Limb Lengthening Surgery | FAQ

Q:  – Who applies to increase height for aesthetic reasons?
A: – In our many years of practice we have seen many patients who were not happy with their appearance, leading to psychological complexes called Height Dysphoria or Height Neurosis.  According to our understanding this syndrome has no direct correlation with height; that is to say, there are many short people who don’t have Height Dysphoria. The important factor is with whom people compare themselves, and how they estimate themselves in comparison.  Height standards often vary nationally.  For example, short people in Denmark may not feel themselves short in Vietnam.  We also hear many anecdotal stories of people deciding on limb lengthening by just comparing themselves to their immediate environment, such as one in which a man came all the way from Australia to increase his height 6 cm. When Dr. Mirzoyan asked him what his main reason was, he answered that he worked at a big slaughterhouse and his job was to differentiate types of sheep bodies and to hang them on meat hooks at different heights.

Our practice illustrates that frequently most of our male patients are admitted for height increase, whereas female patients more often seek improvement of tibia/femur proportion.

In our practice, a staff psychologist is involved in evaluation of patients’ motivations and decisions regarding height increase.

Q: – What is the complication rate?
A: – Complication rate is the most frequent concern.  We never underestimate the fact that in cases of aesthetic surgery we are operating on healthy adults, and the price of complication for aesthetic and orthopedic patients is quite different. This is why recommend the most reliable methods with the fewest complications, even though they may not be the most comfortable and least time consuming.

Our complication rate is low. In many years of practice we have had sporadic complications, such as:

• premature consolidation in the process of lengthening;
• delay of callus formation;
• callus malunion after earlier frame removal;
• broken wires or pins;
• metalosis (individual allergy for metal);
• stiffness of joint ROM.

These sporadic cases can be considered obstacles rather than real complications, because they did not affect final results.  A serious issue is the delay of restoration of joint ROM and gait.

To prevent stiffness of joint ROM and maintain patients’ physical activity, physical therapy is essential. Our medical cost includes a regular course of physical therapy: every day (6 days a week) we provide one hour of training with a physical therapist. If patients wish, the course can be more intensive for an additional cost.

However, if patients are not willing to do physical therapy, leading to stiffness of joint ROM, we offer an additional surgery for an additional charge to lengthen the Achilles tendon for tibial lengthening,  and quadriceps muscles for femur lengthening.

Among serious complications we have had one infected implant, one nerve injury and one severe stiffness of joint ROM (Patella Baja). These complications required an additional surgery and treatment.

In case of significant complications, a patient pays only for hospital and accommodation fees. We provide comprehensive treatment of the mentioned complication with no additional charge.

We strongly recommend that all of our patients make a serious decision to completely dedicate the necessary time for aesthetic limb lengthening from the beginning to a successful end.

Q: – What is the cost for limb lengthening?
A: – The cost of our Center for limb lengthening covers both medical and accommodation expenses. Cost/quality ratio of our Center is pretty reasonable; patients from more than 20 countries have chosen our service. Price and duration depend on the amount of lengthening.

Q: – What is a patient’s physical activity after surgery?
A: – One of the advantages of the classical Ilizarov method in comparison to fully implantable devices (Fitbone, Precise, Albizzia, etc.) is the patients’ physical activity. The day following surgery patients take their first steps with crutches or walker, with the help of a physical therapist.  We encourage patients’ physical activity and, as a rule, on day 5-7 they are able to walk in the room. At the end of the lengthening period physical activity is a bit reduced and more intensive physical therapy is required. We place great importance on our patients’ physical activity. It expedites bone healing and leg function, and reduces psychological stress.  During the treatment our patients are usually taken to picturesque places, social events, hot springs, or even an Olympic village.

After frame removal we recommend that patients reduce physical activity for 1-2 months (wheelchair, walker, crutches) but after 3 months no limitation is required, including things like contact sports, etc.

Q: -I am concerned about scar tissue left after the procedure.
A: – The incision we make for a bone cut is, as a rule, 5-10 mm long, so it hardly can be seen after it heals. Spots of scar tissue are left from pins and especially half pins.  In a majority of cases, they are insignificant and do not bother patients. In some cases, we suggest the use of ointments that help to erode the scars and help healthy skin to regenerate. New technologies of skin shaping by laser also can be helpful. Important: scar tissue depends not only on surgical technique, but also on individual characteristics of the patients’ skin.

Q: – What is the maximum lengthening you can do?
A: – In our practice we have increased height by 16 cm (6.2 inches) for cosmetic reasons. This was indicated because of obvious disproportion between the patient’s body/arms and legs.

Theoretically, there is no limit. For patients with dwarfism (achondroplasia) we have done lengthening up to 32 cm in two periods, and at the Ilizarov Center the record case is 58 cm.  It is important to estimate comprehensively how much lengthening and from which segment any patient ultimately needs to be proportional after the treatment. Proportion between the tibia (lower leg) and the femur (upper leg) is also very important.

Frequently patients ask us to lengthen only tibias by 7 and more cm. We never recommend this unless patients assure us that they will do femur lengthening as well in the near future.

Our first priority is the final aesthetic result, and, more important, biomechanical correctness. ( See also what we mean by saying perfect legs).

Q: – How long does the procedure take?
A: – It is a time consuming process. Simultaneous lengthening of both tibias from one cut (1mm per day) takes about a month per each cm of lengthening. This includes both lengthening and fixation periods. Lengthening from two cuts (2mm per day) shortens the procedure by up to 30%. Cross lateral two stage tibia/femur lengthening takes longer, because of the necessary rehab period to restore ROM of knee and ankle joints between lengthening steps. 10 cm lengthening, for example, takes about 11 months, including two sets and rehabilitation. These durations refer to the classical Ilizarov method. Taking into account the long lasting period of this method, lately we have been applying lengthening over the nail method (LON). The aim of this method is that lengthening is done by Ilizarov frames, the fixation of callus – by nails, applied either with the device simultaneously or after leg lengthening. This reduces the necessary application time of external fixators more than twice. The disadvantage of this method is the risk of deep infections, as well as the volume of surgery. To know more about this method, please visit here.

Important: the duration of fixation, rehabilitation and the whole procedure depends very much on a patient’s motivation, willingness to be physically active, and cooperation with the physical therapist.

Q: – How to prepare for surgery?
A: – Our mutual goal with a patient is that a patient should be maximally informed about upcoming treatment. If you need additional information that you don’t find on our website you are welcome to contact us.

• Physical preparation: Stretching your muscles and tendons;

• Stop smoking and using anti-inflammatory drugs;

Q:  – Where will I live after discharge from the hospital?
A: – There are three options:

1. After discharge from the hospital you can continue your treatment at a comfortable apartment near the hospital in Yerevan. For living and renting an apartment you will have to pay an additional $1800 per month. The fee includes rent, facilities, care, 3 meals/day, cleaning, laundering, cable TV, and internet.
2. If you rent an apartment on your own, come either with someone who will look after you or hire a person. The first days after the surgery and at the end of the lengthening period patients usually have difficulty taking care of themselves and need a caring person.
3. Some patients prefer to stay in the hospital during the whole period of treatment. Hospital stay is $80 per day.

Q: – What medications will I take after discharge from the hospital?
A: – NSAIDs are not prescribed as they significantly reduce collagen synthesis.
– Pain killer during the lengthening period: Solpadeine (paracetamol with codeine), Analgini, Tramadol, etc.
– Muscle relaxing medicine: Tolperisone.
– Sleeping pills: Eskart, Atarax, Valium if necessary.
– Vitamin D, Calcium and other necessary minerals, Poly-vitamin pills.
– Blood thinner to prevent blood clot: Antithrombotic agents.

Q: – Who does the lengthening?
A: – The lengthening is usually done by a patient after training by a doctor.

Q: – What is covered in medical cost?
A: – Meeting at the airport;
– Pre-surgical clinical and radiological examination;
– Anesthesiologist fees;
– Surgeon fees;
– Surgery assistant fees;
– Hospital stays up to 7 days after each surgery;
– Radiological examinations;
– Transportation from and to hospital;
– Wheelchair, walker, crutches, bedside tables as needed.

Q: – What is not covered in medical cost?
A: – Intramedullary nail (surgical implant) removal, which costs $ 1500 for each implant;
– Health problems not related to limb lengthening. For example, our patient from Australia in the process of lengthening had an appendix which was laparoscopically removed for an additional cost;
– If patients are not willing to do physical therapy, which leads to stiffness of joint ROM, we offer an additional surgery for an additional charge to lengthen Achilles tendon for tibial lengthening  and quadriceps muscles for femur lengthening;
– Visa extension (legal stay in Armenia is 120 days);
– Additional physical therapy.

Q: – Do I need a visa?
A: – Citizens of the North America, Europe, Japan and other countries don’t need a visa. The visa is given at the Zvartnots International Airport of Yerevan. For countries who are required to have a visa in consulates, we usually provide necessary documentation and apply to the Ministry of Foreign Affairs for invitation. The cost of preparation is $ 50 and takes about a month.

Q: – What about privacy regarding consultation and surgery?
A: – We pay much attention to the privacy of our patients and never release their names and medical information to anyone. However, to be better informed about the upcoming procedure we usually suggest that the potential patient get information at first hand from someone who has already undergone the similar procedure. Needless to say, contacts are provided only after mutual agreement between potential and former patients is reached.

Q: – Is limb lengthening painful?
A: – After surgery patients are under epidural anesthesia and don’t feel pain. Actually the anesthesia doesn’t hinder patients to take their first steps the next day after surgery.  There is certain pain in the first period of lengthening and in the process of physical therapy, but generally, pain is easily manageable per oral painkillers.

Q: – How long will I stay at hospital?
A: – Patients usually stay at the hospital up to 5 days, rarely up to 7 days.

Q: – Do I need a blood transfusion?
A: – The classical Ilizarov method anticipates no blood loss and there is no need for blood transfusion. In case of the LON method, due to the necessity of reaming the bone marrow, blood transfusion can be done, depending on blood tests, in less than 10 % cases.

Q: – When should I have the nails removed?
A: – Intramedullary nails should be removed in 6-12 months after the lengthening when bone consolidation is completed according to radiological examination.

Q: – What is the cost for an intramedullary nail removal?
A: – An intramedullary nail removal costs $ 1500 for each implant.  The price covers all medical expenses and 3 days in hospital after surgery.