I speak to Lewis the day after Rishi Sunak, who is reported to be 5ft 6in, becomes prime minister. He’s seen all the usual jokes on Twitter and elsewhere. “I think it’s one of the last prejudices that’s considered acceptable,” says Lewis. “It’s interesting that people fixate on something you can’t change… Well, at least I thought you couldn’t.” A few years ago, Lewis paid tens of thousands of pounds to a surgeon to break his legs and make them longer. He knew it would be a dangerous, painful process. But he also knew that, if all went well, he would come out of it about three inches (7.6 cm) taller. “The day before the operation I started to get very anxious,” says Lewis, who is British and prefers not to give his real name or details about the operation, including its exact cost. “But that’s what I really wanted.” The demand for cosmetic leg lengthening, also known as height lengthening, is increasing, especially among young men. Thanks to technological advances, changing attitudes toward cosmetic surgery, and growing entrepreneurship among orthopedic surgeons, clinics around the world are competing for patients. However, there is also concern about this growing industry. What does it say about a society that potentially vulnerable people are queuing up for major surgery? And what motivates the surgeons who offer it? “What’s driving it, unfortunately, is cash,” says Dr Dror Paley, a pioneering orthopedic surgeon in Florida and one of the world’s most experienced limb-lengthening specialists. He now receives half a dozen inquiries from new patients each day, up from one a day just five years ago. “For the first time, orthopedic surgeons have a piece of the plastic surgery business, but that doesn’t mean it’s done well,” he says. “In reality, patients are victimized and come to me with horrendous complications.” The operation is a remarkable feat of medical engineering – and not for the faint of heart. Techniques and devices vary. Paley’s version uses nails or rods similar to those that have long been used to stabilize bad fractures. But when it pierces the marrow cavity and pierces the nail, it also intentionally breaks the bone in half. The smart part comes after the surgery itself. A portable device placed on the leg at home creates a magnetic field. This activates a magnetic screw mechanism inside the nail, which is telescoping. At a typical rate of one millimeter per day, spread over three or four activations of a few minutes each, the nail removes the two sections of bone. The body creates new bone tissue to bridge the growing gap. X-ray of a leg lengthening procedure at a clinic in Turkey, showing the internal nails and external fixators. Photo: Wannabetaller This lengthening process takes several weeks and includes a period of relative immobility, sometimes requiring time in a wheelchair, and months of physical therapy to help the muscles adapt. Once lengthening is complete, the nail can be removed. Patients typically stretch both femurs (thigh bones) by up to 8 cm (3.1 in). The pain is apparently not from the magnetic activation, but from the combined effects of the surgery and a double broken leg. It is also possible to widen the tibia, or tibia bones, up to 5 cm (2 in). Paley, who operates on around a dozen UK patients a year, charges $95,500 (£83,000) for both femurs and up to $275,000 (£240,000) for a two-year package that extends all four leg bones for height increase of up to 16 cm (6.2 in); A handful of UK surgeons offer leg lengthening operations, charging between £50,000 and £70,000 for both femurs. Prices can drop to about half that, depending on the device used, in “cosmetic tourism” hotspots like Turkey and India. A 32-year-old American man, who prefers not to be named, wanted to expand all four leg bones to go from 5ft 8in to 6ft. He tells me he paid about $50,000 to the Wanna Be Taller clinic in Istanbul – a quarter of the price he was quoted in the US. “I was working 80-hour weeks and took out loans to pay for it,” he says. What concerns Paley is not the growing international competition, but the fact that general orthopedics are increasingly marketing themselves as specialists without the proper experience, infrastructure or awareness of complications. These can include infections, blood clots, joint dislocation and a sometimes fatal condition in which fat expelled from the rod ends up in the lungs. “You have the potential to disadvantage a patient—it has to be taken extremely seriously,” says Paley. He points out that China banned height-enhancing in 2006 after a reported string of failed attempts. A patient undergoing leg lengthening in Beijing in 2005, a year before China banned the procedure. Photo: Elizabeth Dalziel/AP Hamish Simpson, a surgeon and professor of orthopedics and trauma at the University of Edinburgh, does not offer cosmetic lengthening, but he is getting more and more inquiries from shorter people. “I almost always try to prevent them,” he says. He estimates that, even in the best hands, the risk of complications is twice that of, say, a knee replacement. Limb lengthening was never intended as a cosmetic solution. Modern techniques emerged in the early 1950s when a Soviet doctor named Gavriil Ilizarov invented an external stabilizer system for injured soldiers. Extendable pins that rest in a halo shape, attached directly to the leg. Ilizarov gained national fame in 1967 after treating Soviet champion high jumper Valeriy Brumel, but was sequestered behind the Iron Curtain until an Italian surgeon discovered his work. Dr Dror Paley in 2013. Photo: ZUMA Press Inc/Alamy In 1983, Paley, then an ambitious young secretary in his native Canada, heard about the method. “This was a whole new field of orthopedics that was being ignored,” he says. He studied the technique in Italy and Russia and began practicing in Canada in 1987, later moving to the US. The device, which was first used in the UK in 1989, was cumbersome, unsightly, painful – and revolutionary. Bone lost in accidents or infection could magically regrow, saving limbs from amputation. Children born with deformities or leg length discrepancies could escape a life of stigma and pain. People with height insecurity also showed an early interest. “My first cosmetic patient was in 1988,” says Paley. “The market has always been there.” But it remained small. Paley, who appreciates the transformation his cosmetic patients report in terms of their self-confidence and well-being, performed about 10 height extensions a year for the next two decades. The first telescoping nails arrived in the 1990s. They worked mechanically: patients twisted the tip to activate a ratcheting mechanism in the nail. The big change came in 2011 with the release of the Precice magnetic nail, which Paley helped develop and which is now owned by NuVasive, an American medical technology company. In 2018, NuVasive launched the Precice Stryde nail, which allowed patients to bear weight on their still-lengthened legs immediately after surgery. With each new development, leg lengthening looked more like a futuristic body hack than medieval torture. A doctor caring for a patient wearing the Ilizarov device, which was used in the first modern limb lengthening procedures. Photo: Svyatoslav Lypynskyy/Alamy Even the recall of the Precice Stryde nail in 2021 due to “biocompatibility” issues – which Nuvasive tells me are still being investigated – failed to dampen demand. Paley now uses the Precice 2.2 nail, which is still available in the US, and is also developing a new smartphone-connected device. All types of Precice nails remain unavailable in the UK. While the pandemic shut down clinics and tourism for months, surgeons tell me it created only limited demand as people had more time to reflect on their imperfections. Paley says that inquiries about height extension have increased from one per month in 2013 to 40 per month in 2017 – and 200 per month today. He now performs 100 cosmetic procedures a year and 84% of his patients are men. As surgeons advertise through social media and Google search results, shorter people are discovering a brave new world – and a minefield. Victor Egonu, director of a health clinic in Baltimore, has emerged as a lightning rod for their questions. The amateur bodybuilder had his leg lengthened in 2012 to correct a two-inch gap caused by a childhood skating accident. Since early 2020, he has interviewed dozens of surgeons and patients for his Cyborg 4 Life YouTube channel, which has had more than a million views. Now he receives up to 30 messages a day from prospective patients, almost all of them young men. While no one estimates the total number of surgeries performed worldwide, Egonu estimates that it is in the thousands each year and growing rapidly. He says men make up 95% of his views and that women who undergo surgery start proportionately smaller – he recently had a message from a woman in her 20s who is 140cm and is fed up of being treated like a child. Egonu wants patients to be better informed. She also wants to address a secondary stigma that faces people trying to escape height prejudice. “People say breaking your legs to get taller is barbaric and you should never do it,” he says. “But when you hear about the misery patients wake up to every day, you understand.” I’m talking to a father, who doesn’t want to be named, whose teenage son is convinced that…
