Limb Lengthening Surgery

Limb lengthening surgery is an option that has only become available to people of short stature in the past few years. In addition to adding three to six inches of height for cosmetic reasons, it can sometimes be used to correct deformities such as bowed legs or length discrepancies.

The procedure works in three phases: First is the surgery itself, in which the leg bone is broken and an external fixator is attached to it with wires and pins that are worn outside of the leg. Second is the lengthening phase, which can generally begin about a week after the initial surgery. The external fixator includes a small crank that is turned ¼ turn four times a day, pulling the two sections of bone apart. New bone is naturally generated to fill the gap, but it is important not to pull them apart too quickly. Lastly, there is the regeneration phase which involves extensive physical therapy to strengthen the new bone. The patient must remain confined to a wheelchair and the external fixator must remain in place until the new bone growth is strong enough to bear weight. According to the International Center for Limb Lengthening at Sinai Hospital in Baltimore, “the total time in the external fixator can be estimated to be approximately 1 month for each centimeter lengthened in children and 1.5 to 2 months or longer per centimeter in adults.” A cast is sometimes worn for a short time at the very end of the procedure as an added precaution.Both long bones in a single leg are rarely lengthened at the same time, and both legs cannot be lengthened at the same time, so the entire process can sometimes take years.

When it first became available, limb lengthening surgery was highly controversial. Little People of America issued a position statement strongly advising against it, citing its experimental nature and the relatively high risk of complications such as infection and permanent bone damage. It is an extremely involved and painful process, yet many patients are opting to endure it.

The psycho-social benefits of limb lengthening surgery are very personal and quite profound. There is a marked increase in self esteem and confidence, but more importantly, there will be critical differences in the way a patient is treated by others. While people of average stature don’t generally commit intentional acts of heightism, it happens subtly and too often goes unnoticed. A busy businessman may push past a little person in the lunch line without even realizing it, and a waitress might unconsciously turn to her average height customer for his little companion’s dinner order. Even when they are not pushed aside so outwardly, subtle changes in tone and behavior are almost always directed at little people that resemble the way one would relate to a much younger person.

Being of short stature shapes a person’s personality. Certain behaviors that are rewarded when we are young become cumbersome and annoying later on, but they are deeply ingrained by the time adulthood sets in. The “outgoing” child becomes a “pushy” adult. Doll-like behavior doesn’t become a hard worker with an eye for business, and it certainly doesn’t earn promotions. With a few inches of extra height, these pressures are relieved the real work of adulthood can begin. Little people who undergo limb lengthening surgery develop more than self esteem and confidence. They are soon taken more seriously and develop a new maturity that serves them well in all aspects of their lives.

Opponents of the procedure have facts to support their position, but their case is quite emotional as well. They argue that little people should not have to endure a long, painful, procedure in order to realize their full potential. They would prefer to see little people embrace their identity and educate those around them. They have developed a culture and a community of their own, and those who turn their backs on it by opting for surgical alteration cannot serve the cause. Many would argue that it was a cause they were born into and they do not have a choice.

It must also be noted that limb lengthening surgery only addresses an individual’s height. It cannot change breathing problems, heart conditions, hearing loss, or any of the other challenges that little people face. It cannot bring a little person immediately to average height. It is a lengthy procedure that can only add three to six inches, while most little people are much further than that below average, and would appear very disproportional if more height were added. It is therefore not a “cure.” It can only help.

Many patients who have successfully completed limb lengthening procedures have allowed their stories to be documented and published. They are to be congratulated for their determination and their openness. Even those who have decided against surgery can be inspired by them. In the end, limb lengthening is a very personal decision that must be made- and respected- on a purely individual level.