Short Stature Individuals without a Medical Diagnosis of Dwarfism (Cosmetic Stature Lengthening)
Some otherwise healthy, non-dwarf individuals are unhappy with their height, to the point that they are concerned and even psychologically distressed about being short. For these unusual situations, we offer bilateral simultaneous leg elongation—where both legs are lengthened at the same time. At the International Center for Limb Lengthening, Dr. Janet Conway, Dr. Michael Assayag, and Dr. John Herzenberg perform cosmetic stature lengthening procedures for this special population. There are many potential risks, so it is reserved for those few individuals who are suffering from profound psychological pain related to their short stature. The process is expensive, time consuming and not covered by medical insurance. Candidates for cosmetic stature lengthening must be fully informed, highly motivated and financially able.
Who is a candidate for cosmetic stature lengthening?
To be considered, you must be at least 18 years of age. All candidates should be psychologically stable and have the support of their family. We do not set specific initial height requirements, because we assess individuals on a case-by-case basis.
Is cosmetic stature lengthening covered by medical insurance?
The initial consultation, hospitalization, surgery, physiotherapy and follow-up care are not covered by insurance. The patient must be prepared to pay the full cost of all treatments, as well as any secondary treatments that may result from complications.
How much height can I gain?
The total recommended lengthening is 2-3 inches (5-8 cm) in the thigh bone (femur). Lengthening more than 3 inches in one bone is associated with higher complication rates. If desired, another entirely separate lengthening procedure can be performed one year later in the shin bones (tibiae) to gain an additional 2 inches (5 cm) of height.
What happens during the initial consultation?
The first step is to make an appointment with Dr. Conway, Dr. Assayag, or Dr. Herzenberg for a thorough evaluation. At this visit, the doctor will examine you and have a frank and detailed discussion about stature lengthening. You will have at least two X-rays taken at this time.
How do I schedule the surgery?
After your initial evaluation with our doctors, and with their agreement, you can schedule the surgical appointment for the surgery with the doctors’ surgical scheduler. Payment is required before actually undergoing the surgery.
Which bones will be lengthened?
For an overview of the limb lengthening process, click here. We recommend simultaneous lengthening of both femur (thigh) bones. Two femoral PRECICE internal devices are inserted during one surgery. The total recommended lengthening amount is 2-3 inches (5-8 cm). Lengthening more than 3 inches is associated with higher complication rates. If desired, another entirely separate lengthening procedure can be performed one year later in the tibia (shin) bones to gain an additional 2 inches (5 cm) of height.
How do you lengthen the bones and soft tissues?
The bone is cut through a 1-cm (<0.5-inch) incision. The PRECICE (NuVasive) telescopic internal lengthening nail, our current preferred device for stature lengthening, is inserted into the marrow of the bone and is fixed to the upper and lower part of the bone with screws. Unlike previous devices, the PRECICE is accurate and controllable. It can even be programmed to go in reverse to compress the bone, if needed, to help speed healing. Some of our surgeons at the International Center for Limb Lengthening were on the original surgeon design team of this device, and we have implanted over 400 PRECICE nails as of February 2019.
Procedures may also be performed to prevent nerve problems and to help the patient gain full range of motion during physical therapy. These procedures include peroneal nerve decompression, injection of Botox into the thigh muscles and fascia lata release.
Five to seven days after surgery, you will begin the lengthening process. The PRECICE is a telescopic rod that contains a miniature magnetic motor. The magnetic motor is activated by applying a magnetic field generator to your thigh, called an ERC (External Remote Controller). When the motor is activated, the telescopic rod lengthens, which lengthens the bone and soft tissues. The magnetic field generator can be applied two to four times per day, to lengthen a total amount of up to 1 mm per day. Most people do not experience pain when the magnetic field generator is applied.
What happens after the initial surgery?
Expect to be in the hospital for three days after surgery. If problems occur, your hospital stay might be longer. You will start physical therapy while you are in the hospital and continue physical therapy throughout the entire lengthening process. Physical therapy is critical to a successful lengthening.
You will need to come to our clinic five to seven days after surgery to learn how to lengthen the PRECICE rod. During this visit, you will be trained how to use the magnetic motor, called the external remote controller or ERC, to lengthen the PRECICE rod. After training, you will be able to take the ERC home and use it to lengthen the rod several times a day.
During the lengthening process, you will need to be seen by your surgeon in the clinic every 2 weeks for X-rays and a physical examination. Be advised to limit your weight bearing. You will be prescribed a wheelchair to make it easier to traverse long distances. We have available a newer version of the PRECICE nail, the so-called ”STRYDE” nail, which permits full weight bearing, even in the early phases of treatment. During the 2 week visits, X-rays are made to gauge the bone healing. Based on the X-rays, we may speed up or slow down the rate of distraction.
Where can I stay during the lengthening process?
We have relatively inexpensive housing available right on the campus of Sinai Hospital at the Hackerman-Patz House to make this easier for you. It is required that you have an adult caregiver (relative, friend, significant other) stay with you at the Hackerman-Patz House. If family or friends are not available to help, this type of service can be hired.
What happens after I complete the lengthening process?
After you complete the lengthening process, you will need to see our doctors at the following points during your recovery: one, two, three, six and 12 months after lengthening. In some cases, your local physician cannot handle these follow-up examinations.
After the lengthening is completed, the bone must fill in and solidify. You will have to wait until the X-rays show that the bones are sufficiently healed to permit full weight bearing, unless we have implanted a STRYDE version of the PRECICE nail, which permits nearly full weight bearing. Full healing, to the point of allowing sports participation can take longer. In rare cases where the bone does not heal, bone grafting (additional surgery) may be required.
Approximately one year after lengthening, you can undergo surgery to remove the PRECICE. Removal is recommended, as the PRECICE nail contains a magnet inside which would otherwise preclude you from getting an MRI scan in the future.
What are the potential complications?
Many potential complications are associated with limb lengthening. These will be discussed with you in detail during your initial consultation and again during your pre-surgical visit. They include nonunion, leg length discrepancy, nerve stretch injury, muscle/tendon contracture leading to stiff joints and joint arthritis. Medical complications can include deep vein thrombosis and fat embolism. In rare cases, the bone might fail to heal completely and bone graft surgery might be required. A nerve may become too stretched, which occasionally requires surgery to decompress the nerve. Tight muscles and tendons might require tendon-lengthening surgery. These problems are unlikely in most cases, but, should they occur, they can be corrected by surgery. Lengthening that occurs too slowly or failure to place the magnetic field generator directly over the internal magnet in the PRECICE can lead to premature bone healing. If this happens, additional surgery is needed to re-cut the bone to allow the lengthening process to continue.
What results have we seen after cosmetic limb lengthening?
The majority of our patients achieve satisfactory results without significant complications. Those who do experience complications usually achieve good outcomes as long as the complications are recognized and treated promptly. It is a lengthy rehabilitation process, and it can take up to one or even two years until full recovery and return to normal function is achieved, including sports activities.
In summary, cosmetic stature lengthening is a challenging, expensive and arduous process. However, for a small group of carefully screened patients, the psychological benefits are worthwhile.
Why come to the International Center for Limb Lengthening for cosmetic stature lengthening?
Limb lengthening is a complex processes. The International Center for Limb Lengthening is the most experienced center for limb lengthening in North America. Our patients have come from over 60 countries and six continents to receive comprehensive orthopedic treatment by our world-renowned team. Your doctor will take the time to make sure you understand all of your options and then will customize your treatment to meet your specific needs. Our patients benefit from our team-centered approach with expert orthopedic surgeons and specialized physician assistants, nurses and physical therapists. We help patients who undergo cosmetic stature lengthening achieve their best possible result.