Once the natural growing process is complete, as it was in Kadakia by age 16, human growth hormone cannot be used and surgery becomes the only option. With intense pain, months of grueling recovery and physical therapy, and the risk of complications and decreased function, this option is truly only for those determined to be taller.
The external approach used on Kadakia and an internal one that involves a telescoping rod both work by "breaking the bone and pulling it apart about a millimeter a day. Bone is a living substance so as you pull apart, it makes new bone to fill in the gap. As long as you go slowly, the limb will lengthen safely," Paley says.
The majority of Paley's patients are those who have a leg length difference or other deformity that can be corrected by leg lengthening. For the small percentage of people who see him for cosmetic reasons, "I can't improve their function like in others. The improvement that we get with these patients is purely body image."
The increasing popularity in cosmetic lengthening, and its hefty price tag, has spawned many less-than-qualified surgical centers throughout the world that can often leave patients much worse off than when they started, Paley warns.
"Lengthening is a very dangerous thing to do unless you're very experienced with it," he says, noting that many patients come to him to fix the disastrous results of procedures done elsewhere.
For Kadakia, the procedure was a success and today he is fully recovered and stands 5'6", same as his dad.
The pain and long recovery was worth it, he says, and he would do it all again. He missed the first semester of college due to the procedure and after some complications barely made it to the second semester, still unable to walk at that point.
"People say that you change a lot in college, but I'm pretty sure the biggest change in my life was during my recovery time. I was short, but I wasn't a dwarf. When you see other patients around you who actually have genetic problems, it makes you appreciate what you have," he says.
One year away from his M.D., Kadakia said he is considering specializing in orthopedic surgery "just like Dr. Paley," though he hasn't decided quite yet.