Growth dysphoria - cosmetic limb lengthening

Dysfunction is no longer a problem. Thanks to advances in the field of orthopedics, we can easily achieve bone elongation by additional centimeters and equalize the length of limbs in relation to the proportions of the whole body.

The term growth dysphoria

Dr. Walter Windisch, a psychologist, used the term growth dysphoria (dysphoria literally means dissatisfaction, as opposed to euphoria). In other words - dissatisfaction with one's own growth. In the literature we find another term - by Karen Horney - growth neurosis.

The graph of the distribution of growth in a population is arranged in the shape of a bell, the so-called Gauss curve (normal distribution). At its top is the average value, characteristic of the largest percentage of the population. Normal growth is considered to be values within ± 3 standard deviations (SD) from the mean. Growth less than 3 SD from the mean, in individuals not affected by dwarfism or growth hormone deficiency, is considered short stature. For a doctor, normal height is between the 5th and 95th percentile. The lower limit of the so-called normal height for men is 166 cm, while for women it is 153 cm.

Relationship between body height and growth dysphoria

The condition is related to one's actual height, but there is no cutoff value above which one cannot suffer from height dysphoria and experience its symptoms. Most of us assume that dissatisfaction with one's height can only affect "short" people. The problem, however, is that perceptions of low height can vary widely. Dysphoria has causes depending on racial, national, as well as cultural factors - 178 cm is a lot in India, but not much in the Netherlands.

This can also be illustrated by the following anecdote from Dr. Dr. Paley:

"A man flew all the way from the Netherlands to see me for a consultation on the possibility of limb lengthening. He was 180 cm tall. He recounted that he felt short even as a teenager. He was the lowest man in his family, even his sister was the same height as him. All his friends were much taller. He reminded me that the Dutch were the tallest nation in the world. We were the same height. I myself had never considered myself short, nor had I heard such opinions from my family or friends. Therefore, it was difficult for me to qualify him for the limb lengthening procedure. I sent him for a psychological consultation. The psychologist's report confirmed that the patient had the same problems with his body image as all the other patients we examined. Despite his objectively tall height, he suffered from height dysphoria. Examining the relationship between height and a diagnosis of growth dysphoria, we found that our patients' initial height ranged from 147 to 180 cm in men and 137 to 173 cm in women. Although most of the patients were closer to the lower end of the range, the presence of those in the upper range indicates that height alone is not the primary problem. The most important thing is the patient's own perception of height and proportion, something we call self-image. Body figure dysphoria is a disturbance of one's self-image. The patient considers himself short regardless of his actual height, and regardless of the opinions of those around him."

In practice, we have learned not to follow our own opinions when qualifying for lower limb lengthening surgery. What matters is the patient's feelings. As for the riskiness of the procedure, it is not higher for tall people. Theoretically, it should even be lower, because in relation to the size of the whole body, the increase in bone length is smaller in percentage terms.

Additional centimeters

Most patients dream of an extra 7-8 cm of height, sometimes it's more. PRECICE technology (developed through Dr. Paley's collaboration with Ellipse) has been approved by the US FDA. The maximum extension of the Precice nail is 8 cm. Patients who want more than eight additional centimeters should consider another procedure to lengthen the second bone (femur first and then tibia, or vice versa). A total of up to 13 additional centimeters of height (8 cm on the femur and 5 cm on the shin) can be achieved with two lengthening procedures . Lengthening on the order of 8 cm on the tibia is not well tolerated, already exceeding 5 cm can lead to serious complications. Most patients cannot tolerate more than 5 cm in the shinbone. Of course, carrying out a double procedure for limb lengthening is a price almost double that of a single operation.

Although the design of the nail provides for lengthening up to 8 cm, not every patient can safely achieve such a result, even within the femur. At our center, we lengthen limbs only as much as the patient's bones and soft tissues allow. SAFETY is paramount. We do not risk loss of function just to achieve one extra centimeter. There are several limb lengthening strategies to achieve optimal results from each procedure. Here are some of them:

1. Bilateral femoral lengthening (up to 8 cm),
2. Bilateral tibial lengthening (up to 5 cm),
3. combined lengthening of the tibia (5 cm) and femur (8 cm) three weeks apart - a total of 13 cm,
4. Femoral lengthening (8 cm), followed by tibial lengthening (5 cm) after one year - a total of 13 cm,
5. combined lengthening of the tibia (4 cm) and femur (4 cm) at an interval of three weeks - a total of 8 cm, followed by re-fracture of the femur and tibia with the same Precice in situ nails, and repeat lengthening of the femoral and lower leg sections at 4 cm each after at least a year - a total of 16 cm.

Lengthening of the femur and tibia bones

Options 3, 4 and 5 provide for lengthening in both the tibia and femur.

Lengthening both bones allows for a taller height, as well as better body proportions - thighs and shins. However, such a two-stage procedure requires more work and is more expensive than lengthening only one pair of bones. It is also sometimes associated with more pain if both stages are carried out at the same time. It is not practiced to place nails in the femur and tibia in a single surgical procedure due to the increased risk of fat embolism from reaming the marrow canal of more than two bones simultaneously. Implanting 4 nails during one operation would increase the risk of fat embolism and death. We have performed such a procedure successfully and without complications in two patients, but we do not recommend or even offer this option at this time for safety reasons.

Option 3 allows for a shorter treatment period by lengthening the femurs and tibias at the same time. We start with the tibia, and three weeks later perform the procedure on the femur. The indicated order is due not only to the slower regeneration of the tibia compared to the femur, but also to the fact that the placement of the nail in the tibia requires maximum flexion of the knee joint, which could be hindered if the muscles were already strained due to lengthening in the femur. The treatment time is extended by about three weeks compared to option 1.

Option 4 allows for maximum femoral lengthening, as the femur and tibia are lengthened separately. This procedure requires more physiotherapy and time. This option is more time-consuming because the two lengthening procedures are performed independently of each other a year apart.

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Option 5 is interesting because it allows for maximum length gain with the highest safety. The Precice/Stryde nail allows for lengthening up to 8 cm. Such an elongation cannot be achieved once in the tibia without weakening the Achilles tendon or its plication (leading to a permanent weakening of the rebound phase during gait). Achieving 8 additional centimeters in the tibia, however, is possible and safe if done two stages one year apart. In order to achieve a maximum lengthening of up to 16 centimeters, we need to carry out simultaneous lengthening of the tibia and femur, with the operations taking place 3 weeks apart and the extent of lengthening of each bone not exceeding 4 centimeters. Then a break is necessary to allow the bone tissue to heal. A year later, the femur and tibia and fibula bones can be cut again, the implant reactivated and elongation resumed. This yields the remaining 4 cm on each bone. 4 cm is not much in terms of bone lengthening, so the risks associated with such a procedure are much lower. The strategy discussed is therefore very safe, while minimizing the duration of a single stage. Stage one takes 11 weeks, during which a 4+4 cm lengthening of the femur and tibia is achieved. The second time around, since the nails are already in place, there is no need for two operations. In addition, the bones can be cut once, making only very small incisions. The biggest downside of this method is the cost - three separate surgeries are involved. It is therefore higher than with the other options.

Limb lengthening - treatment of asymmetries in the locomotor system

Limb lengthening is a surgical treatment. Depending on the case and the individual predisposition of the patient, the treatment technique chosen may be more or less invasive. One of the least invasive techniques for treating asymmetries in the locomotor system is one that uses a magnetic field. The procedure requires only a few incisions on the skin, so the patient's stay in the hospital is reduced to an absolute minimum, and recovery immediately after the procedure is relatively quick and unobtrusive. An additional advantage of the offered technique is the absence of external elements in the form of stabilizers, which impede daily functioning and significantly affect the range of motion.

Limb lengthening using Precice intramedullary nails is offered both to patients struggling with asymmetry - we successfully treat skeletal dysplasias - and to patients suffering from growth dysphoria. It is also an excellent solution for limb axis deformities or osteochondrodysplasia.

Limb lengthening - price of the procedure

The price of a limb lengthening procedure depends on a number of factors, including the individual nature of the procedure, which is designed to provide the best possible result in a particular case. Patients interested in the opportunity to benefit from innovative methods of treating limb asymmetry and growth dysphoria are encouraged to contact us. The final price of the procedure will be determined on the basis of the medical history, the tests performed and the feasibility of the chosen limb lengthening technique.

If you have any questions or concerns, we remain at your disposal. We deal with both pediatric orthopedics and help adult patients. We perform limb lengthening in patients struggling with congenital and acquired defects. We offer professional consultation and diagnosis, as well as comprehensive post-operative care.