Cosmetic Stature Lengthening (for short individuals who do NOT have a medical diagnosis of “dwarfism”)
A small number of otherwise healthy, non-dwarf individuals are not happy with their height, to the point that they are psychologically distressed and continually bothered by this issue. For these unusual situations, we offer bilateral simultaneous leg elongation. In our group, Dr. Janet Conway performs all stature lengthening procedures for this special population. We do not encourage this procedure, as there are many potential risks. 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 may result in medical complications. Because of these factors, not every interested person is eligible. We determine eligibility on a case-by-case basis.
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To be considered, men must be at least 18 years of age and women must be at least 17 years of age. All candidates must undergo a psychological evaluation with our consultant psychologist before being accepted as a candidate for the procedure. We do not set specific initial height requirements because we assess individuals on a case-by-case basis.
The initial consultation, psychological evaluation, 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.
The total recommended lengthening is 2 inches (5 cm) in the thigh bone (femur). Lengthening more than 2 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.
The first step is to make an appointment with Dr. Conway for a thorough evaluation. At this visit, Dr. Conway 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. If you choose to pursue this treatment, you will need to undergo a psychological evaluation before scheduling surgery.
Before being accepted as a candidate for cosmetic stature lengthening, you need to undergo a psychological evaluation. The evaluation must be conducted by our consultant psychologist, who understands the emotional effects of this procedure. The psychological evaluation consists of an in-depth, clinical interview and a battery of psychological tests. The psychological evaluation requires one full day or two half-days to complete. Once the psychological evaluation has been completed and the results have been shared with Dr. Conway, you will be informed about whether you have been approved for limb lengthening treatment. This process takes approximately two or more weeks after the evaluation.
Our staff will contact you to inform you whether or not you have been accepted into our program. If you have been accepted, you will then be able to schedule a pre-surgical appointment with Dr. Conway's secretary. You cannot schedule the surgical appointment or the surgery until you have been officially accepted into the program.
We recommend simultaneous lengthening of both thigh bones (i.e., femora). Two femoral Precice devices are inserted during one surgery. The total recommended lengthening amount is 2 inches (5 cm). Lengthening more than 2 inches 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.
The bone is cut through a 1-cm (<0.5-inch) incision. The Precice (Ellipse Technologies), 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 other 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.
Procedures are also 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. 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.
Expect to be in the hospital for three days after surgery. If problems occur, your hospital stay might be longer. Please note that the cost estimate that is listed above is based on a three-day stay; a surcharge is billed for longer stays.
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 1 to 2 weeks for x-rays and a physical examination. During lengthening, you will not be able to walk. You will be in a wheelchair and will be allowed weight bearing only for transferring from chair to bed or bed to chair.
We have relatively inexpensive housing available on the campus of Sinai Hospital (Hackerman Patz House) to make this easier for you. It is absolutely essential 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. Visit http://www.thehackermanpatzhouse.com for more information about the Hackerman-Patz House.
After you complete the lengthening process, you will need to see a doctor at the following points during your recovery: one, two, three, six and 12 months after lengthening. Your local physician cannot handle these follow-up examinations.
Even after the lengthening is completed, you cannot bear weight right away. You will have to wait until the x-rays show that the bones are sufficiently healed to permit full weight bearing. This usually takes one or two months after the lengthening stops but can take longer in some cases. If 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.
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. In some 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 usually 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(s).
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 two years until full recovery and return to normal function is achieved, including sports activities.
In summary, cosmetic stature lengthening is a difficult, expensive, and arduous process. We discourage our patients from choosing this route. However, for a small group of carefully screened patients, the psychological benefits can be worthwhile.