Lengthening Surgeries in 10 Steps

Limp Lengthening Surgery: Understanding the Procedures, Candidates, and Considerations 

Orthopedics and Traumatology Specialist Serkan Gürcan MD answers frequently asked questions about height increase surgery. 

1. Why Do People Want to Increase Height?

The active use of social media, changes in global trends, visual materials, and technological advancements have significantly increased mutual interaction among people today. This, in turn, has heightened people's desires for more admiration, acceptance, and elevated social status.

The desire for self-acceptance as an individual over time also increases visual expectations. Although aesthetic and beauty perceptions have changed over centuries, the desire for self-approval and social acceptance persists. These expectations are independent of gender. 

2. Who Undergoes Height Increase Surgery?

Height increase surgeries can be categorized into three main groups: 

- The first group includes patients with single-leg, arm, or finger shortening due to various reasons such as congenital anomalies, accidents, bone infections, tumors, and relative shortening due to bone deformities. 

- The second group involves individuals with congenital dwarfism, with the most common cause being achondroplasia. This condition can also occur due to growth hormone deficiencies. Generally, men cannot exceed a height of 135 cm, and women cannot exceed 130 cm.

Treatment for these patients should ideally start around the age of 5-6, and second-stage surgeries are performed around the age of 10-12, with some cases requiring a third-stage surgery.

The maximum extension achievable is around 20-25 cm. In adults, deformity correction and lengthening surgeries can be performed in the same session. 

- The third group consists of individuals seeking cosmetic height increase surgeries. According to the Turkish Statistical Institute (TUIK), the average height in Turkey is approximately 172.6 cm for men and 161.4 cm for women as of 2010.

Cosmetic height increase surgeries are performed on individuals with heights below these averages, and whose growth plates are closed with no expectation of natural growth. 

3. How to Prepare for Height Increase Surgeries?

In patients presenting with short stature, general health status, bone quality, and age, depending on the openness of growth plates, should be assessed.

In children and patients with open growth plates, the causes of short stature should be investigated, and appropriate treatments should be carried out in coordination with relevant branches if necessary.

Individuals with closed growth plates seeking cosmetic lengthening should consult with a specialized psychologist. 

4. How are Height Increase Surgeries Performed?

Height increase or shortening surgeries are now more common and less problematic due to recent technological and medical advancements. The bones to be lengthened are carefully cut, and controlled extension is achieved by gradually opening them about 1 mm per day. 

There are three main techniques for lengthening surgeries used in Turkey, as in all developed countries: 

1. External Fixation-Assisted Lengthening:

- This can be performed with two basic lengthening devices.

- The first one is the Ilizarov External Fixator, known as the ring extension device, developed by Russian physician Gavriil Abramovich Ilizarov in the 1950s.

- The second external fixation method is the Monolateral External Fixator, which is a more refined version of Ilizarov and is widely used due to its advantages in terms of patient compliance. 

2. Closed System Lengthening (Precice, Fitbone):

- This method, known as the closed method, is performed by placing a nail with a motor or magnetic lengthening device into the bone's medullary cavity.

- The lengthening process is controlled by an external device, allowing for precise adjustment. 

3. Combined System Lengthening:

- This method combines the advantages of both closed and external systems, aiming to provide the patient with an earlier release from external devices and a more stable lengthening process. 

5. How Much Can You Grow with Height Increase Surgeries?

While theoretically it is possible to lengthen up to 80% of the bone to be extended, practical limitations exist due to restrictions imposed by muscles, nerves, and blood vessels. 

- In children, starting around the age of 5-6 and undergoing 2-3 surgical sessions, it is possible to achieve an extension of up to 20-25 cm.

- In adults, a single session can result in an average extension of 4-8 cm, while in those requiring two sessions, an extension of approximately 10-16 cm can be achieved. 

6. How Long Does the Lengthening Process Take?

Regardless of the method used, the lengthening process begins after a rest period of 7-10 days. Daily lengthening is applied at a rate of 1 mm per day, and the process continues for approximately 60 days for a 5 cm extension. The maturation of the newly formed bone takes about one year. 

7. How Long Can Lengthening Devices Be Removed?

The fundamental difference in lengthening methods lies in the duration of visible extension device removal. 

In external methods (lengthening with an external fixator), this duration is approximately 4-5 times the lengthening period. 

For the combined method, the duration is between 4-5 months due to the load-bearing capacity of the internal nail. Closed methods do not involve an external device.
 

TABLE: Average treatment durations for 5 cm lengthening. 

*In closed methods, since the device cannot bear the load for cosmetic lengthenings, sides are done separately, doubling the time. 

As the system is beneath the skin, removal is not considered. The specified time is the required duration for the second side, and overall lengthening is completed in 120 days. 

8. Can Lengthening Surgeries be Performed on Other Parts Than Legs?

In selected cases with suitable conditions, lengthening surgeries for discrepancies in arms, fingers, and toes can be successfully conducted. 

9. How Long is the Hospital Stay?

The hospital stay is approximately 5 days. During this period, patients are taught basic wound care, the use of lengthening devices, walking and joint movements, strengthening exercises, sitting and standing exercises, pain management methods, and personal hygiene. 

Psychological support is provided, aiming to equip patients with essential skills for independent living. 

Patients coming from out of town are advised not to leave the city for 10 days. 

In the subsequent process, weekly follow-up X-rays are sufficient. 

Professional physical therapy should start in the 4th week after the beginning of lengthening. In closed methods, unilateral application is necessary due to the inability to bear weight during lengthening. 

Once lengthening is complete, full weight-bearing is possible for walking. 

In other methods, full weight-bearing for walking is possible from the day after the surgery. Since the newly formed bone fully matures in approximately 1 year, engaging in demanding sports should begin after this period. 

Swimming, cycling, walking, and low-intensity running are permissible. 

10. Are There Risks in Lengthening Surgeries?

Fundamentally, the risks of these surgeries can be examined in two main categories. 

The first includes risks related to the chosen anesthesia method. These surgeries can be performed with spinal-epidural anesthesia or general anesthesia, depending on the patient's preference and overall health. 

Postoperative risks include pain, bleeding, infection, joint stiffness, thrombosis (thromboembolism), and delayed union. 

These risks have significantly decreased in parallel with current technological and medical advancements. 

The use of painkillers, appropriate antibiotic applications, conscientious consumption of minimally risky blood thinners, early movement and walking exercises, balanced nutrition, and personal hygiene have reduced these risks to almost negligible levels.