Tall Order for Leg Lengthening Surgeons

When John entered the hospital in southern Russia two weeks ago, he was a healthy, athletic 29-year-old. But for the next nine months he will be struggling just to walk. When he leaves the hospital he hopes to walk out a new man, or at least one that is over three inches taller.

John has elected to undergo a controversial and painful procedure because he wants to be taller. His legs will remain broken on purpose for up to four months while doctors work to lengthen the bones. Then John will have to spend another four to five months recuperating in the hospital. He will essentially have to learn to walk again.

"Right now I feel good," he said by phone 10 days after doctors broke his legs to begin the process.

"The first few days were pretty bad," he admitted. "Now it hurts, but it's tolerable."

John traveled thousands of miles from his home in New York to the Center for Anthropometrical (Orthopedical) Cosmetology and Correction in the Russian city of Volgograd for the surgery. He's one of a small, but apparently growing, number of medical tourists traveling to Russia for this procedure, which is banned in some countries and both rare and costly in the United States.

John (not his real name, which he asked not be revealed because he hasn't told anyone but his mother what he is doing) can now walk slowly with a walker although his lower leg is swollen to about "double" its normal size. But his biggest obstacle has been inside his own head.

"You become handicapped from day to night, so that's also a challenge psychologically," he said. "You start doubting what you are doing."

"I was a normal person, completely healthy. There was no reason to do this. So these thoughts get into your head," he said.

John is currently 5-foot-5 and wants to add 8.5 centimeters, or about 3.3 inches, to his height. (The longest length the center has been able to add is nine to ten centimeters) It means he will have to be in the hospital for eight to nine months, three to four for lengthening and then another four to five for healing.

"Since I was 14 to 25 years old I really wanted to be taller. I wasn't happy with my height," he said. After turning 25, John became more comfortable with his body, but always wondered what it would like to be taller. He opted to have the surgery because he said he did not want to regret missing the chance.

"I was a very happy person, but I always wanted to be taller," he said.

The surgery is not for the faint of heart.

It involves strategically breaking the tibia, or shinbone, and then slowly separating the ends of the broken bone over a long period of time. As the body tries to heal the break by creating new bone, the fracture is extended yet again and the body creates even more bone in the gap.

Doctors extend the fracture by a tiny amount several times a day, only a millimeter total each day, until the desired length is reached. The trick is to do it slow enough so that new bone continues to grow, but fast enough that it does not heal entirely.

The procedure was pioneered by Soviet Prof. Gavriil Ilizarov in 1951 as a way to treat World War II veterans with leg injuries. Recently the technique attracted attention from the Pentagon, which is funding a study into its use for leg trauma wounds. It has also been commonly used to treat leg deformities, like bowed legs. But in recent years it has also become a popular cosmetic choice for those, like John, who always dreamed of being taller.

According to Dr. Alexander Sergeevich Barinov, the chief surgeon at the center, they began offering the leg lengthening surgery in 1992 and, after it was featured in an English-language news article a few years later, foreigners began to inquire about it. He said the hospital has successfully operated on about two dozen foreigners over the past 15 years.

Some orthopedic experts, however, warn about the risks.

"I worry people are putting themselves at risk for only cosmetic reasons," said Dr. Alex Jahangir, an assistant professor of orthopedic surgery at Vanderbilt University Medical Center, who has used the technique for corrective purposes and is involved in the Pentagon study.

Those risks, he said, include stretching the blood vessels and nerves around the bone more than they can endure, which could result in long-term complications.

"It involves the breaking of a perfectly good bone, possible risk of infection, and six to twelve months of very meticulous care," Jahangir said. "If someone just wants to gain two or three inches, I don't think the risks are worth it."

Barinov, however, insists the procedure is safe.

"It is as dangerous as any other operation," he said, adding that the center has not had any patients suffer long-term problems as a result.

"If some problem does arise, we are able to handle it," he said.

Barinov says he only recommends the procedure for those who are physically and psychologically prepared.

"I usually have a long conversation with the potential patient and try to put him off the operation," he said. "It is a very serious operation and your approach cannot be frivolous."

He also recommends that patients stay active during their recovery as a way to manage the pain.

"If someone is lazy then this won't work. You have to be active," he said. "Of course we do give painkillers, in the form of injections, but of course there is a limit to how much painkillers they can have."

Asked about the quality of care at the Russian hospital, Jahangir said he had never been there but said that the Russian doctors are generally well regarded internationally.

"There is a lot of respect for their technique. They pioneered it and they continue to revolutionize it. Some of their doctors are probably better trained than a lot of Americans," he said.

John says he heard about the surgery on the internet and opted to do it in Russia because it was invented there and because, at a cost of $15,000 - $16,000 including hospitalization, it is several times cheaper than doing it in the United States. The American clinics, he said, usually send the patient home to recover.

But John admits there are some downsides, including sacrificing comfort. He complained about slow service from some of the nurses and bland food, but said that overall he was satisfied with the care he is receiving. He suggested people who want to do the same thing splurge for a private nurse, which would make the stay more comfortable, something he had not done.

His more immediate challenge, apart from the pain, is to maintain his cover story with family and friends to explain why he is gone for several months. He is not worried that they'll be suspicious when he comes back taller because he used to wear shoes with a heel to compensate for his height.

Now, just over a week after he began the long process, he doesn't think it will drastically alter his life.

"We'll see. It won't change. The only thing I can say, it will probably be better. I'll be taller. It'll be nice," he said.

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