Cosmetic Stature Lengthening
Candidates: men 18-52 years old who are shorter than 5 feet 9 inches
women 18-52 years old who are shorter than 5 feet 3 inches
Initial Consultation: The first step is to make an appointment to be evaluated by the surgeon. Special x-
rays will be taken at the time of this visit. You will be examined by and have a discussion regarding stature
lengthening with the surgeon.
Scheduling Surgery: Someone from our staff will contact you to inform you whether you have been
accepted into our program. If you have been accepted, you will then be able to schedule a surgical
appointment with the surgeon’s secretary. You cannot schedule the surgery before being officially accepted
into the program
Costs: The initial consultation and surgery are not covered by insurance. You will need to pay for your initial
consultation and initial x-rays at the time of the visit. If you schedule surgery, you need to pay for it yourself
before the operation can commence. The entire cost must be paid in advance of the operation. A cost
estimate of this is available upon request. These costs do not include physical therapy, which takes place
over 3 to 5 months. Therapy can be paid for as you go; it does not have to be paid in full up front. No
refunds will be made for the initial consultation if you are not accepted into the program.
Not included: The costs estimate does not include medications, durable medical goods, equipment purchase
or rental. You will need to pay for a wheelchair, crutches and walker and possibly a commode. You will be
responsible for obtaining and paying for your own room and board after discharge from the hospital; it is not
included in these costs. Removal of the external fixator after healing or the intramedullary skeletal kinetic
distractor (ISKD) 1 year after surgery incurs an additional expense. The physician’s fee for follow-up visits
during the first ninety days is included but the cost of x-rays is not. After the ninety-day period, you will be
responsible for paying the physician’s fees as well.
Candidates: men 18-52 years old who are shorter than 5 feet 9 inches
women 18-52 years old who are shorter than 5 feet 3 inches
Initial Consultation: The first step is to make an appointment to be evaluated by the surgeon. Special x-
rays will be taken at the time of this visit. You will be examined by and have a discussion regarding stature
lengthening with the surgeon.
Scheduling Surgery: Someone from our staff will contact you to inform you whether you have been
accepted into our program. If you have been accepted, you will then be able to schedule a surgical
appointment with the surgeon’s secretary. You cannot schedule the surgery before being officially accepted
into the program
Costs: The initial consultation and surgery are not covered by insurance. You will need to pay for your initial
consultation and initial x-rays at the time of the visit. If you schedule surgery, you need to pay for it yourself
before the operation can commence. The entire cost must be paid in advance of the operation. A cost
estimate of this is available upon request. These costs do not include physical therapy, which takes place
over 3 to 5 months. Therapy can be paid for as you go; it does not have to be paid in full up front. No
refunds will be made for the initial consultation if you are not accepted into the program.
Not included: The costs estimate does not include medications, durable medical goods, equipment purchase
or rental. You will need to pay for a wheelchair, crutches and walker and possibly a commode. You will be
responsible for obtaining and paying for your own room and board after discharge from the hospital; it is not
included in these costs. Removal of the external fixator after healing or the intramedullary skeletal kinetic
distractor (ISKD) 1 year after surgery incurs an additional expense. The physician’s fee for follow-up visits
during the first ninety days is included but the cost of x-rays is not. After the ninety-day period, you will be
responsible for paying the physician’s fees as well.
Unexpected Costs: If the initial hospital stay is longer than 3 days, additional charges will apply and will be billed. If during
lengthening, complications arise that require additional surgery, this will add unexpected expenses. Unplanned surgery occurs in
approximately 25% of the cases. The cost of treatment for complications is not covered by insurance because it is a result of
cosmetic limb lengthening.
Methods:
1) The ISKD implantable limb lengthening device is an intramedullary telescopic rod (nail) that is inserted through a very small
incision and is fixed with four screws to the bone. Movements of the leg during activities of daily living activate lengthening. A
digital magnetic monitor is used to make sure that lengthening does not occur too slowly or too quickly. The activity level is
adjusted to the rate of lengthening.
Which Bones: We usually start with lengthening of both femora (thigh bones). Two femoral ISKDs are inserted during one
surgery. The total lengthening amount is 2 inches (5 cm). If you want to gain an additional 2 inches (5 cm), both tibiae can be
lengthened at a separate surgery 6 or more months later. This requires inserting two tibial ISKDs. The 5 cm limitation is not
negotiable. This is because lengthenings over 5 cm have much higher complication rates.
After-treatment: Expect to be in the hospital for 3 days after surgery. If problems occur, your hospital stay might be longer.
Please note that the hospitalization cost is based on a three day stay. A surcharge is billed for longer stays. Next, you begin
daily physical therapy as an outpatient. After surgery you need to be seen by your surgeon every 2 weeks. I prefer that you
remain in the area during the lengthening process; however, if you cannot, you still must come to to see me every 2 weeks for
follow-up visits. These include clinical examinations and x-rays. After you complete the lengthening (average rate, 1 mm/day or
3 cm/month; this may go faster or slower), you need to be seen 3 months later, then 3 months after that, and then 6 months
after that. Your local physician cannot do these follow-ups. During lengthening, you will not be able to walk. You will be in a
wheelchair and will be allowed weight bearing for transferring from chair to bed or bed to chair only. Even after the lengthening is
completed, you cannot bear weight right away. You will have to wait until the x-rays show that the bone is sufficiently healed to
permit full weight bearing. This usually takes 1 or 2 months after the lengthening stops but can take longer in some cases. If
the bone does not heal, bone grafting will be required, but this is not common. Regardless of where you are staying, it is helpful
to have the help of a caregiver. If family or friends are not available to help, this type of service can be hired.
Complications: Many potential complications are associated with limb lengthening. These will be discussed with you in detail
during your evaluation and again during your pre-operative visit. The main risks come from lengthening too quickly or too
slowly. The ISKD can lengthen faster than desired. If this occurs, activities need to be decreased and a brace might be used.
The maximum amount of lengthening allowed per bone is 2 inches. Therefore, the lengthening process will stop automatically
when 2 inches have been gained. Fast lengthening usually is well tolerated and usually has no associated complications.
However, in some cases, the bone might fail to heal completely and bone graft surgery might then be required. Lengthening that
occurs too quickly can also irritate and stretch the nerves and occasionally requires minor surgery to decompress a nerve. It can
also lead to tight muscles and tendons and might require tendon-lengthening surgery. These problems are unlikely in most
cases but should they occur they can be usually be corrected by surgery. The opposite can also occur: distracting too slowly.
Lengthening that occurs too slowly can lead to premature bone healing. If this happens, additional surgery is needed to
re-break the bone(s).
Results: The majority of our ISKD patients achieve excellent results without significant complications. Those who do experience
complications usually achieve excellent outcomes as long as the complications are recognized and treated promptly. To date, all
our patients who have undergone cosmetic stature lengthening have been able to return to normal function, including sports
activities, by 1 or 2 years after the lengthening(s).
2) Lengthening of both femurs and both tibias with external fixation
I recommend this method when a patient will not accept only 2 inches of lengthening and does not want to undergo two
lengthening surgeries. This method allows up to 4 inches of lengthening (two inches in each bone) and gives more normal
proportions. The down side is the need to wear external fixators for a long time. The advantage is better lengthening rate
control and more normal proportions.
After-treatment: Lengthening proceeds at ¾ mm per day in each bone. Visits are every two weeks and PT is daily. After the
length desired is achieved the patient sends xrays every month. One the bone is healed the device can be removed under
anesthesia. After removal one must use a wheelchair again for a month before resuming full weight bearing and physical
therapy. Gradual return to normal function proceeds. For a two inch lengthening of a bone the devices are in place for about
5-7.5 months.
lengthening, complications arise that require additional surgery, this will add unexpected expenses. Unplanned surgery occurs in
approximately 25% of the cases. The cost of treatment for complications is not covered by insurance because it is a result of
cosmetic limb lengthening.
Methods:
1) The ISKD implantable limb lengthening device is an intramedullary telescopic rod (nail) that is inserted through a very small
incision and is fixed with four screws to the bone. Movements of the leg during activities of daily living activate lengthening. A
digital magnetic monitor is used to make sure that lengthening does not occur too slowly or too quickly. The activity level is
adjusted to the rate of lengthening.
Which Bones: We usually start with lengthening of both femora (thigh bones). Two femoral ISKDs are inserted during one
surgery. The total lengthening amount is 2 inches (5 cm). If you want to gain an additional 2 inches (5 cm), both tibiae can be
lengthened at a separate surgery 6 or more months later. This requires inserting two tibial ISKDs. The 5 cm limitation is not
negotiable. This is because lengthenings over 5 cm have much higher complication rates.
After-treatment: Expect to be in the hospital for 3 days after surgery. If problems occur, your hospital stay might be longer.
Please note that the hospitalization cost is based on a three day stay. A surcharge is billed for longer stays. Next, you begin
daily physical therapy as an outpatient. After surgery you need to be seen by your surgeon every 2 weeks. I prefer that you
remain in the area during the lengthening process; however, if you cannot, you still must come to to see me every 2 weeks for
follow-up visits. These include clinical examinations and x-rays. After you complete the lengthening (average rate, 1 mm/day or
3 cm/month; this may go faster or slower), you need to be seen 3 months later, then 3 months after that, and then 6 months
after that. Your local physician cannot do these follow-ups. During lengthening, you will not be able to walk. You will be in a
wheelchair and will be allowed weight bearing for transferring from chair to bed or bed to chair only. Even after the lengthening is
completed, you cannot bear weight right away. You will have to wait until the x-rays show that the bone is sufficiently healed to
permit full weight bearing. This usually takes 1 or 2 months after the lengthening stops but can take longer in some cases. If
the bone does not heal, bone grafting will be required, but this is not common. Regardless of where you are staying, it is helpful
to have the help of a caregiver. If family or friends are not available to help, this type of service can be hired.
Complications: Many potential complications are associated with limb lengthening. These will be discussed with you in detail
during your evaluation and again during your pre-operative visit. The main risks come from lengthening too quickly or too
slowly. The ISKD can lengthen faster than desired. If this occurs, activities need to be decreased and a brace might be used.
The maximum amount of lengthening allowed per bone is 2 inches. Therefore, the lengthening process will stop automatically
when 2 inches have been gained. Fast lengthening usually is well tolerated and usually has no associated complications.
However, in some cases, the bone might fail to heal completely and bone graft surgery might then be required. Lengthening that
occurs too quickly can also irritate and stretch the nerves and occasionally requires minor surgery to decompress a nerve. It can
also lead to tight muscles and tendons and might require tendon-lengthening surgery. These problems are unlikely in most
cases but should they occur they can be usually be corrected by surgery. The opposite can also occur: distracting too slowly.
Lengthening that occurs too slowly can lead to premature bone healing. If this happens, additional surgery is needed to
re-break the bone(s).
Results: The majority of our ISKD patients achieve excellent results without significant complications. Those who do experience
complications usually achieve excellent outcomes as long as the complications are recognized and treated promptly. To date, all
our patients who have undergone cosmetic stature lengthening have been able to return to normal function, including sports
activities, by 1 or 2 years after the lengthening(s).
2) Lengthening of both femurs and both tibias with external fixation
I recommend this method when a patient will not accept only 2 inches of lengthening and does not want to undergo two
lengthening surgeries. This method allows up to 4 inches of lengthening (two inches in each bone) and gives more normal
proportions. The down side is the need to wear external fixators for a long time. The advantage is better lengthening rate
control and more normal proportions.
After-treatment: Lengthening proceeds at ¾ mm per day in each bone. Visits are every two weeks and PT is daily. After the
length desired is achieved the patient sends xrays every month. One the bone is healed the device can be removed under
anesthesia. After removal one must use a wheelchair again for a month before resuming full weight bearing and physical
therapy. Gradual return to normal function proceeds. For a two inch lengthening of a bone the devices are in place for about
5-7.5 months.
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Limb Lengthening.us
Dror Paley, MD, FRCSC
Dror Paley, MD, FRCSC
| ORTHOPEDIC EDUCATIONAL SITE BY THE MOST EXPERIENCED LIMB LENGTHENING SURGEON IN THE WORLD |
