Stature lengthening is a cosmetic procedure for individuals who wish to become taller. The majority of people who seek this surgery are unhappy with their body image. Body image is the way we perceive ourselves. As it relates to height, it is the way we perceive our own height and our body proportions (limb length relative to trunk length).
Dr. Walter Windisch, a psychologist who worked with Dr. Paley for over 20 years and evaluated all his cosmetic lengthening patients between 1988 and 2008, called this condition “height dysphoria” (dysphoria literally means unhappy, the opposite of euphoria); in other words, unhappy with your height. Another term that Dr. Paley coined is “height neurosis.”
Some patients also have Body Dysmorphic Disorder. They usually also need psychological support and medication but may be candidates for this surgery. Psychiatric consultation is warranted in this group.
Height Range in Normal Adult Population
When assessing distribution of height in the population, we consider the normal bell curve. We divide people by distribution around the mean (average). Normal height is considered within 3 standard deviations (SD) from the mean. Stature below 3 SD from the mean in persons without a medical condition, such as dwarfism or growth hormone deficiency, is considered constitutional short stature. A physician defines the normal range of height between the 5th and 95th percentiles. The lower limit of so-called “normal stature” for men is 5’5” (166cm) and for women is 5’0” (153cm).
|Percentile||SD||Height Women (in.)||Height Women (cm)||Height Men (in.)||Height Men (cm)|
Relationship of Height to Height Dysphoria
While a person’s actual height is related to the condition, there is no height threshold under which you cannot suffer from height dysphoria. Most of us would assume that you could only suffer from height dysphoria if you are “short.” The problem is that the perception of who is short varies from person to person. That threshold differs along racial, national, and cultural lines; for example, 5’10” is tall in India but short in Holland.
The following anecdote illustrates the point: a gentleman flew all the way from Holland to see Dr. Paley regarding stature lengthening. He was 5’11” tall. He said that since he was a teenager he has suffered from feeling short. He is the shortest male in his family and even his sister is his height. All of his friends are much taller. He reminded Dr. Paley that the Dutch are the tallest people in the world. Although Dr. Paley is the same height as the patient, he had never considered himself as short nor had any of his family or friends. Dr. Paley therefore had difficulty considering him for stature lengthening and sent him for psychological evaluation. The psychologist’s report showed he suffered from the same body image problem as all of the other patients they had evaluated. Despite his seemingly tall height, he suffered from height dysphoria.
When Dr. Paley studied the relationship of starting height to the diagnosis of height dysphoria, he found that patients’ starting height varied from 4’10” to 5’11” for males and 4’6” to 5’8” for females. While more of the patients were at the lower end of the spectrum, the fact that some were at the upper end clearly demonstrates that height is not the primary problem. The primary problem is the psyche’s perception of height and proportion. We call this body image. Stature Dysphoria is a body image disorder. The patient perceives themselves as short irrespective of the actual height and irrespective of how others see them.
One might ask: is there a height threshold above which stature lengthening is not appropriate? Based on the above findings, the answer should be no. Dr. Paley has learned to remove his personal bias regarding height from the evaluation. It is the patient’s perception that counts. The risks of the procedure are no greater if you are taller. The risk, theoretically, should be less since the percent increase in length of a longer bone is less.
How Does Lengthening Work?
Limb lengthening works through a process called distraction osteogenesis. The bone to be lengthened (femur or tibia) is broken during surgery into two segments. The segments are slowly pulled apart, at a rate of one millimeter per day. For stature patients, the lengthening is performed by an intramedullary nail (the PRECICE) that is inserted inside the marrow cavity. New bone will form in the gap, resulting in increased length. Any faster and the bone may fail to form in the gap, muscles will become contracted, and nerves may become paralyzed; any slower and the bone will reform in the gap, a process known as premature consolidation, which halts the lengthening. For more information on how lengthening works, see Limb Lengthening Center.
Is the Procedure Painful?
Immediately after surgery, there is post-surgery pain. Most patients have epidural anesthesia or patient-controlled analgesia (PCA). Both of these methods result in excellent post-operative pain control for about two days. After that, most patients are switched to oral pain medication. After discharge, all patients receive a prescription for oral pain medication. Most patients report some post-surgical pain for the first two weeks after surgery. Once this subsides, the comfort level is greatly improved. The most painful times are during stretching exercises during physical therapy and when going to sleep. We often prescribe some medication to assist with sleeping. Most patients do not complain of much pain during the daytime. The actual lengthening of the nail is painless. Ultimately, everyone reacts to pain differently. It is important to be honest with yourself about your pain tolerance and adjust your expectations accordingly.
Will I Have Scars?
We use a minimally invasive method to implant the PRECICE device into the bones. A half-inch incision is made at the hip and 4 or 5 quarter-inch incisions are made on the side of the thigh. These scars are so small they are not very noticeable. Most look no bigger than a mosquito bite.
How Long Will I Be on Crutches?
As a quick reference: an 8 cm lengthening takes nearly three months to complete the lengthening in the femur and another two months for the bone to heal enough to allow full weight-bearing without crutches; total of 5 months. A 5 cm femoral lengthening takes nearly two months to complete the lengthening and another month to allow for full weight-bearing without crutches.
For the tibia, a 5 cm lengthening takes nearly three months to complete the lengthening and another two months until the bone is healed enough to allow for complete weight-bearing without crutches.
How Much Height Can I Gain?
Most patients desire 3 inches (7.5cm) of stature gain and some more than that. The PRECICE 2 (developed through collaboration of Ellipse with Dr. Paley) is now FDA-approved for use. The PRECICE 2 can lengthen 8cm. Patients who desire more length should consider a second lengthening of the other bone (femur first and tibia second or vice versa). The total height gain with two lengthenings is up to 14.5cm (8cm in the femurs and 6.5cm in the tibia). Tibial lengthening up to 8cm is not well-tolerated and exceeding 6.5cm can lead to more serious complications. Of course, the cost of two lengthenings is twice that of one lengthening. Although the device can go up to 8cm, not every patient can safely achieve that length. We will only allow lengthening to the tolerance of the patient’s bone and soft tissues.
The limits of lengthening are determined by the soft tissues. The risk of complications from lengthening increases with increased length. Up to 5cm is a low-risk lengthening; between 5–8 cm is medium risk; and over 8cm is high risk. For example, to achieve 10cm of lengthening, it is much safer to lengthen the femur and tibia each by 5cm than to lengthen either bone by 10cm.