The long and the short of it: what is leg-lengthening?

Leg-lengthening is a form of surgery traditionally recommended for individuals (especially children) as a way of addressing limb length discrepancies. However, it has received recent media attention due to its cosmetic use: namely, as a way of obtaining several inches of additional height for primarily male clientele. The practice is controversial due to the ways that it could potentially exploit what is being termed "height dysphoria": disproportionate feelings of anxiety, shame and neurosis related to feelings of not being tall enough.

Cosmetic leg-lengthening involves fracturing the femur bones by drilling a hole in each and inserting a metal rod, which is slowly lengthened over time, and then leaving the bones to heal. The surgery is expensive, associated with elevated levels of pain and requires patients to learn to walk again after the procedure through extensive physiotherapy. To learn more about what this process is like, what motivates it, and what the risks are, journalist Patrick Heardman speaks to Callum, someone who underwent the procedure, as well as a surgeon who has carried out the surgery on numerous occasions.*

It’s Friday evening, Callum* is getting ready for a night on the town with his friends. But something that happened a few days earlier is irritating him. His company had organised a team-bonding social so they could get to know each other a little better. Like many people since the coronavirus pandemic, he’s only interacted with some of his colleagues online, via email, Slack, or video call. This was a chance for them to meet in person. But a comment from one of his co-workers caught Callum off guard: “It’s crazy how you can’t tell a person’s height from Zoom calls”.

“He was taller than me,” Callum says, “and it was obvious that he really meant; ‘I thought you’d be taller’.” With these words reverberating inside his head, Callum looked down at his Timberland boots, stuffed with high-platform insoles, and thought to himself; “Enough is enough." Almost immediately, Callum messaged Live Life Taller, a limb-lengthening clinic in Turkey. He recalls feeling reassured by the numerous patient testimonies on their Instagram page, giving him confidence to go ahead with their surgery. Soon after, he booked a flight to Istanbul for the following month.

Limb-lengthening, or leg-lengthening is a surgical procedure that can increase your height. While there are no official stats, there appears to be an increasing number of anecdotal stories of patients – predominantly young men – who are choosing to go under the knife in the pursuit of a few extra inches. The origin of leg-lengthening, however, lies in medical necessity rather than aesthetics. It was pioneered by Gavriil Ilizarov, a Soviet doctor tasked with caring for wounded soldiers returning from the Second World War. His discovery that you could intentionally sever a human bone, pull the two halves apart by a few centimetres via an external apparatus, and allow them to bond back together, earned him the nickname "the magician from Kurgan".

Not long after treating Valeriy Brumel, the 1964 Olympic high-jump champion who injured his leg in a motorcycle accident, Ilizarov would go on to achieve international renown in 1980 for successfully operating on Italian mountaineer and photojournalist Carlo Mauri. The Italian’s tibia, which he fractured in a skiing accident, had healed incorrectly, and European doctors were unable to help him. Ilizarov, however, was able to correct this by slightly lengthening the leg.

Technology has moved on since then, however, and the more modern LON (Lengthening Over Nail) method is the preferred limb-lengthening technique used today. Similar to the Ilizarov method, the LON procedure uses an external fixator, but it also makes use of an internal rod inserted in the bone marrow. Screws on the external apparatus are turned by the patient four times a day for 80 days, allowing them to manually stretch their own legs by roughly 1mm every 24 hours, with a maximum height increase of around 8cm. There is also the much more expensive Precice 2 method which uses an internal magnetic rod that is lengthened using a remote control device.

There are only a handful of clinics offering these procedures in the UK and the costs can run into the tens or even hundreds of thousands of pounds. As a result of the cost associated with the procedure, people are turning to clinics in Turkey offering less expensive services. That’s exactly what Callum decided to do when he contacted Live Life Taller.

It seems like an extreme action – enduring painful surgery, months of rehab, physiotherapy and even gambling with the prospect of losing the use of your legs – just to be slightly taller. And, at 5’9 Callum was already the exact height of the average British man. However, throughout his life he felt like this wasn’t enough. “Even at that height I felt inferior,” he says. “A sense of nothing being enough loomed over me daily. I would stand in the mirror after a night out, take my shoes off and feel my entire confidence disappear as I stood 5’ 9” barefoot. I was afraid to take off my shoes anywhere, even in my own home if somebody was visiting,” Callum recalls.

After learning about limb-lengthening, he couldn’t get the idea out of his mind. “I told my ex girlfriend about it in passing one day and she was worried about the surgery going wrong, but even the fear of paralysis didn’t scare me if it meant not having to wear boots and insoles on a night out to feel good.”

“We tell people ‘don’t focus on what you can’t change,” he says. “Well, I took that advice and focused on what I can change, and with the right amount of money and time, that was my height.”

For Callum, the right amount of money was 25,000 euros, plus a 3% processing fee. A huge sum of money to manually lengthen your leg bones using a large nail, but only a fraction of the amount he could have paid for either the Precice method, or for surgery in a UK clinic. Callum paid in crypto, and flew to Turkey.

Two days after his surgery, a nurse from the clinic’s limb-lengthening team gave him a walker. “Walking without a nurse helping you is pretty much impossible in the first few days,” he says. “It’s a difficult process and you will feel light-headed trying to walk, usually to the point you need to sit down.” Due to inflammation, your legs will also be considerably larger than they were before. “You will realise how subconscious walking was previously, because after the surgery you have to train your brain again to make the connection to your legs.”

“Yes, lengthening surgeries require a certain preparation, both physically and psychologically,” says Professor Muharrem Inan of Fix the Height, a veteran limb-lengthening surgeon who has performed the operation in Turkey since 2001. “With determination, psychological preparation, physical fitness and patience, satisfactory results can be achieved.”

Originally, the majority of Professor Inan’s operations were for correcting “deformities”, but the balance started to swing in favour of cosmetic surgeries over the years, accelerating significantly since 2015. Demand increased further following the pandemic due to lockdown backlogs and an increase in the international promotion of Turkish clinics for this procedure. “In the post-pandemic period, Turkey is strengthening its place among the top five most active countries in the international market,” Professor Inan says. “We have around 15-17 active clients every day and 60% of them apply from the UK.”

After an initial 2-4 days of “not trusting” his legs, Callum found he needed to utilise most of his upper body strength to support himself with the walker – the only way he could move around for the next few months. After a week in hospital attached to a catheter, he moved to a rehab centre. “This is the stage where you start to lengthen,” he says.

Helped by a cocktail of seven different painkillers, Callum started daily physiotherapy to offset the “extreme amount of pain” caused by manually cranking his leg bones apart. During this period of rehabilitation, which lasts between 6 and 12 weeks, he remembers “screaming from muscle pain” as his thighs ached under the pressure the apparatus fixed to his leg. “Sleeping on my back was impossible as I had two big metal fixators on my side. Sleeping on my front was also impossible most nights as the pain of the pressure of my quads simply lying on the bed was too much.”

“Diet is also extremely crucial,” Callum adds. “You need to eat like you’re an actor training for a Marvel movie and you’re the main character.”

Callum has now been back in the UK for around a month and his recovery is going well. Despite the painful journey, he seems relatively happy with the outcome. He is still taking daily blood-thinning medication, a host of painkillers, and experiences some nerve pain, but is recovering well. “I can walk now without crutches but it will definitely take another 3 to 6 months until it’s somewhat normal in speed and gait.”

But is this exactly how he hoped things would turn out? “I would have liked to be 6’ 1” however the pain was too much for me so I stopped at 6’ 0”. But I no longer have in-sole shoe anxiety and started wearing normal non-platform shoes again. So I am extremely happy with the result.”

*Name has been changed.

Leg-lengthening is a serious, time-consuming and expensive procedure. While this is yet to be implemented, researchers have recommended pre-operative counselling to allow patients to fully understand the risks associated with the procedure. Due to the need for repeated follow-ups and elevated likelihood of the necessity of reinterventions to address soft tissue and bone complications, ensure that you know the risks and that any clinic you use also includes aftercare and follow-up services.

While height dysphoria is not yet fully recognised as a mental health condition in its own right, individuals who are struggling with extreme insecurity related to their height, particularly if it is negatively impacting their life, should make an appointment with their GP to assess whether a diagnosis of body dysmorphia and related treatment would be of help to them.