Second Consultation: Dr Manish Dhawan at Private ClinicAfter the consultation with Dr Verma I took a taxi back to Hotel Indira and hung out in my room for a while. It was nice to just browse the net and feel the cool breeze of the air conditioning. Around 7:30pm I took a taxi and arrived at Dr Dhawan’s clinic 15 minutes before my 8:00 pm appointment time. A male receptionist greeted me at the front desk and told me to have a seat. As usual I received intense stares from everyone inside the clinic that was waiting for Dr Dhawan in the main lobby. Soon a couple brought in their young daughter who was wearing a cast on her leg. From what I saw in the lobby, Dr Dhawan seemed to have a good mix of adult and child patients. After waiting for some time, Dr Dhawan rushed into the clinic wearing business casual attire and carrying takeout. After another 10 minutes of waiting the receptionist brought me into Dr Dhawan’s office and told me to sit at the desk and wait for him. I saw in the adjacent office that Dr Dhawan was checking on a patient currently. Taking a look around his office I saw various awards, pictures of himself at conferences, and a large assortment of models of different parts of the skeleton. The fan on the corner of the ceiling was focused on the chairs in front of Dr Dhawan’s desk and while I was sitting there people in the lobby were staring at me through the open door, which made the wait a little uncomfortable.
Dr Dhawan eventually came in at 8:30 and parked himself on his office chair. He reminded me a bit of the middle eastern guys in Beverly Hills that wear bling and have the top of their shirt unbuttoned. He asked with a very thick accent “So what questions do you have for me? What is your current issue?” I wasn’t sure how good his English was just judging by the accent but after telling him that I was there to consult about cosmetic lengthening it was clear from his response that he understood English perfectly. After brief small talk about how he remembered me from the e-mails I sent and how he just got back from the USA and Canada, he decided to get right to business and asked what questions I had for him. The consultation was about a half hour, cut short by the large amount of patients waiting for him in the lobby that he needed to see before he closed for the night. Here's what I took from the consultation.
1) He really stressed the point that cosmetic lengthening has to be done extremely carefully because you are performing surgery on a normal person to increase stature, so the outcome has to be absolutely perfect.
2) Two inches is the safe limit for him. Beyond that, he said your ankles and knee joints take a hit by starting to get stiff and can develop all sorts of problems. There's a risk of your legs going into valgus and also a risk of procurvatum with extensive lengthening beyond two inches.
3) Dr Dhawan prefers to lengthen with two methods. One method is LON. The other is doing very precise lengthenings with a hexapod fixator (basically India's version of the Taylor Spatial Frame). He much prefers lengthening with a hexapod because he can use computer software to exactly relocate your mechanical axis while lengthening if anything goes wrong. The thing with hexapod fixators is that you cannot put a nail inside while doing it.
4) Dr Dhawan said I have to make a choice between LON or hexapod. He said with LON I can remove the fixator early but I cannot do any adjustments with the nail inside, although the need for adjustments shouldn't be too much as the nail inside helps the bone form straight. However, he said with LON I should be less greedy with how much I lengthen, in addition to being aware that I can get a bone infection.
5) I told him of the concern I had with developing chronic knee pain if I choose LON and he said that he's found that people have had that problem, but that he prefers using the hexapod anyway because everything is under his control and there won't be any incidence of knee pain. The only drawback is the fixation time being equal to your typical external fixators.
6) Distraction will start 7 to 10 days after the surgery at a rate of 1 mm per day. The amount of time you would need to wear the hexapod is around 2 and a half times the amount of days you lengthened. So for 5 cm taking 50 days, you should expect to wear it for 150 to 200 days to be safe.
7) He would make you stop at 5 cm with LON but would let you go up to 7 cm for tibia lengthening with hexapod.
8 ) He would not do LATN because the regenerate is very soft and inserting the nail can harm it.
9) Told me I should not worry about the time it will take to remove the hexapod because I should pick the method that is safest. He said that he is a very careful surgeon and that he doesn't like to do "mass production" lengthening like certain other doctors. He will do the surgery "with perfection and not very fast". Dr Dhawan was also curious as to how I found him because he never advertises his services beyond posting medical info on his website.
10) Apparently people who went to Dr Sarin have come to see him for advice on how to fix their problems, so he's aware of the controversy that happened as former Sarin patients told him about the whole Sarin/Sysop deal that was going on. He said he also knows pretty much every limb lengthening surgeon because he is Secretary of Limb Lengthening Society of India.
11) I asked about the availability of internal methods and he said that although it is true that Precice is available, the issue is that he personally has never performed internal lengthening, nor has anyone else in India due to the lack of approval for use. He said that he has seen internals performed in front of him, Fitbone specifically when he had a fellowship in Germany, but that he has not performed it himself and will not use any method that he is not confident about. He said that he will only do lengthening with methods that he is an expert on and knows will safely make you taller and that he will not experiment on anybody.
12) Price for LON and hexapod is similar to what Dr Sarin charged before his price hike. Hexapod would cost a little more because software has to be purchased. Price would not cover follow up visits or stay in India, though on his website you can see a list of hotels where you can get anywhere from a 20% to 45% discount on your stay depending on which hotel you go to. The discount is for patients who are treated at Sir Ganga Ram Hospital, where Dr Dhawan performs surgery.
13) He will perform follow ups at either Sir Ganga Ram or his private clinic, whichever is more convenient for you.
14) He will talk to each prospective patient to judge for himself whether or not he believes the person is a candidate for limb lengthening. He will not perform surgery on anyone he thinks has some sort of "psychotic complex."
15) Doesn't necessarily have a height limit but discourages every person who comes to see him. Even for me at 165 cm, he didn't get why I would want the surgery. He said there are too many problems that can happen with limb lengthening, which is why according to him "a good surgeon is not one who does it [cosmetic lengthening] en masse. A good surgeon is one who knows how to handle the complications which happen with Ilizarov."
16) Will not let you bear weight during distraction. Once distraction is complete, then he will let you bear weight depending on the bone strength.
17) Said he would not do externals with monorails because you cannot change its axis, whereas with the hexapod everything is under his control. Believes that a good surgeon would not choose to use monorails for cosmetic cases. It was pretty funny because when I asked about using monorails he said "Why do you want to go and f*** yourself?"
18) I asked him about his opinion on fibula fixation and told him that I've seen other surgeons not fixate the fibula. He replied along the lines of "People who do not fixate the fibula are foolish people and they do not know limb lengthening. Fibula has to be fixated with angle at upper part and lower part." When I asked him about the dangers of avoiding it he said if you distract and the fibula is not fixed in both parts it will collapse. When I told him that I was told you only need the last few inches of the fibula by the joints he responded that without question it's mandatory to fixate both proximally and distally.
19) Said I could expect some pin tract infection, stiffness of ankle joints, and stiffness of knee while lengthening, but complications can be reduced by being conservative in the amount.
20) Suggests for people who want to do cosmetic lengthening that they go to the gym and bulk up their leg muscles for 6 weeks before surgery, in addition to stretching regularly.
21) Asked him if it's true you cannot get x-legs with LON and he said that it's very possible even with LON, especially if you lengthen higher amounts.
22) Will only lengthen femurs with monorails because he has experience with it, unlike internals. Said the limit for femurs would be 7 cm.
23) Follow ups will be every 10 to 15 days.
24) Asked him if he would perform limb shortening and he highly recommended against it because he said the "muscle gets pushed together and looks ugly."
25) Will do plate fixation if you really, really want it, but suggests to avoid it because of more scarring and possibility of infection.
After Dr Dhawan answered my last question, he called in a patient from the waiting room right as I shook his hand goodbye. The receptionist charged 2,000 INR for the consultation, twice as much as the fee for Rockland. I took one of those bike taxis back to the hotel and had a lot to think about. Dr Dhawan had effectively reduced the amount of consultations I planned to have by half. Speaking to him, it really drove the point home that I needed to do this with a specialist focused specifically on limb lengthening and not any orthopedic surgeon who will also do it. This is why I decided not to consult with the Spinal Injuries Center or Dr Murthy.
Photos By ClinicJust a couple pics. One of the outside of his clinic and one of a relaxing park across the street.
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Topic: No More Mal-Kahn-Tent - External Tibias - Dr Parihar (Read 445816 times)