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[KiloKAHN]

Wow, thanks for the abundance of interesting information! That's a lot of releases the doc wants to do on you. He's confident that you'll recover from all of them? The gastrocnemius soleus release seems like it would have the most long term effect. I thought after that release people who need them aren't ever quite the same. Interesting reading that Paley thinks you'll rebuild that strength. Maybe the effects of that release aren't permanent like some others have said?

Judging from your witnessing of Dr. Paley's depth of knowledge, if you did not have the funds to go to him do you think you would have a higher degree of confidence in a different surgeon who had a fellowship or took a course under him, as opposed to a surgeon who has not studied under Paley?

[mediocre]

This is extremely informative.

Thanks a lot.

[rickybobby]

BD,

excellent post!

Did paley mention if you did one surgery on your femurs and did 8cm would you have any knee pain in the future do to a large femur:tibia ratio.?

[BilateralDamage]

I wonder how much is your allotted budget for your LL, if you don't mind. Dr. Paley is on my top list if money is not an issue.

Does he really give old forum  members discount? How about us, LL Forum members?

The budget question is a real complicated one for me!  I know I can spend at least $100,000 on this surgery, but when we start getting in the upper 100s range (for quadrilateral), then I get very nervous.  I want to be able to have enough money for when I have to do taxes at the end of the year.  Also, I have to base being able to afford the quadrilateral surgery on whether or not my projected income can afford it.  I'm going to email him later to see if he has any financing plans.

As far as discounts, nope, that's just an old forum  ploy.  His prices are actually much higher than they were years ago, so whoever called that LL was going to become more expensive over time was right!

Good for you. Are you going to him for sure? Can't wait for that update

Thanks Smallguy   I think if I were to do LL with any doctor now, it would definitely be Dr. Paley.

So no go for Birkholtz? I agree with everyone else, if you have the money, go with Paley. I was banking on you being Birkholtz's first though.

Dr. Birkholtz is a fantastic doctor who is still my #2 choice for PRECICE 2.  The only reason he isn't #1 is because he operates in a time zone much different than mine, and in a country that has less than great internet speeds.  My job relies on me being in the states and having very good Internet.  Also, not to downplay the successes of Dr. B, but he hasn't had as much experience in cosmetic lengthening as I'd like.  Once he has a breakthrough and starts seeing more cosmetic lengtheners, I think his practice is going to be an absolute hit.  I also think anyone considering PRECICE 2 who can't afford Dr. Paley and would have no problem moving to a foreign place should definitely have the surgery done with Dr. B.  At least schedule a consult with him, and you'll see that you're in safe hands. 

I wonder how much would be the difference between Dr Paley and Dr Franz. If not that big, then definitely Paley.

It's pretty significant    Paley charges $80,000 for bilateral femoral lengthening which only includes physio, while Birkholtz charges only $48,000 for bilateral femurs, physio and accommodation for 75 days included.  That's an absolutely amazing price Birkholtz is charging because his profit margins are so thin.  A pair of nails cost $30,000!

Hey BD!

This is an awesome post that is extremely valuable.
Gives you a lot to think about. I think it is evident that Paley is certainly the best option out there. What I love is his vast experience, honesty and focus on safety. Most of us have been influenced by him in some way.
If you can afford it, go for it, but be careful about quad.
Good luck with your decision.

Dr. B,

I cannot express my gratitude to you enough.  You've helped educate and inform so many people on this forum, including myself.  Thank you!  I really really hope your practice starts seeing a lot of guys from this forum visit you, since you offer such a tremendous opportunity at the best prices anyone will find anywhere for PRECICE 2.

Any LL doctors reading this, Dr. B is a class act.  Watch and learn!

Wow, thanks for the abundance of interesting information! That's a lot of releases the doc wants to do on you. He's confident that you'll recover from all of them? The gastrocnemius soleus release seems like it would have the most long term effect. I thought after that release people who need them aren't ever quite the same. Interesting reading that Paley thinks you'll rebuild that strength. Maybe the effects of that release aren't permanent like some others have said?

Judging from your witnessing of Dr. Paley's depth of knowledge, if you did not have the funds to go to him do you think you would have a higher degree of confidence in a different surgeon who had a fellowship or took a course under him, as opposed to a surgeon who has not studied under Paley?

I agree, I'm nervous actually about how many releases I would need.  I had a feeling too that it would come to this, because I'm a naturally tight individual, no matter how much I stretch.  My dorsiflexion is a joke especially.  He's confident that I'd recover from the ITB release and also the biceps femoris release.  But, when talking about the gastrocnemius release, it seemed to me like he was unsure when talking about its potential for full recovery.  I understand that it'd probably result in a permanent reduced strength in my calves.  It's a risk I'm willing to take because I'm not a professional athlete and I can live with being weaker in my calves for height.

I'm not sure if I would go to one of his fellow to be honest.  Dr. Donghoon Lee was one of his fellows, and is running a very successful clinic in South Korea, but he doesn't believe in ITB releases and his patients have been having bad results with the PRECICE 2.  I still don't know if that's because of his decisions or the nails, but I do believe being a fellow underneath Dr. Paley does give the doctor a lot more credibility.  But I'm not sure if it would make me more compelled to select them.

This is extremely informative.

Thanks a lot.

My pleasure.  It really helps me to write all this stuff out!

BD,

excellent post!

Did paley mention if you did one surgery on your femurs and did 8cm would you have any knee pain in the future do to a large femur:tibia ratio.?

We went over my x-rays and my tibia/femur ratio is actually .84.  This means I can afford to do more lengthening on my femurs to keep the ideal .8 tibia/femur ratio.  They recommended 8 cm/5 cm if I were to do two separate lengthening (as opposed to quadrilateral).


----


After a lot of discussion with my girlfriend, we realized I probably shouldn't go the quadrilateral route, instead play it safe and lengthen 7-8 cm on my femurs.  Recover, consolidate, and then come back for 5 cm on my tibias.  Who knows, I may even be happy with my height after 8 cm!   And I come that much closer to my goal of being 5' 10" one day...

This reason is not only for safety, but also financial security.  160K-180K is a s**t-ton of money, so I'm better off being completely financially secure and doing just 1 LL surgery this year, and then a 2nd next year.

[mediocre]

I was planning on consultation with Dr Paley, now I don't have to. Thanks again.

Seems like you're more likely to get it done with Dr Paley in May? I don't think I can afford him unless I score big in a poker tournament. All the best.

It looks like he does not believe that one can avoid those releases just by stretching pre-LL to improve flexibility.

[TRS]

This is very informative, thanks BD!!
Is the ITB and Biceps femoris release a standard procedure on all his patients? Or does he release other thigh muscles for femur lengthening?

[BilateralDamage]

I was planning on consultation with Dr Paley, now I don't have to. Thanks again.

Seems like you're more likely to get it done with Dr Paley in May? I don't think I can afford him unless I score big in a poker tournament. All the best.

It looks like he does not believe that one can avoid those releases just by stretching pre-LL to improve flexibility.

No problem!  I'm probably going to book my surgery with Dr. Paley very soon so I can get a May date.  As long as nothing else comes in the way

I think it makes sense too that one cannot just stretch to avoid a release.  When you look at this way, no one can stretch any amount that will make the current muscles we have able to easily withstand an extra 6-8 cm of length.  The muscles would have be loose and droopy pre-lengthening for that to happen.

This is very informative, thanks BD!!
Is the ITB and Biceps femoris release a standard procedure on all his patients? Or does he release other thigh muscles for femur lengthening?

No problem   The ITB release is standard, and biceps femoris release is almost as common as well.

[kneehowguys]

Hey BD!

This is an awesome post that is extremely valuable.
Gives you a lot to think about. I think it is evident that Paley is certainly the best option out there. What I love is his vast experience, honesty and focus on safety. Most of us have been influenced by him in some way.
If you can afford it, go for it, but be careful about quad.
Good luck with your decision.

Dear Dr Fanz,

These questions below are a bit hypothetical. I don't mean it literally, and I do not mean to be disrespectful to people involved in CLL but I am curious what your thoughts on it are.

1. What is the motivation for LL surgeons to ever perform CLL? It seems like not much of the money from the surgery actually goes to the doctor, and I wonder with the very long process and hours spent that perhaps it is not financially worth it compared to doing other operations?

2. Could they not improve their profitability just by rejecting every CLL patient or only charging for a consultation and then rejecting every candidate?

3. People on these forums report greatly improving their outlook on life/feeling better about themselves after becoming taller. Do doctors find this outcome to be smaller/more of a nuisance compared to fixing someone with an actual physical deformity? I look at hair transplant surgeons and I know the comparison is not perfect but they are in some ways mainly treating the mind, not a physical body part.  And they believe, or at least say they do, that their work and mission helps people and is worthwhile.

And

4. Why 165cm upper limit? And do you think if the year was 1800 the limit would be more like 155 cm? Or if you were from the Netherlands it would be a higher limit like 170cm? I remember Dr Paley in one of his writings at first resisting to operate on a man from the netherlands because the man was still taller than the average male height.

I hope I asked these in respectful ways. I am just musing.

[Cooper]

Bd,
Did you ask if precise malfunction than what will be immediate solution. Do you get free nail and surgery or you have to pay entirely everything again. I hope it's not the latter.

Thanks

[Franz]

Dear Dr Fanz,

These questions below are a bit hypothetical. I don't mean it literally, and I do not mean to be disrespectful to people involved in CLL but I am curious what your thoughts on it are.

1. What is the motivation for LL surgeons to ever perform CLL? It seems like not much of the money from the surgery actually goes to the doctor, and I wonder with the very long process and hours spent that perhaps it is not financially worth it compared to doing other operations?

2. Could they not improve their profitability just by rejecting every CLL patient or only charging for a consultation and then rejecting every candidate?

3. People on these forums report greatly improving their outlook on life/feeling better about themselves after becoming taller. Do doctors find this outcome to be smaller/more of a nuisance compared to fixing someone with an actual physical deformity? I look at hair transplant surgeons and I know the comparison is not perfect but they are in some ways mainly treating the mind, not a physical body part.  And they believe, or at least say they do, that their work and mission helps people and is worthwhile.

And

4. Why 165cm upper limit? And do you think if the year was 1800 the limit would be more like 155 cm? Or if you were from the Netherlands it would be a higher limit like 170cm? I remember Dr Paley in one of his writings at first resisting to operate on a man from the netherlands because the man was still taller than the average male height.

I hope I asked these in respectful ways. I am just musing.

Thanks. With regards to points 1&2. Personally I believe there is merit in this surgery. See my post on the ethics of CLL elsewhere. This is a small part of most respected LL surgeons' practice and is certainly not as lucrative as other pursuits. On average around 10-15% of th cost of CLL ends up in the doc's practice and the profit margin on this amount is around 25% in most practices.
This means that for a 50K CLL, I personally take home 2K. Probably not worth it. Unless you count the fact that you're helping someone.
Point 3: it is certainly worthwhile. Changing height is almost like science fiction and fundamentally changes peoples lives. It is definitely life changing.
Yes, the limit is arbitrary. Consensus has it that CLL is worthwhile for individuals more than 2 standard deviations shorter than the average. This means 165 in most western societies. Is this acceptabe? I dont know.

[Cooper]

[quote author=Franz link=topic=237.msg7056#msg7056 date=
Point 3: it is certainly worthwhile. Changing height is almost like science fiction and fundamentally changes peoples lives. It is definitely life changing.

[/quote]

Great point Dr. F. I am forever grateful for your input and opinions. I am always excited to read your comments and get some invaluable information plus always great to hear the REAL doctor opinion.

I was cracking up when you commented...THIS FAKE DOCTOR HAS 8 operation to perform tomorrow on other thread with smiley face.

Your contribution is overwhelming and I truly hope and praying you will stay with us for a looooooong time.

[BilateralDamage]

Holy  ... I'm scheduled with Dr. Paley for May 29th!!!!!! 

This is becoming a reality fast!  Also booked my stay for one of Paley's recommended extended-stay hotels (because shuttle between hospital and hotel runs here so that way I don't have to rent a car).  Rate wasn't bad and it includes all handicap accessible amenities with also a kitchen within the room.

[alps]

Congrats dude! All the very best! 
Keep a detailed diary!

[BilateralDamage]

Congrats dude! All the very best! 
Keep a detailed diary!

Will do   I think there's a severe lacking of videos for LL patients doing physical therapy so I'm going to film a lot!

[Cooper]

Congrats BD... Looking forward to your diary.

[BilateralDamage]

Congrats BD... Looking forward to your diary.

Thanks Cooper!  I look forward to seeing the doctor you choose as well, it's been hell getting to this point.

[Cooper]

I am not able to focus on anything. So frigging difficult and I suppose should be that way. After all this can make or break a life and well being. You should be fine with Precise and especially with dr. Paley tutelage.

[Sweatpants]

Congrats, BD!!

It's getting more and more real for you
I'll be leaving Florida by the end of May, so probably would be only able to wish you luck here.
Anyway, best of luck, you r gonna be in goods hands all way long and I  sure you are not going to regret your choice.

[JP]

Hi Bilateral Damage,

Dr. Guichet does not recommend doing the ITB release. If your goal is more than 5 cm have you consider going to Doctor Guichet?

[mediocre]

You're all locked in.

All the best!

[BilateralDamage]

Congrats, BD!!

It's getting more and more real for you
I'll be leaving Florida by the end of May, so probably would be only able to wish you luck here.
Anyway, best of luck, you r gonna be in goods hands all way long and I  sure you are not going to regret your choice.

That's too bad, I wanted to be able to see you in person.   I truly know I'm in good hands with Dr. Paley, so I'm not nervous at all for the surgery!

Hi Bilateral Damage,

Dr. Guichet does not recommend doing the ITB release. If your goal is more than 5 cm have you consider going to Doctor Guichet?

Hey Drew, you're right, I saw leechlet's video on Guichet's explanation for it.  His reasoning was interesting, but I think all doctors have different opinions in every aspect on LL.  Even the world renown ones have differences in opinion, and for that reason, I made by decision based on experience of doctor.  Guichet is experienced, but I don't think anyone comes close to Dr. Paley's experience with CLL and LL.  Also, as for convenience sake, it made more sense for me to stay in the U.S. for my job.

You're all locked in.

All the best!

Thanks! 

[ChrisIsaak]

All the best, BD! 

[JP]

Hello,

Are you able to have surgery with Dr. Paley and not get a release?

[Disobedient]

Holy s**t... I'm scheduled with Dr. Paley for May 29th!!!!!! 

This is becoming a reality fast!  Also booked my stay for one of Paley's recommended extended-stay hotels (because shuttle between hospital and hotel runs here so that way I don't have to rent a car).  Rate wasn't bad and it includes all handicap accessible amenities with also a kitchen within the room.

that's about 70days from now.. you should really enjoy you're next 70 days and do all taboo in LL
like drinking , jumping , dancing 

all the best.

[BilateralDamage]

Hello,

Are you able to have surgery with Dr. Paley and not get a release?

Yes, but of course this depends on your consultation with him.  If he really recommends you to get an ITB release (which is included in the cost of the surgery) you should follow your surgeon's advice.

that's about 70days from now.. you should really enjoy you're next 70 days and do all taboo in LL
like drinking , jumping , dancing 

all the best.

Haha you bet!  I've been drinking more now to make up for lost time during LL.

[BilateralDamage]

All the best, BD! 

Thanks Chris!  I hope I can do LL as well as you did

Paley is the godfather of modern CLL and LL.
All the best bro

Cheers   You're in great hands with Dr. B too.

[BilateralDamage]

Additional Costs for LL

Hey guys!  Surgery's coming up soon so I thought I'd bump this thread and give everyone a quick update on what I'm expecting to spend outside my surgery.

So far I've got:

• Homewood Suites living for 3 months, includes fully furnished room and kitchen, dinner Monday - Thursday, breakfast everyday, pool, fitness room, handicap-accessible shuttle transport between Hotel and Dr. Paley's office (very important). Cost incl. taxes =  $6,433.56
• Caretaker. Unfortunately my girlfriend cannot assist me the first few weeks due to commitments so I will be on my own and hiring a caretaker.  I'm going to play it by ear and see how much help I truly need each day for the first 2 weeks.  United Nurses is very flexible and allows me to hire a caretaker 2 hours before I need them.  Cost = $20/hour.  I'm expecting to pay at least $1,000 for this service.
• Silical System 1,2 and Boost, 3 months supply.  Cost = $200.
• Flights Cost = $1,100.
• X-Rays + Consult with Paley pre-surgery.  Cost = $1,050

I'm expecting to pay at least $10,000 on top of the surgery, so try to account for these costs if you're going with Paley.

Forgot to add- I'm also bringing my car down to Florida (I'm having it delivered by truck shipping).  Cost = $600.  I won't be permitted to drive for at least 3 weeks after surgery, but after then I'll be permitted to drive (at my own peril and off of any pain meds).  I only want to drive down the road from my Hotel for quick Walmart runs.

Sentiment

Pretty excited and ready to get this over with.  I'm in extremely good physical shape right now and I intend on being one of Paley's fastest recoverers.  I'm going to be doing at least 4 hours PT daily and bringing my own exercise bike (will probably be living on this bike after my session with PT is complete each day).  8 cm is the goal, but I'll believe it when I see it. 

[Blackhawk]

Good luck BD!!!

When is the surgery?

[BilateralDamage]

Good luck BD!!!

When is the surgery?

Cheers BH

Surgery's on May 29th, 16 more days to go!

[Disobedient]

you must be counting the hours right now... 

all the best BD

[BilateralDamage]

you must be counting the hours right now... 

all the best BD

Approximately 15 days 9 hours 51 minutes and 25 seconds to go 

Thanks Diso!!