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[TakingAction]

Dr Donghoon Lee, who has followed up with over 400 CLL patients, says that people lengthened between 6cm-8cm developed a higher risk of problems than those who did 6cm.

Is 6cm on femur the tipping point for high risk? Do you think that the correlation between additional millimeters after 6cm and risk is exponential growth or linear growth? Does anyone have a web link that shows the risk data of 6cm vs 8cm on a research paper / studies?

[ReadRothbard]

8 cm on your femurs is generally considered the safe limit. Tobias are about 6-7 cm, but it depends on your initial bone length.

[TakingAction]

8 cm on your femurs is generally considered the safe limit. Tobias are about 6-7 cm, but it depends on your initial bone length.

Did you make the above safety statement because a doctor told you? Or did you make that conclusion because you read a scientific study? It’d be very helpful to have a scientific study to read the raw data so we can interpret the data by our own judgment because the word “safe” sometimes is a subjective term. If 6cm has a 2% probability of complication but 8cm has a 9%, some people may still call the 9% safe and some don’t, depending on personal preference.

[ReadRothbard]

Did you make the above safety statement because a doctor told you? Or did you make that conclusion because you read a scientific study? It’d be very helpful to have a scientific study to read the raw data so we can interpret the data by our own judgment because the word “safe” sometimes is a subjective term. If 6cm has a 2% probability of complication but 8cm has a 9%, some people may still call the 9% safe and some don’t, depending on personal preference.

This is referring to Paley and a few others' general guidelines, but there is a pretty substantial amount of literature showing 20% of your initial limb length is the safety cutoff.

[TakingAction]

This is referring to Paley and a few others' general guidelines, but there is a pretty substantial amount of literature showing 20% of your initial limb length is the safety cutoff.

Would you please send any web link of those “literature” you mentioned? I’d like to read them. (Please do not send the Paley guidebook because I have read that multiple times)

[Masteryourlife]

Dr Donghoon Lee, who has followed up with over 400 CLL patients, says that people lengthened between 6cm-8cm developed a higher risk of problems than those who did 6cm.

Is 6cm on femur the tipping point for high risk? Do you think that the correlation between additional millimeters after 6cm and risk is exponential growth or linear growth? Does anyone have a web link that shows the risk data of 6cm vs 8cm on a research paper / studies?

After years of research I  go by logic most times because LL does not have extensive literature for cosmetic porpuses regardless so I will not put my faith in one lecture .
I start always saying that 8 cm is the MAX for precice nail which is designed for LLD not CLL ,which means that those 8cm are the max for someone with bigger problems then the one the LL could create to him .
Synoste Nitinail has a max lenght of 7cm max and the nail can work or not but it has been discussed  by great surgeons (Dr.Lee,Dr.Thaller and I believe Dr.Testworth too and others but those are the top ones I know) and by a smart team of people working on it for over 10 years .
Point is that if they took out the 1cm extra they might have evaluate the pros and cons and they can potentially lose clients in both LL and CLL but that extra 1cm was not worth it for their practice .
Also we have diares of succesfull 8cm CLL but we have people with long recovery and problems too that could have been avoided with less lenghtening (admitted by themself as well) . They are probably fine now but not as if they did 6 or less and it took so much time to recover or to get back from the complications ; we understimate what tool that can be on us.
The only way I would aim (maybe) for 8 cm is if I was 172cm and that 8 cm would make me a fair and square 180 cm to just put my soul at peace and not have that ''7'' in my height number anymore .
We are doing this for mental porpuses so that is the only reason I would aim to 8 to be honest , other then that I would aim to 6 cm all the time .
More then literature I think we should read behind lines of people diares and see if their path can work for us ; some here are for real psycopaths and a bad recovery for them is fine and they don't mind staying with problems as long as they get their height .
No matter what your starting height is , + 6cm is a huge boost ..maybe go for 6.5 and call it a day .
To make an example , I'm 5'9 (175cm) and using the full nail I would stand at 183 cm which to me ,from 183 to 188 is the perfect height range .
I usually dress nice and use a lot designer shoes like  leather cowboy boots of ysl,balenciaga etc. (not for height porpuses) so I would really be 10/10 with myself if I was 183 cm tall . I would look taller because of longer legs ,on top of that I would have boots adding 1 or 2 cm because its their design and I would stand at 185 looking more like a 186/187 guy when out .
It would feel like I conquered the world but there is no way I will do more then 6 cm . I will settle with 181cm and call it a day because the regret would be HUGE if a complications occur because of my greed .

Stay on the safe side , we have one life so LL its a way to improve it , but do it according to your body and not your heart .
I know it is not the scientific point of view you were looking for but I really think that its up to us to be mature enough to understand and make logical decision because those surgeons did not get this surgery so they stick to the literature (the small one we have) and if 10 years down the line (like people doing 9 cm tibia not even 6/7 years ago) The literature will change , they will not be the one to pay the price but you .

[TakingAction]

After years of research I  go by logic most times because LL does not have extensive literature for cosmetic porpuses regardless so I will not put my faith in one lecture .
I start always saying that 8 cm is the MAX for precice nail which is designed for LLD not CLL ,which means that those 8cm are the max for someone with bigger problems then the one the LL could create to him .
Synoste Nitinail has a max lenght of 7cm max and the nail can work or not but it has been discussed  by great surgeons (Dr.Lee,Dr.Thaller and I believe Dr.Testworth too and others but those are the top ones I know) and by a smart team of people working on it for over 10 years .
Point is that if they took out the 1cm extra they might have evaluate the pros and cons and they can potentially lose clients in both LL and CLL but that extra 1cm was not worth it for their practice .
Also we have diares of succesfull 8cm CLL but we have people with long recovery and problems too that could have been avoided with less lenghtening (admitted by themself as well) . They are probably fine now but not as if they did 6 or less and it took so much time to recover or to get back from the complications ; we understimate what tool that can be on us.
The only way I would aim (maybe) for 8 cm is if I was 172cm and that 8 cm would make me a fair and square 180 cm to just put my soul at peace and not have that ''7'' in my height number anymore .
We are doing this for mental porpuses so that is the only reason I would aim to 8 to be honest , other then that I would aim to 6 cm all the time .
More then literature I think we should read behind lines of people diares and see if their path can work for us ; some here are for real psycopaths and a bad recovery for them is fine and they don't mind staying with problems as long as they get their height .
No matter what your starting height is , + 6cm is a huge boost ..maybe go for 6.5 and call it a day .
To make an example , I'm 5'9 (175cm) and using the full nail I would stand at 183 cm which to me ,from 183 to 188 is the perfect height range .
I usually dress nice and use a lot designer shoes like  leather cowboy boots of ysl,balenciaga etc. (not for height porpuses) so I would really be 10/10 with myself if I was 183 cm tall . I would look taller because of longer legs ,on top of that I would have boots adding 1 or 2 cm because its their design and I would stand at 185 looking more like a 186/187 guy when out .
It would feel like I conquered the world but there is no way I will do more then 6 cm . I will settle with 181cm and call it a day because the regret would be HUGE if a complications occur because of my greed .

Stay on the safe side , we have one life so LL its a way to improve it , but do it according to your body and not your heart .
I know it is not the scientific point of view you were looking for but I really think that its up to us to be mature enough to understand and make logical decision because those surgeons did not get this surgery so they stick to the literature (the small one we have) and if 10 years down the line (like people doing 9 cm tibia not even 6/7 years ago) The literature will change , they will not be the one to pay the price but you .

You mentioned that you did "years of research." Is the research all based on some anecdotal evidence of the forum? Or did you read any medical research journals? If you studied medical journal, please send the web link because decisions made by anecdotal data is probably not logical by definition. Just because one chose 6cm instead of 8cm, doesn't mean the risk is lower if we only have a sample size of a few patients. We need at least hundreds of patients such as the research studies Dr. Lee did for his 400 patients because he followed up with all of them and found some risk correlation data.

[Masteryourlife]

You mentioned that you did "years of research." Is the research all based on some anecdotal evidence of the forum? Or did you read any medical research journals? If you studied medical journal, please send the web link because decisions made by anecdotal data is probably not logical by definition. Just because one chose 6cm instead of 8cm, doesn't mean the risk is lower if we only have a sample size of a few patients. We need at least hundreds of patients such as the research studies Dr. Lee did for his 400 patients because he followed up with all of them and found some risk correlation data.

I think you did not read carefully what I said and there is no need to tell you that if you ride your motorcycle at 150 mph the risk of death are higher then 60mph . I struggle to believe there are scientific papers on that since you can die also at 30mph but its logic and works perfectly if used correctly .
CLL is a new field,there is no extensive literature on it unless you want to pause your lenghtening journey for some good years to have them maybe in 5 or 10 years .
And no my research is based on years of reading online pubblications, this forum ,youtube and several orthopedics surgeons consultations .
You already have the scientific study you looking for , so I don't really know what is your question at this point if a study of 400 people its not enough ,and a logical thinking is not what you need .
I'm not ''attacking'' you or something but I feel like you already have your answear in Dr.Lee study , you just don't like it lol
 

[SuchLL]

I find it hard to not be greedy once I went through surgeries, pain and those things… especially when I’m surrounded by other greedy patients lol.

[TakingAction]

I think you did not read carefully what I said and there is no need to tell you that if you ride your motorcycle at 150 mph the risk of death are higher then 60mph . I struggle to believe there are scientific papers on that since you can die also at 30mph but its logic and works perfectly if used correctly .
CLL is a new field,there is no extensive literature on it unless you want to pause your lenghtening journey for some good years to have them maybe in 5 or 10 years .
And no my research is based on years of reading online pubblications, this forum ,youtube and several orthopedics surgeons consultations .
You already have the scientific study you looking for , so I don't really know what is your question at this point if a study of 400 people its not enough ,and a logical thinking is not what you need .
I'm not ''attacking'' you or something but I feel like you already have your answear in Dr.Lee study , you just don't like it lol

You're right I don't like Dr. Lee's study because I love his study lol, and I want more studies just like his! In fact, I have read one study similar to his studies that shows the correlation between additional height and probability of risk. However, I forgot which medical journal I read, and I couldn't find the web link. That's why I was asking people to see if anyone else who can share web link/studies here so we can all review and understand the risk better in a quantitative/objective way.

P.S. Yes we all know that the 150mph motorcycle is riskier than the 60mph one but how much more are we talking about here? It'd be helpful to know if it's like 1% riskier or 80% riskier because there is actually a tipping point of death rate once the speed reaches 50mph I believe, then the correlation to death increases like exponentially instead of linearly, and that was counterintuitive for me at first when I saw that data. It's almost like the correlation between happiness and annual income is strong until one reaches $75K per year based on a Princeton study a decade ago. There is a diminishing return, which is counterintuitive.

[TakingAction]

I find it hard to not be greedy once I went through surgeries, pain and those things… especially when I’m surrounded by other greedy patients lol.

Hey, pretty sure you're surrounded by me in Florida, and I'm not that greedy lol

[TakingAction]

There're some studies my assistant found that may or may not be helpful but I wanted to share here because it helps me make the decision between the 6cm or 8cm. It'd be even better to read more studies similar to them to make a better decision on the final length to achieve.

Complications in limb-lengthening procedures: a review of 49 cases:
Key Point: The most serious complications occurred in patients with >30% bone lengthening. Patients with <15% lengthening had a significantly decreased complication rate.
https://pubmed.ncbi.nlm.nih.gov/11411874/

Upper and lower limb length equalization: diagnosis, limb lengthening and curtailment, epiphysiodesis
Key Point: Limb lengthening procedures up to 5 cm lead to rapid consolidation and minimal complications. Lengthenings exceeding 5 cm require a good psychological preparation and careful monitoring. In lengthenings more than 10 cm, a faster rate of consolidation requires a double corticotomy, the use of intramedullary fixation and the immobilization of adjacent joints.
https://pubmed.ncbi.nlm.nih.gov/22788093/

[SuchLL]

Hey, pretty sure you're surrounded by me in Florida, and I'm not that greedy lol

There’s a patient whose goal is also 6-6.5 cm on tibias. There’s also a patient who is lengthening both segments at the same time and his goal is 8 cm femur + 5 cm tibia when Dr Paley states 5 cm + 5 cm in his guidebook. 8 cm on femurs isn’t greedy at all in my opinion since most people are able to reach 8 cm.

[Masteryourlife]

You're right I don't like Dr. Lee's study because I love his study lol, and I want more studies just like his! In fact, I have read one study similar to his studies that shows the correlation between additional height and probability of risk. However, I forgot which medical journal I read, and I couldn't find the web link. That's why I was asking people to see if anyone else who can share web link/studies here so we can all review and understand the risk better in a quantitative/objective way.

P.S. Yes we all know that the 150mph motorcycle is riskier than the 60mph one but how much more are we talking about here? It'd be helpful to know if it's like 1% riskier or 80% riskier because there is actually a tipping point of death rate once the speed reaches 50mph I believe, then the correlation to death increases like exponentially instead of linearly, and that was counterintuitive for me at first when I saw that data. It's almost like the correlation between happiness and annual income is strong until one reaches $75K per year based on a Princeton study a decade ago. There is a diminishing return, which is counterintuitive.

I understand exactly what you are saying but it is impossible to obtain .
You need to take in consideration starting height (the taller the better because of bones/soft tissue length) .
You have to take in consideration if the bone was growing fast or slow and therefore the rate of distraction.
You need to take in consideration the single clinical case in order to understand why someone at 8 had a better result then someone at 6 with the same doctor or it's just a combination of factors mixed altogether .
You need to take into account age , ethnicity, PT (not everyone is diligent) and so many other contributing factors .
In order to determinate if it its exponential or linear a doctor must make follow ups many years after with patient with same method at least , and it's quite hard that someone 2 years post op even bothers to think at such a thing .
Your question (according to me) has no answear also because a healthy 22 yo patient with a relatively tall starting height ,from 6 to 8 has a linear increase of risks because of tot factors while in a 35/40 yo patient with a shorter starting height might have an exponential increase because of other factors playing .

Maybe I am wrong tho so if someone happen to find anything interesting about this topic , It might help a lot because it's an intresting topic.

[TakingAction]

I understand exactly what you are saying but it is impossible to obtain .
You need to take in consideration starting height (the taller the better because of bones/soft tissue length) .
You have to take in consideration if the bone was growing fast or slow and therefore the rate of distraction.
You need to take in consideration the single clinical case in order to understand why someone at 8 had a better result then someone at 6 with the same doctor or it's just a combination of factors mixed altogether .
You need to take into account age , ethnicity, PT (not everyone is diligent) and so many other contributing factors .
In order to determinate if it its exponential or linear a doctor must make follow ups many years after with patient with same method at least , and it's quite hard that someone 2 years post op even bothers to think at such a thing .
Your question (according to me) has no answear also because a healthy 22 yo patient with a relatively tall starting height ,from 6 to 8 has a linear increase of risks because of tot factors while in a 35/40 yo patient with a shorter starting height might have an exponential increase because of other factors playing .

Maybe I am wrong tho so if someone happen to find anything interesting about this topic , It might help a lot because it's an intresting topic.

I understand that there're many variables, which make the studies very difficult to do. It seems that the following studies show a correlation between the probability of complication and the height gained (based on original height).

Complications in limb-lengthening procedures: a review of 49 cases:
Key Point: The most serious complications occurred in patients with >30% bone lengthening. Patients with <15% lengthening had a significantly decreased complication rate.
https://pubmed.ncbi.nlm.nih.gov/11411874/

[Masteryourlife]

There’s a patient whose goal is also 6-6.5 cm on tibias. There’s also a patient who is lengthening both segments at the same time and his goal is 8 cm femur + 5 cm tibia when Dr Paley states 5 cm + 5 cm in his guidebook. 8 cm on femurs isn’t greedy at all in my opinion since most people are able to reach 8 cm.

Out of curiosity , besides you 2 , how many other patients are doing CLL currently at the Paley institute?

[SuchLL]

Out of curiosity , besides you 2 , how many other patients are doing CLL currently at the Paley institute?

Last year there’re many CLL patients because of covid and stryde nail. I wasn’t able to count since I kept seeing new faces. This year I’ve only met 10 CLL patients including one also doing arm lengthening. There’s probably more since I only came in the morning, but still can’t compare to last year.

[ReadRothbard]

I understand that there're many variables, which make the studies very difficult to do. It seems that the following studies show a correlation between the probability of complication and the height gained (based on original height).

Complications in limb-lengthening procedures: a review of 49 cases:
Key Point: The most serious complications occurred in patients with >30% bone lengthening. Patients with <15% lengthening had a significantly decreased complication rate.
https://pubmed.ncbi.nlm.nih.gov/11411874/

I can't even imagine someone lengthening over 30% of their original bone length. That'd be like 9 inches for me.

[Masteryourlife]

Last year there’re many CLL patients because of covid and stryde nail. I wasn’t able to count since I kept seeing new faces. This year I’ve only met 10 CLL patients including one also doing arm lengthening. There’s probably more since I only came in the morning, but still can’t compare to last year.

Thank you, do you hear any update in there about stryde return ?
Idk like general talks ?!

[Height Journey]

For the original poster, there aren't many official scientific studies on correlations on amount lengthened and complications or athletic ability. As Masteryourlife stated, it's very unrealistic to have abundant scientific studies on cosmetic leg lengthening patients.

First, I'll start off with the few scientific studies.

You already mentioned this one, which is the most famous one.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5385113/

Excessive tibia lengthening is correlated to higher ipsilateral hip and knee arthritis
https://pubmed.ncbi.nlm.nih.gov/26398436/


I've also watched videos of well-respected and credible LL doctors (like Dr Donghoon Lee) saying that higher lengthening correlates to more complications, like less athletic ability. Even if they did not link to an official scientific study, that's all the public has to go by for now.

[Height Journey]

We also have many diaries of CLL patients on this website. I am one of them. As I lengthened 7cm on the femurs, I can tell you from personal experience that the more you lengthen, the more your range of motion (ROM) or flexibility will decrease. I don't need any scientific study to confirm this.

Of course, PT is essential and you can get most of your ROM back, but not at 100% pre-surgery levels. And ROM is much of your athletic ability.

[Height Journey]

Another scientific study on tibia lengthening and athletic activity recovery.

Functional recovery of daily living and sports activities after cosmetic bilateral tibia lengthening
https://link.springer.com/article/10.1007/s00264-018-4159-5

Results
SARS and IKDC scores decreased at post-operative one year and improved significantly at post-operative two years. SARS and IKDC scores recovered similarly to pre-operative levels. Average patient self-reported ability scores at post-operative two years were 94.6 and 89.9 for daily living and light sports, respectively. However, the average score for moderate-to-strenuous sports was 68.1 and 39 patients (31.2%) recorded below average score for the moderate-to-strenuous sports.

Conclusions
Patients who had undergone bilateral cosmetic tibial lengthening may expect almost full recovery of daily and light sports activities at post-operativetwo years. However, several patients may feel some limitation in moderate-to-strenuous sports activities.

[SuchLL]

Thank you, do you hear any update in there about stryde return ?
Idk like general talks ?!

I haven’t heard of any update about stryde return. I’ll ask Dr Robbins next time if I remember.

[ReadRothbard]

Another scientific study on tibia lengthening and athletic activity recovery.

Functional recovery of daily living and sports activities after cosmetic bilateral tibia lengthening
https://link.springer.com/article/10.1007/s00264-018-4159-5

Results
SARS and IKDC scores decreased at post-operative one year and improved significantly at post-operative two years. SARS and IKDC scores recovered similarly to pre-operative levels. Average patient self-reported ability scores at post-operative two years were 94.6 and 89.9 for daily living and light sports, respectively. However, the average score for moderate-to-strenuous sports was 68.1 and 39 patients (31.2%) recorded below average score for the moderate-to-strenuous sports.

Conclusions
Patients who had undergone bilateral cosmetic tibial lengthening may expect almost full recovery of daily and light sports activities at post-operativetwo years. However, several patients may feel some limitation in moderate-to-strenuous sports activities.

I heavily suspect this is due to a change in biomechanics, honestly. If they lengthened the other segment to similar proportions more than likely these scores would heavily improve.