This is a very good question. Firstly, lengthening and limb reconstruction is a long-time interest. I just love the magic that happens when you create new tissue from nothing - like magic.
The ethical question is more complex. I guess I have a sort of reverse ethical opinion about this. My take is not whether it is ethical to perform the surgery, but whether it is ethical not to. You see, I know I can lengthen patients safely with relatively low complication risks and I do that almost daily. I also know that there are individuals who will get CLL no matter what the risk. They often end up with the wrong doctors and end up losing function etc. If I have the tools, skills and capabilities, am I not unethical by not preventing these disasters?
Anyway, this is controversial, but there's my 5 cents worth...
Dr. Birkholtz's philosophy is sound in my book. There seems, in general, to be an enlightenment occurring in medicine, as doctors seem to be realizing that certain physical quiddities people obsess over can most easily and most readily be ameliorated by treating the condition directly. This is proven by the fact so many people completely distance themselves from their LL story and simply enjoy their new height, as if it were always there.
This not only applies to a height complex, but a whole variety of procedures. People get braces to straighten crooked teeth, breast augmentation for small breasts, laser eye surgery for poor vision, etc. Of course, some of these procedures carry far more medical necessity than an increase in height, but leaving someone to deal with height dysphoria when they are willing to pay their own hard earned money to free themselves of it should be allowed to do so, in my humble opinion. Leaving someone in a lifetime of mental anguish is more cruel than informing them of the complications that can occur during this procedure and allowing them to decide for it of their own volition.
Take this story for instance: I remember when I was young I developed moderate gynecomastia and my family doctor told me that I had to simply accept it and that it would resolve itself eventually. This condition affected me severely through adolescence. I finally saw a doctor at 19 and had it removed. Now its torment is but a distant memory and it was even covered by my country's health insurance, so it was free. In this case, I deemed my doctor to be more of a tormentor than a helper.
Even Dr. Paley himself has revamped his philosophy towards cosmetic LL and checked conventional ethics at the door. He's conceded to the fact that many people obsess to no end over this procedure and will venture to other worlds to have it done if it cannot be performed in their own countries. He's also done what many other doctors still feel trepidation in allowing: he's removed the height contraindication from his checklist. This makes complete sense to me, as someone can be entirely happy at 165cm as a male, while in a country with a taller average, such as the Netherlands or most other developed countries, we can see a young male at 170-175cm despise his height. It is of course all relative and I applaud Dr. Birkholtz for offering his services to those who want them. I hope it will save a great many from venturing to shady doctors as a last resort in the future.