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[Argent_Lecter]

Hello there,

I've been reading here since 2015 and FINALLY I made up my mind - I decided it that I want the surgery. But with the big decisions, the doubts come right to you: "What doctor will I give my legs to?"

The first one I had in consideration was Dr Sarin, from India, although after reading some of his patients' diaries I got a bit scared, so I discarded him. Obviously Dr. Paley is in the minds of many, but it is too expensive and I have to be realistic... I cannot afford him. Dr Xia, some Russian doctors and other Indians were my options, however I was still doubtful and started to think about ditching my dream of gaining a few inches.

Days ago I read about Dr. Pili, from Italy, and boy, I think this is it. Could any of his patients tell me if it's worth going 8 to 9 months to Italy by myself and start this trip to be taller? It would be really nice to read some of your opinions or experiences.

Take care y'all.

- A. Lecter

[myloginacct]

Most of his and Catagni's patients stopped posting here.

You need to go into the patients' diaries section of the forum and use the search terms "Pili" or "Catagni".

Sarin is called a "butcher" around these parts, and a Chinese user recently warned us Xia is not even a certified doctor in China. Sringari also had terrible results. India is a non-option unless you go to Parihar (based on all of what I have read in my time here).

I'm not one of his patients, but I can at least share my opinion. My main issue with Pili is that he seems to be fine with almost anything (e.g. lengthening 8cm on tibias, patients traveling far away post-op). However, I respect Catagni a lot and their patients had good results so far. That's all I can say without being a LL veteran.

[Body Builder]

Go to Pili and especially Catagni for external tibias and do about 6cm without problems.

But never let him perform you atl surgery to lengthen more because you'll simply be crippled.
So yes, Pili is a very good option for externals but stay away from atl at all costs.

[Argent_Lecter]

Most of his and Catagni's patients stopped posting here.

You need to go into the patients' diaries section of the forum and use the search terms "Pili" or "Catagni".

Sarin is called a "butcher" around these parts, and a Chinese user recently warned us Xia is not even a certified doctor in China. Sringari also had terrible results. India is a non-option unless you go to Parihar (based on all of what I have read in my time here).

I'm not one of his patients, but I can at least share my opinion. My main issue with Pili is that he seems to be fine with almost anything (e.g. lengthening 8cm on tibias, patients traveling far away post-op). However, I respect Catagni a lot and their patients had good results so far. That's all I can say without being a LL veteran.

Hi man, I've read most of their patient's diaries and they seem to be doing pretty good.

Yeah I know Sarin's reputation, he fked up Sweden and some others. I'm not fking going there to be 'butchered'.

Right now my options are Pili or Salameh in Germany. Is he good for what you know?

My goal is to lengthen like 6 cm MAX and not getting by any means the ATL surgery because obvious reasons.

Take care buddy, thanks for the info.

- A. Lecter

[Argent_Lecter]

Go to Pili and especially Catagni for external tibias and do about 6cm without problems.

But never let him perform you atl surgery to lengthen more because you'll simply be crippled.
So yes, Pili is a very good option for externals but stay away from atl at all costs.

Pili and Catagni seem like my particular best option based on budget, language (I speak italian and I have family there) and location because it's kinda scary going to india or russia by myself.

I'm not doing the atl surgery, that's just not an option.

Take care man.

- A. Lecter

[Great321]

I sent an email to Dr. Pili today:

Dear Dr. Pili,
 
I have read good things about you and I’m planning to do this surgery (5-6cm – external tibia) soon.
I have a few questions:

1. Is it possible to get an surgery appointment by the end of August or in September?
2. Do you recommend (for safety reasons) to stay in Italy for the lengthening and consolidation phase?
3. If I aim 5-6cm how long does it take until the frames come off?
4. What location do you recommend for me to stay a few to several months that are not too expensive (less than 500/month) and not too far away from an airport?
5. How much PT is needed and how much does it cost?

His answer a few hours later:

You can have indeed 5-6 cm with HEF on tibia, it should take 7-11 months.
You can have an appointment with me in August-September.
http://drpiliortopedico.it/bookings/ for bookings

You can stay in Italy in Lecco for as long as you like. There are apartments you can rent for around 500 € and we will help with visa.

The surgery costs 19-20.000 €, if Achilles tendo lengthening is needed (80% chance) it will cost you around 4500 €, for frame removal another 3500 €.


Kind regards

Dr D Pili
info@drpiliortopedico.it
www.drpiliortopedico.it


Is the Achilles tendo lenghtening really that common? I think it's strange that the cost of the frame removal isn't added to the price in the first place. On their website it's also written that full consolidation takes up to 5-6 months for 8cm. But he wrote me something with 7-8 months for 5-6cm ...?? I don't understand that

[..]

I sent an email to Dr. Pili today:

Dear Dr. Pili,
 
I have read good things about you and I’m planning to do this surgery (5-6cm – external tibia) soon.
I have a few questions:

1. Is it possible to get an surgery appointment by the end of August or in September?
2. Do you recommend (for safety reasons) to stay in Italy for the lengthening and consolidation phase?
3. If I aim 5-6cm how long does it take until the frames come off?
4. What location do you recommend for me to stay a few to several months that are not too expensive (less than 500/month) and not too far away from an airport?
5. How much PT is needed and how much does it cost?

His answer a few hours later:

You can have indeed 5-6 cm with HEF on tibia, it should take 7-11 months.
You can have an appointment with me in August-September.
http://drpiliortopedico.it/bookings/ for bookings

You can stay in Italy in Lecco for as long as you like. There are apartments you can rent for around 500 € and we will help with visa.

The surgery costs 19-20.000 €, if Achilles tendo lengthening is needed (80% chance) it will cost you around 4500 €, for frame removal another 3500 €.


Kind regards

Dr D Pili
info@drpiliortopedico.it
www.drpiliortopedico.it


Is the Achilles tendo lenghtening really that common? I think it's strange that the cost of the frame removal isn't added to the price in the first place. On their website it's also written that full consolidation takes up to 5-6 months for 8cm. But he wrote me something with 7-8 months for 5-6cm ...?? I don't understand that

So 25.000 € in total. Wow! That's just about 1/4 of Paley's price.

[LongueEpopée]

So 25.000 € in total. Wow! That's just about 1/4 of Paley's price.

is it me or you're just comparing internal price (paley) with external price (pili) ?

[..]

is it me or you're just comparing internal price (paley) with external price (pili) ?

Does Paley do external? I only found his PRECICE price here.

[myloginacct]

Does Paley do external? I only found his PRECICE price here.

He doesn't. He uses Precice internals even for tibias.

I think he only uses external fixators for non-cosmetic cases, from what I recall reading in some diaries. I know he did use them cosmetically in the past, though. He showcased his CLL results on achondroplastic patients, which, as far as I'm aware, were done with externals since an early age, as those achondroplastic children grew and developed into adults. So, before their growth plates were closed.

[Great321]

E-Mail to Dr. Pili

1.   I will soon book an appointment. How long after consultation do I have to wait for surgery?
On your webiste it’s stated that consolidation for 8cm is about 5-6 months:
„Usually it takes around 100 days for lengthening up to 8 cm and 5-6 months to achieve a full consolidation.“  Why would it take longer for less cm?

2.   Do I need visa as a German citizen if I want to stay for multiple months?
3.   Is the Achilles tendo lengthening risk percentage the same if you do 5cm or more than 5cm?

Dr. Pili's answer

Usually after the consultation around 2-3 months but sometimes I can offer some last minute spaces.
Consolidation time is pretty much the same for 5 or 8 cm.
A german citizen can stay as long as he wishes without a visa.
For ATL, lengthening 5 cm is around 40-50%.

(He didn't answer my first question really)

[..]

He doesn't. He uses Precice internals even for tibias.

I think he only uses external fixators for non-cosmetic cases, from what I recall reading in some diaries. I know he did use them cosmetically in the past, though. He showcased his CLL results on achondroplastic patients, which, as far as I'm aware, were done with externals since an early age, as those achondroplastic children grew and developed into adults. So, before their growth plates were closed.

But I thought we should only do tibia with external?

By the way, I send an email to Dr. Pili too.

E-mail to Dr. Pili

Hi Dr. Pili,

My main concern with the surgery is the safety and athletic recovery. To be frank, I am a devoted martial arts practicioner. On the other hand, I also worry that I might not end up taller, but on a wheelchair or even dead instead. I don't know how true it is but I read that LL could cause some serious nerve damage and infection which can lead to death.

So basically, I'd like to know what is the chance of me ending up being permanently disabled or dead if I follow anything you say? And how much athletic recovery could I expect post-surgery in comparison to the original athleticsm?

Dr. Pili's answer

I can reassure you will not end up on a wheelchair or dead! On the other hand I have to warn you that to go back to full martial arts you will need at least 18-20 months.
Where are you from? You should come to Italy for a consultation in order to discuss the details and see weather you are a good candiate for this surgery.

Wow he gives a full assurance

[myloginacct]

E-Mail to Dr. Pili

1.   I will soon book an appointment. How long after consultation do I have to wait for surgery?
On your webiste it’s stated that consolidation for 8cm is about 5-6 months:
„Usually it takes around 100 days for lengthening up to 8 cm and 5-6 months to achieve a full consolidation.“  Why would it take longer for less cm?

2.   Do I need visa as a German citizen if I want to stay for multiple months?
3.   Is the Achilles tendo lengthening risk percentage the same if you do 5cm or more than 5cm?

Dr. Pili's answer

Usually after the consultation around 2-3 months but sometimes I can offer some last minute spaces.
Consolidation time is pretty much the same for 5 or 8 cm.
A german citizen can stay as long as he wishes without a visa.
For ATL, lengthening 5 cm is around 40-50%.

(He didn't answer my first question really)

Consolidation varies on an individual by individual basis. If you are young, don't smoke, have wider, strong bones, have been blessed by good genetics, are getting great nutrition and calcium+vitamin d3 suppplementation, doing all you should be doing, your consolidation will be better than someone who is doing the bare minimum and and eating like crxp.

Anyone feel free to correct me if I'm wrong.

[Android]

He doesn't. He uses Precice internals even for tibias.

I think he only uses external fixators for non-cosmetic cases, from what I recall reading in some diaries. I know he did use them cosmetically in the past, though. He showcased his CLL results on achondroplastic patients, which, as far as I'm aware, were done with externals since an early age, as those achondroplastic children grew and developed into adults. So, before their growth plates were closed.

Correct. For cosmetic patients it's only Precice for all leg segments.

Patients requiring complex deformities may use externals like the TSF, since that's what the device excels in.

[..]

Correct. For cosmetic patients it's only Precice for all leg segments.

Patients requiring complex deformities may use externals like the TSF, since that's what the device excels in.

Android. I thought it's best to use externals for tibia?

[Argent_Lecter]

I sent an email to Dr. Pili today:

Dear Dr. Pili,
 
I have read good things about you and I’m planning to do this surgery (5-6cm – external tibia) soon.
I have a few questions:

1. Is it possible to get an surgery appointment by the end of August or in September?
2. Do you recommend (for safety reasons) to stay in Italy for the lengthening and consolidation phase?
3. If I aim 5-6cm how long does it take until the frames come off?
4. What location do you recommend for me to stay a few to several months that are not too expensive (less than 500/month) and not too far away from an airport?
5. How much PT is needed and how much does it cost?

His answer a few hours later:

You can have indeed 5-6 cm with HEF on tibia, it should take 7-11 months.
You can have an appointment with me in August-September.
http://drpiliortopedico.it/bookings/ for bookings

You can stay in Italy in Lecco for as long as you like. There are apartments you can rent for around 500 € and we will help with visa.

The surgery costs 19-20.000 €, if Achilles tendo lengthening is needed (80% chance) it will cost you around 4500 €, for frame removal another 3500 €.


Kind regards

Dr D Pili
info@drpiliortopedico.it
www.drpiliortopedico.it


Is the Achilles tendo lenghtening really that common? I think it's strange that the cost of the frame removal isn't added to the price in the first place. On their website it's also written that full consolidation takes up to 5-6 months for 8cm. But he wrote me something with 7-8 months for 5-6cm ...?? I don't understand that

Thanks for the info man! it really helped me.

I'm pretty convinced with Pili... except for the ATL surgery. I don't trust that and I think the recovery that will be longer or you'll be movement-limited for life. That's just my opinion but I'd better ask a few doctors that I know to see what they think about it.

Does anyone here in this forum has had the ATL surgery? Did you recover after it?

- A. Lecter

[Argent_Lecter]

is it me or you're just comparing internal price (paley) with external price (pili) ?

Pili charges like 50 K for internals, I guess.

[Body Builder]

Thanks for the info man! it really helped me.

I'm pretty convinced with Pili... except for the ATL surgery. I don't trust that and I think the recovery that will be longer or you'll be movement-limited for life. That's just my opinion but I'd better ask a few doctors that I know to see what they think about it.

Does anyone here in this forum has had the ATL surgery? Did you recover after it?

- A. Lecter

Me. And no I havent and noone recovers in an acceptable degree.
Atl should be banned, simply as that.

1 year before I did at shortening and now I am much better though. If I've left myself with atl I would be ruined forever.

[Great321]

but if the doctor says ATL is necessary what should you do then ? does it help to stop lengthening? what if it's too late?

[myloginacct]

but if the doctor says ATL is necessary what should you do then ? does it help to stop lengthening? what if it's too late?

E-mail doctors like Paley, Birkholtz, Solomin, Kulesh, and get their opinions. No one in this forum can appropriately answer a medical question like that.

One paper I read did suggest physiotherapy could deal with external fixator lengthening problems rather than straight ATL. But if your doctor says you need ATL, what are you gonna do? You're not an orthopedic surgeon to make a medical call about your specific instance. Get the most opinions you can on this.

[myloginacct]

You can probably ask Pili himself why he believes ATL is generally so needed too. But get more opinions to be safe.

[Android]

Android. I thought it's best to use externals for tibia?

Dr. Paley's reasoning is that the benefits outweigh the cons. Cosmetic patients are much pickier, and they often do bilateral lengthening unlike correction patients (e.g. limb length discrepancy), which make discomfort a point of complaint. From what I've read anterior knee pain risk is lowered with the correct technique, so that probably solidified his decision to go all-in with Precice (he is a consultant for them after all).

Edit: typo, "picker" to "pickier".

[..]

Dr. Paley's reasoning is that the benefits outweigh the cons. Cosmetic patients are much picker, and they often do bilateral lengthening unlike correction patients (e.g. limb length discrepancy), which make discomfort a point of complaint. From what I've read anterior knee pain risk is lowered with the correct technique, so that probably solidified his decision to go all-in with Precice (he is a consultant for them after all).

Which one would you rather do or believe is safer?

Femur with PRECICE2/3 by Dr. Paley or Tibia with Hybrid external fixator by Dr. Catagni (If am not mistaken, the best Dr. for external?)

There will be a huge discrepancy in cost between the two although I am not sure which one would result in less long-term complications and loss of functionality.

[Argent_Lecter]

Femur with PRECICE2/3 by Dr. Paley or Tibia with Hybrid external fixator by Dr. Catagni (If am not mistaken, the best Dr. for external?)

HEF with Pili/Catagni on tibiae and PRECICE with Paley but in femurs.

[..]

HEF with Pili/Catagni on tibiae and PRECICE with Paley but in femurs.

Yeah, I was asking if we had to choose between the two, which one wins?

Thing is lengthening only femurs would not look aesthetically pleasing whereas long tibia and higher knee level will make you look visually taller especially if you're wearing shorts. But safety and athletic recovery are the priority.

[Android]

Which one would you rather do or believe is safer?

If money was no concern, I'd go with Precice out of convenience. I'd swallow the risk since it'd be a smoother experience overall, plus the ERC would make lengthening a mindless task. Less scars too.

But in reality, I'd go with bilateral external tibias and put the savings toward something else. It's much better tolerated unlike external femurs. As for scars, that's what my leg hairs are for!

[..]

If money was no concern, I'd go with Precice out of convenience. I'd swallow the risk since it'd be a smoother experience overall, plus the ERC would make lengthening a mindless task. Less scars too.

But in reality, I'd go with bilateral external tibias and put the savings toward something else. It's much better tolerated unlike external femurs. As for scars, that's what my leg hairs are for!

So you believe that on paper, uniteral external tibias are technically the safest method compared to anything else even when it's not done by Paley? Which doctor is the best for external tibias?

[Android]

So you believe that on paper, uniteral external tibias are technically the safest method compared to anything else even when it's not done by Paley? Which doctor is the best for external tibias?

Just a reminder that I haven't done CLL yet, so don't take my replies as hard advice. A memorable avatar and posting frequency is no substitute for experience.

That being said, I wouldn't say unilateral external tibias is necessarily safer than bilateral, just more convenient to have a fully working leg (frames are weight bearing though, so not as beneficial as unilateral internals IMO). Doing unilateral means you'd have to go under general anesthesia and take pain killers more times, which can be seen as a risk, not to mention paying more (surgery, hospital stay, PT, accommodation, etc.). In the end you have to balance and decide which pros and cons make sense to you: safety, convenience, duration, pain level, etc.

Even veterans usually only have one doctor, so it's hard to say who is the best (but they certainly have a better idea on what to look for). I tend to agree with what has been echoed in this community: Dr. Catagni/Pili, Dr. Birkholtz, Dr. Parihar, and Dr. Solomin/Kulesh. I even suggest Dr. Mahboubian; his latest diaries are all for Precice, but I believe he still offer externals (who knows, maybe Dr. Rozbruch might too). They're all published contributors in their field and are relatively conservative in their treatment methods.

[fokid]

What is not spoken of enough about unilateral CLL is that you have to decide on a length while lengthening the first leg and stick to the same length in the other leg afterwards. If you lengthen 7cm on your good leg and your bad leg has bad nerve pain and preconsolidation at 5cm you cannot stop because you would then have a 2cm discrepancy.

If this wasn't an issue I would have recommended unilateral for anyone who can afford it and has the time. Also you will generally have a better and more productive time dealing with one leg at a time.

[..]

Just a reminder that I haven't done CLL yet, so don't take my replies as hard advice. A memorable avatar and posting frequency is no substitute for experience.

That being said, I wouldn't say unilateral external tibias is necessarily safer than bilateral, just more convenient to have a fully working leg (frames are weight bearing though, so not as beneficial as unilateral internals IMO). Doing unilateral means you'd have to go under general anesthesia and take pain killers more times, which can be seen as a risk, not to mention paying more (surgery, hospital stay, PT, accommodation, etc.). In the end you have to balance and decide which pros and cons make sense to you: safety, convenience, duration, pain level, etc.

Even veterans usually only have one doctor, so it's hard to say who is the best (but they certainly have a better idea on what to look for). I tend to agree with what has been echoed in this community: Dr. Catagni/Pili, Dr. Birkholtz, Dr. Parihar, and Dr. Solomin/Kulesh. I even suggest Dr. Mahboubian; his latest diaries are all for Precice, but I believe he still offer externals (who knows, maybe Dr. Rozbruch might too). They're all published contributors in their field and are relatively conservative in their treatment methods.

Don't worry. Not taking what you said as hard advice but in general I see that you post good stuffs.

Yeah you're right, we should factor the anesthesia and painkillers too. I just thought with unilateral, if the surgery goes south, you'd still have the other healthy leg. But with bilateral, you might lose both legs. Isn't that so? Not to mention less risk for fat embolism.

I think Paley might have decided not to do external because he makes more money doing PRECICE and not because classic Illizarov is obselete.

What is not spoken of enough about unilateral CLL is that you have to decide on a length while lengthening the first leg and stick to the same length in the other leg afterwards. If you lengthen 7cm on your good leg and your bad leg has bad nerve pain and preconsolidation at 5cm you cannot stop because you would then have a 2cm discrepancy.

If this wasn't an issue I would have recommended unilateral for anyone who can afford it and has the time. Also you will generally have a better and more productive time dealing with one leg at a time.

If we could follow the rules and don't lengthen more than 5cm, do you think it'd still be an issue? I just want the safest scenario possible.

[Android]

Yeah you're right, we should factor the anesthesia and painkillers too. I just thought with unilateral, if the surgery goes south, you'd still have the other healthy leg. But with bilateral, you might lose both legs. Isn't that so? Not to mention less risk for fat embolism.

Even if things went really badly with bilateral, losing function of both legs doesn't sound likely to me. If something went wrong, it'd be isolated to one leg. Surely it's possible, but it's like being struck by lightning twice.

I think Paley might have decided not to do external because he makes more money doing PRECICE and not because classic Illizarov is obselete.

Correct. Externals are superior when it comes to complex deformities or fractures, since they offer six axis of manipulation, which is just not possible with a telescoping internal rod. It's an easier decision to say "internals only for cosmetic patients" since it's relatively simple and it offers a more pleasant experience (and since it's elective surgery, the high price can be justified).

And indeed, Dr. Paley is a paid consultant for Precice, and receives royalties (second to last page). I don't think it's a bad thing since obviously it's a great product, and therefore this relationship makes it a no-brainer to feature it front and center. You can also tell by how he talks about the device that he's passionate about it, so I believe that he sincerely believes in the product too.

If we could follow the rules and don't lengthen more than 5cm, do you think it'd still be an issue? I just want the safest scenario possible.

As you may have seen elsewhere, I think it's relatively safe as long as lengthening is around 20% of the initial bone length. What's most important seems to be: stay near clinic during distraction, regular PT, diet conducive to bone healing, maintain weight, slow down distraction rate if necessary, and to not hesitate to ask the clinic for any reason if you suspect something is wrong (there are no stupid questions when your limbs are on the line).