that the most common obstacle was “ankle equinus deformity” (reduced flexibility, particularly dorsiflexion of the foot) and the most common complications being “deformation of the regenerate after the end of treatment and subtalar joint stiffness”(3). Looking at the surgery as a whole, patients may also be at risk of infections, joint dislocations and the potentially fatal complication of fat embolism syndrome. Despite this, the mean number of complications per patient was as low as 0.15 (3) and another study stated that patient satisfaction was at a remarkable 94%(4).
Why the sudden rise in demand?
The reasons behind the sharp rise in demand for stature lengthening are numerous. First and foremost, recent technological advancements have made the surgery itself safer and more reliable. Additionally, orthopaedic surgeons who do such procedures now have gained more experience in this field and are therefore better at spotting complications earlier and mitigating any long-term effects. Secondly, societal attitudes towards cosmetic procedures have improved in tandem with a rise in height prejudice in dating culture, pushing vulnerable people to view stature lengthening as a viable option. Lastly, and somewhat surprisingly, there has been a substantial rise in the number of orthopaedic surgeons marketing themselves to prospective patients for such procedures. With surgeries costing patients from anywhere around £50, 000 to upwards of £200, 000 it is easy to see how financial incentive has persuaded many orthopaedic surgeons around the world to offer these cosmetic surgeries(2).
The Wider Issue
The fact the vast majority of people seeking out these procedures are young men, speaks to a much larger issue present here. In today’s society, height is increasingly equated with attractiveness, success and power. This societal pressure, perpetuated through social media and pop culture, has instilled generational insecurity in men about their height. Indeed many patients opting for stature lengthening show the features of Body Dysmorphic Disorder (BDD). Despite some orthopaedic clinics carrying out psychological assessments of patients before going through with operations, patients who are rejected due to BDD or other psychological issues often find alternative centres with less experienced surgeons offering the service based only on the patient’s ability to pay(3).
Where do we go from here?
In conclusion, the technological advancements that have been made in this field of orthopaedics are incredible and are actively improving the lives of people all over the world who require such procedures for therapeutic treatment. However, when brought into the world of cosmetics, the waters become slightly murkier. Plagued by societal pressure and opportunistic surgeons potentially taking advantage of vulnerable patients, stature lengthening can quickly become a dangerous minefield that has the potential to cause serious debilitating injury. This is compounded by the fact that being such a new field, cosmetic leg lengthening surgeries operate completely unburdened by regulations and guidelines. Urgent action needs to be taken by medicine’s regulatory bodies to control this niche of Surgery to ensure that patient safety is kept as the priority. Greater screening procedures must be implemented to guarantee that individuals with body dysmorphia receive the proper psychological care, preventing them from having to resort to such drastic methods in the first place. Finally, in order to prevent young people from feeling insecure and worthless based on a genetic and wholly arbitrary feature, society’s standards of attractiveness around height need to be questioned and pointed out. Overall, while leg lengthening may be a huge step forward in orthopaedic surgery, whether its use in cosmetics is here to stay, only time will tell.
1 – “Gavriil Ilizarov.” Wikipedia, 6 Dec. 2022, en.wikipedia.org/wiki/Gavriil_Ilizarov.
2 – Usborne, Simon. “Would You Have Your Legs Broken to Make Yourself Taller? the Men Who Go through Hell for a Little Extra Height.” The Guardian, Guardian News and Media, 9 Nov. 2022, www.theguardian.com/lifeandstyle/2022/nov/09/would-you-have-your-legs-broken-to-make-yourself-taller-the-men-who-go-through-hell-for-a-little-extra-height.
3 – Marwan, Yousef, et al. “Cosmetic Stature Lengthening: Systematic Review of Outcomes and Complications.” Bone & Joint Research, U.S. National Library of Medicine, 8 July 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7342054/.
4 – D;, Paley. “Problems, Obstacles, and Complications of Limb Lengthening by the Ilizarov Technique.” Clinical Orthopaedics and Related Research, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/2403498/.
5 – “Precice System.” NuVasive, www.nuvasive.com/procedures/limb-lengthening/precice-system/.
6 – Barker, Joanne. “Limb-Lengthening Surgery: A Look at the Pros and Cons.” Boston Children’s Answers, 8 Aug. 2022, answers.childrenshospital.org/limb-lengthening/#:~:text=Vuillermin%3A%20Limb%20lengthening%20stimulates%20bone,to%20fill%20in%20the%20gap.