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[tacoma94]

Hi,

I have been reading medical articles about LATN/LON and I am very concerned about severe complications. To my knowledge, CLL has the following severe complications:
1. Pulmonary Embolism
2. Deep Vein Thrombosis
3. Deep Infection

I initially wanted to do STRYDE, but decided against it due to the greater risk of PE (4% have symptons, according to Paley). I am deciding on tibial methods, but not pure externals due to time (I have 4-5 months, looking to gain 4-4.5cm MAX, and understand that this could be 8 months in frames). As of now, I am looking at Donghoon Lee, who I understand is very experienced in LATN/LON+Tibias.

Have these questions:
1. Tibias is safer than Femur for PE (and DVT, I think? Might be mixing up). But LATN/LON still involves reaming and internal nail. Would their risk be lower compared to something like pure tibias internal (maybe due to holes already being created due to externals?). Does LATN/LON have a difference in safety wrt to PE and DVT? And IF it occurs, how can they fix it?
2. In a good hospital, like Dr Lee's, is deep infection a serious risk? And IF it occurs, how can they fix it?

[dreamingtall]

Hi,

I have been reading medical articles about LATN/LON and I am very concerned about severe complications. To my knowledge, CLL has the following severe complications:
1. Pulmonary Embolism
2. Deep Vein Thrombosis
3. Deep Infection

I initially wanted to do STRYDE, but decided against it due to the greater risk of PE (4% have symptons, according to Paley). I am deciding on tibial methods, but not pure externals due to time (I have 4-5 months, looking to gain 4-4.5cm MAX, and understand that this could be 8 months in frames). As of now, I am looking at Donghoon Lee, who I understand is very experienced in LATN/LON+Tibias.

Have these questions:
1. Tibias is safer than Femur for PE (and DVT, I think? Might be mixing up). But LATN/LON still involves reaming and internal nail. Would their risk be lower compared to something like pure tibias internal (maybe due to holes already being created due to externals?). Does LATN/LON have a difference in safety wrt to PE and DVT? And IF it occurs, how can they fix it?
2. In a good hospital, like Dr Lee's, is deep infection a serious risk? And IF it occurs, how can they fix it?

Is this Dr. Lee himself ?

[TemakiSushi]

If you are doing tibias with Donghoon, no worries about PE and DVT
Even if you get those you’ll be fine as long as you are monitored by medical staff staying at hospital
You’ll be at the hospital for at least 120 day
Even with tibias they put tubes post surgery to control down the pressure in the compartment of calf muscle and this can reduce edema afterward
With external tibias, it’s very common to get superficial pin site infections, possibly you’ll get it a few times during that 120 days
But they claim they never had deep bone infection. I never heard of such cases from their veterans
Still I recommend you to do the surgery during winter so that you’ll lower the chance of infections
They will actually recommend you to do LON than LATN
Long ago it was considered LATN has faster bone consolidation, but then with Donghoon method, LON bone consolidation became faster.  BMAC is included during the surgery.
You are still young so don’t worry too much about slow consolidation

[tacoma94]

Hi TemakiSushi,

Thank you so much for replying! See you on a lot of posts here. Wanted to check, why do I need 120 days at least? I'm only doing 4-4.5cm. 9 days surgery and post op + 45 days lengthening + rest time and frames removal maybe 21 days + 15 days recovery is only 90 days in hospital.

[TemakiSushi]

Oh I see if it’s only 4cm, average is 90days, it’s confirmed
But I don’t know if they have 90 days package price for LON
In the price list there is only 120 days package is listed for LON
You will not be lengthening 1 mm a day unless you have very fast consolidation
Average actual lengthening amount is 0.5mm a day
They let you turn the bolts 1 mm a day but actual lengthening in X-rays will be much less since muscles will pull back at the beginning when lengthening amount is less than 3cm
Also after finish lengthening you’ll need around 1 to 2 weeks to adjust bone alignment precisely especially if you have bowlegs or xlegs

BTW Many people are fooled by turning amount and cheated by doctors in other countries


Stryde should come out soon

Price list of Precice and LON in KRW and USD
https://imgur.com/J98CdRY

[Great321]

They will actually recommend you to do LON than LATN
Long ago it was considered LATN has faster bone consolidation, but then with Donghoon method, LON bone consolidation became faster. 

What other method do they use to make consolidation faster with LON? Does their new method also reduce the deep infection risk that comes with LON? Because with LATN the infection risk is a bit lower.

With the LATN technique, there is no concomitant use of internal and external fixation, and this should lower the risk of infection. In the lengthening over a nail procedure, if a pin tract infection occurs during the distraction phase, the presence of the nail increases the chances that the infection will spread to become a deep infection.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628243/

[TemakiSushi]

What other method do they use to make consolidation faster with LON? Does their new method also reduce the deep infection risk that comes with LON? Because with LATN the infection risk is a bit lower.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628243/

BMAC helps consolidation
Also alignment is very important for faster consolidation
There are a few cases of misalignment I’ve known from other doctor who does only unilateral. 
The consolidation was very slow or even got  non union case.
Then they went to Donghoon to do the other leg.  Consolidation was much faster like twice as fast as the first misaligned legs
His aighment technique is superb.  very meticulous adjustment he makes upon the completion of lengthening.  Sometimes it takes a few weeks to adjust well with External frames
If slight knee contracture is present, alignment will not be good, so he waits till the slight knee contracture is overcomed by stretching

he doesn’t use regular frames as it is and modified LON frames to get better adjustment

Also they give lots food at hospital such as beef, chicken, pork, soy beans, milk, fish, shells etc..
Supplements aren’t really needed with their food

After seeing lots cases, I’m worried about the dent on the front side of the shins like yours and Jolien

They never have deep bone infections
So there’s no merit of doing LATN unless there’s severe deformity

The inputs from their site
—————-
However, there are some potential weaknesses of LATN. After the lengthening period, a correction period is added. Hence, an external fixator needs to be maintained for an additional 2-4 weeks, compared to LON. Also, one or two more external fixator pins are inserted than in LON. The LATN method was established by Dr. Rozbruch. (https://www.ncbi.nlm.nih.gov/pubmed/18800209), Before he solved the disadvantages of conventional LON (valgus change and bone formation – this is explained in the LON section.), Dr. Donghoon Lee used LATN more than LON.

However, since he has now solved these two problems, he uses the LON method more often for general stature lengthening; it is simpler and less expensive than LATN. In some cases, such as small bone canals, short bone length, and when the intramedullary nail cannot be inserted because of severe deformation, LATN is still the best option. LATN is also very useful in treating many rare diseases that are otherwise difficult to cure.

[Great321]

After seeing lots cases, I’m worried about the dent on the front side of the shins like yours and Jolien

Thanks for the information! Sure it'll help other future LLers. Let's see. I might try "extracorporeal shockwave therapy" if it won't look better in the next X-rays. Have you heard of it?

[TemakiSushi]

Thanks for the information! Sure it'll help other future LLers. Let's see. I might try "extracorporeal shockwave therapy" if it won't look better in the next X-rays. Have you heard of it?

Also for faster consolidation they use ultrasound treatment for some patients.

Paley use Forteo teriparatide
But be careful with this medicine since it’s prohibited to use for more than 2 years in ones life
Considered it may leave some damage in brain if used for a long period

[Great321]

Also for faster consolidation they use ultrasound treatment for some patients.

Paley use Forteo teriparatide
But be careful with this medicine since it’s prohibited to use for more than 2 years in ones life
Considered it may leave some damage in brain if used for a long period

In this German newspaper for doctors, it says that ultrasound has no effect for consolidation. https://www.aerztezeitung.de/Medizin/Ultraschall-bei-Fraktur-ohne-Nutzen-299777.html

I found the study in English: https://www.ncbi.nlm.nih.gov/pubmed/27797787

Conclusion:

Postoperative use of LIPUS (low intensity pulsed ultrasound) after tibial fracture fixation does not accelerate radiographic healing and fails to improve functional recovery

Letztlich, so die Forscher, lässt sich relativ sicher sagen, dass der Ultraschall die Patienten weder schneller arbeitsfähig macht noch Folgeoperationen verhindert oder die radiologische Heilung beschleunigt. Auch werden Schmerzen nicht signifikant gelindert, und die Zeit bis zur vollen Belastbarkeit wird nicht verkürzt – für diese beiden Schlussfolgerungen sehen die Forscher auf Basis der wenigen qualitativ hochwertigen Studien sogar eine sehr gute Evidenz.

--> This basically says that the scientist say that it is very certain that ultrasound doesn't help because of the qualitative studies which are very good evidence.

[TemakiSushi]

Yes I heard in some cases it doesn’t really help much.
Especially when callus is dead it doesn’t work, so for non union case there’s no hope with it
Still ultra sound treatment is done to many fracture cases in Japan also and it’s covered by national insurance
There were studies done about some effectiveness of ultrasound treatment at some point otherwise this doesn’t get approved by government
 Paley also recommended ultrasound to some patients like DIFM

So it’s still considered it can be effective in some cases

Anyways exogen is not that expensive when it’s covered by insurance
I’ll try experiment on my bones

Also I think if enough evidence of the shockwave, which is supposed to be 1000 times stronger than ultrasound waves, are safe and effective, it’s very possible Paley or Donghoon may be using it already now or in the near future
Starting New treatment is good business wise also

[California2]

I would caution you to consider how much weight to give to a poster who has not had the surgery and seems intent on pushing folks toward a specific surgeon.

I am NOT suggesting anything is wrong with the surgeon as a surgeon; rather, I am telling you that some surgeons hire persons to post on this forum in effort to drive more traffic to those surgeons.

Leg lengthening is an elective surgical procedure.  Like any major surgery, leg lengthening involves all of the risks about which you are concerned.  This means that by doing leg lengthening, you are accepting risks that are NOT medically necessary to increase height; just as a person who gets breast implants is accepting risks that are not medically necessary to improve breast appearance.

However, every reputable leg lengthening surgeon is well aware of the risks of surgery and the likelihood of such risks for any particular patient; AND, every reputable surgeon will take steps to minimize those risks.

No matter the precautions taken, NO ONE can guarantee that any particular patient will avoid a complication or an unfortunate result.  In fact, I would be quite hesitant to use any surgeon who claims that complication "X" never happens with him or her.  Even if the claim is accurate, all that such a claim means is that the complication has not happened YET.

Making a claim that a particular surgeon will never have a particular complication is like a lawyer saying he or she never lost a case.  I occasionally encounter lawyers who tell me they never lost a trial--when I hear such claims I know the claim only means that the lawyer has not handled many trials.

Likewise, there is no magic pill or process to aid recovery.  Good general health, good nutrition, an experienced surgical team in a modern facility, and a willingness to follow the advice of that team will result in a good outcome in the vast majority of cases--but not all cases.

In the unlikely event that you do all of the foregoing; yet, something bad happens, it is important to have a surgical team that has handled whatever bad thing before and has a plan to deal with your particular bad thing.

[Donghoon Lee fan]

Donghoon is actually one of the most experienced LL surgeons in the world. He have a hospital where patient stays and nurses, physical therapist and Donghoon himself keeps checking for complications.

[California2]

To be clear--I am NOT saying anything against Donghoon Lee. 

I considered him but decided against him primarily because he charges U.S. prices for services in Korea.  If I am going to pay full price; then, I might as well go down the road to Mahoubian who is in my back yard.

When you are deciding among the pool of top leg lengthening surgeons, in order to go out of your own country, you should have a good reason.

For me, I was never willing to pay ANYONE $100K for leg lengthening.  However, when I learned I could go to Saint Petersburg, Russia, and get the services of some of the top level leg lengthening surgeons in the world for $20K rather than $100K; then, the fear, uncertainty, and inconvenience of going to another country for the surgery became worth it for me.

However again, everyone should do his and her own analysis.  Because something was worth it for me does not mean the same for you.

My earlier message was about recommending caution in giving too much weight to posters who have not had the surgery but regularly talk as if they were knowledgeable while making claims about the purported greatness of a particular surgeon.

All of the top-shelf surgeons are about the same in terms of skill set.  Who you select among the top-shelf surgeon deals more with price, the particular technique offered or recommended for your desired goal, and convenience.

[TemakiSushi]

I would never choose a doctor for a convenience
If Paley had lower than 5% rate of persistent knee pain, and if Donghoon had a higher rate of knee problems, I would definitely choose Paley
But reality is opposit
I almost jumped into Florida before deeply researched

[Great321]

Yes I heard in some cases it doesn’t really help much.
Especially when callus is dead it doesn’t work, so for non union case there’s no hope with it
Still ultra sound treatment is done to many fracture cases in Japan also and it’s covered by national insurance
There were studies done about some effectiveness of ultrasound treatment at some point otherwise this doesn’t get approved by government
 Paley also recommended ultrasound to some patients like DIFM

So it’s still considered it can be effective in some cases

Anyways exogen is not that expensive when it’s covered by insurance
I’ll try experiment on my bones

Also I think if enough evidence of the shockwave, which is supposed to be 1000 times stronger than ultrasound waves, are safe and effective, it’s very possible Paley or Donghoon may be using it already now or in the near future
Starting New treatment is good business wise also

I think it is very interesting that people choose to believe what they want if it fits their mind they already made up. They believe only in certain statistics but the other facts are ignored since your favorite doctor is a flawless god. Pretty sure Paley and whoever have used ultrasound before the better study was published. I hope he doesn't offer it anymore though.

To everyone else who isn't biased I suggest you to not waste your time and money (as in some countries you have to pay it yourself). Look for better options that aren't officially disproven by science!

Believe me once you're in nails with a very slow bone growth you don't want to waste your time and experiment too much with your body. Time will be running and you will want to avoid that next surgery that could not even be helping.

[tacoma94]

Thank you so much for this. This is true. Where do you recommend I get good statistics about doctors? Can doctors lie about statistics? I want the grim truth, no matter how grim.

[TemakiSushi]

https://www.sciencedirect.com/science/article/pii/S001457931400893X

Abstract
Low-intensity pulsed ultrasound (LIPUS) is used for bone healing in orthopedics and dentistry. It has been shown that LIPUS induces the secretion of extracellular adenosine triphosphate (ATP), a key mediator of osteoblast response to mechanical stimuli. However, the detailed mechanism of LIPUS-induced osteogenesis has been elusive. In this study, we investigated the role of the P2X7 receptor in LIPUS-induced osteogenesis. LIPUS induced the release of extracellular ATP, differentiation of osteoblasts and osteogenesis via the P2X7 receptor, without affecting the activity of alkaline phosphatase (ALPase). These results suggest that LIPUS-induced extracellular ATP promotes bone formation via the osteoblast P2X7 receptor independently of ALPase.

—————
There are more studies but omit for space

Anyways I hope tibias of Great321 and Jolien will fill up callus with any methods soon
Did Giotikas give you any mechanical treatment? But these mechanical treatments need to be done when callus are still alive especially during lengthening otherwise it won’t work much
Are there any hospitals with 3D X-rays in Germany to see alignments and bone formations  precisely? 

I’ve been watching out and collecting info on the progresses of about 20 actual patients of Donghoon cases I haven’t heard any of his patients with non union or very delayed consolidation, while I get many information regarding problems from patients of other doctors tibia cases

The slowest full consolidation of precice tibia case Ive known from Donghoon patients is 9 months, 6cm precice tibia
Those data I have include much older people like 30s 40s and 50s

[Ghostfish]

I would never choose a doctor for a convenience
If Paley had lower than 5% rate of persistent knee pain, and if Donghoon had a higher rate of knee problems, I would definitely choose Paley
But reality is opposit
I almost jumped into Florida before deeply researched

I am not so sure whether your analysis is appropriate or not. Paley is one of the earliest pioneers in limb lengthening. He could have experience of many different types of complications. He has been sort of honest about it. I am quite sure that his current rate for many different types of complications could be even lower than he said. Lee was also trained by Paley too. Without training under Paley, Lee could be not as good as he is now.  Of course, the trainee could be better than a teacher in the end. I am also quite sure Lee is one of the best doctors for cll. But I don't really think that anyone can say Lee is better than Paley.

[TemakiSushi]

Like I said already I’ve done quite a research behind the forum
Then I can only choose Lee for my tibias😆
I cannot write everything I know here
Who thinks those Russian doctors Paley did initial training with are any better???

if you have met any old tibia veterans of a few years at Paley institute how were they after a few years post op?
Did you ask Paley very specific questions regarding tibia surgeries?
Most femur patients don’t ask much about tibias unless they do both

There are reasons why the most bilateral cases in the states are femurs

[Great321]

https://www.sciencedirect.com/science/article/pii/S001457931400893X

Abstract
Low-intensity pulsed ultrasound (LIPUS) is used for bone healing in orthopedics and dentistry. It has been shown that LIPUS induces the secretion of extracellular adenosine triphosphate (ATP), a key mediator of osteoblast response to mechanical stimuli. However, the detailed mechanism of LIPUS-induced osteogenesis has been elusive. In this study, we investigated the role of the P2X7 receptor in LIPUS-induced osteogenesis. LIPUS induced the release of extracellular ATP, differentiation of osteoblasts and osteogenesis via the P2X7 receptor, without affecting the activity of alkaline phosphatase (ALPase). These results suggest that LIPUS-induced extracellular ATP promotes bone formation via the osteoblast P2X7 receptor independently of ALPase.

—————
There are more studies but omit for space

Anyways I hope tibias of Great321 and Jolien will fill up callus with any methods soon
Did Giotikas give you any mechanical treatment? But these mechanical treatments need to be done when callus are still alive especially during lengthening otherwise it won’t work much
Are there any hospitals with 3D X-rays in Germany to see alignments and bone formations  precisely? 

I’ve been watching out and collecting info on the progresses of about 20 actual patients of Donghoon cases I haven’t heard any of his patients with non union or very delayed consolidation, while I get many information regarding problems from patients of other doctors tibia cases

The slowest full consolidation of precice tibia case Ive known from Donghoon patients is 9 months, 6cm precice tibia
Those data I have include much older people like 30s 40s and 50s

I suggest anyone to rely on the latest studies which don't reference disproved old studies. Just be a grown-up and accept facts that you might not like.

[TemakiSushi]

Oh poor boy, you don’t get the point
I’m really worried about your dent in the shin, it’s been over a year now?
Jolien got a similar dent
Did Giotikas give you mechanical treatments during lengthening?
Or any other treatment or medicine like Forteo, teriparatide?
Does he provide BMAC?

[Great321]

It's pretty obvious that any criticism on Lee hits you hard on a personal level so you try to distract and focus on the other person. This is not healthy. I don't think that you are ready for LL yet. Because if sth happens it might devastate you as you had trusted that doctor 1000%. Patients shouldn't be the best friend of their doctor, friendly but distanced. Accept that with any doctor something can happen, with some it is less likely but not avoidable.

[TemakiSushi]

I wrote I welcome any negative comments if Donghoon
But you aren’t really hitting any
You are only saying ultrasound doesn’t work 😆 with that recent German paper
But medicine doesn’t work like you imagine.
You may be thinking new practice overwrite all the old studies all sudden?
Studies are done and then take some years to check the reliability of it, unless old studies may bring dangers

Ok anyways at least Donghoon is the kind of doctor who pay lots attention to delayed consolidation trying different approaches before it gets too late
But Giotikas seems not
Also did you ask how thick is the nail diameters?
Which one does he use, 10mm, 11mm?
This can affect consolidation

I’m not attacking your personalities
I just worry about your condition and the readers who are prospective patients with some chances to get into traps of CLL

[limewalk]

To be clear--I am NOT saying anything against Donghoon Lee.

I considered him but decided against him primarily because he charges U.S. prices for services in Korea.  If I am going to pay full price; then, I might as well go down the road to Mahoubian who is in my back yard.

When you are deciding among the pool of top leg lengthening surgeons, in order to go out of your own country, you should have a good reason.

For me, I was never willing to pay ANYONE $100K for leg lengthening.  However, when I learned I could go to Saint Petersburg, Russia, and get the services of some of the top level leg lengthening surgeons in the world for $20K rather than $100K; then, the fear, uncertainty, and inconvenience of going to another country for the surgery became worth it for me.

However again, everyone should do his and her own analysis.  Because something was worth it for me does not mean the same for you.

My earlier message was about recommending caution in giving too much weight to posters who have not had the surgery but regularly talk as if they were knowledgeable while making claims about the purported greatness of a particular surgeon.

All of the top-shelf surgeons are about the same in terms of skill set.  Who you select among the top-shelf surgeon deals more with price, the particular technique offered or recommended for your desired goal, and convenience.

I like how you articulate your thoughts. Can you explain why Mahboubian would have been a good choice (apart from being local to you) based on your research?

[Great321]

I wrote I welcome any negative comments if Donghoon
But you aren’t really hitting any
You are only saying ultrasound doesn’t work 😆 with that recent German paper
But medicine doesn’t work like you imagine.
You may be thinking new practice overwrite all the old studies all sudden?
Studies are done and then take some years to check the reliability of it, unless old studies may bring dangers

Ok anyways at least Donghoon is the kind of doctor who pay lots attention to delayed consolidation trying different approaches before it gets too late
But Giotikas seems not
Also did you ask how thick is the nail diameters?
Which one does he use, 10mm, 11mm?
This can affect consolidation

I’m not attacking your personalities
I just worry about your condition and the readers who are prospective patients with some chances to get into traps of CLL

I'm of course indirectly criticizing any doctor who still offers ultrasound for a better bone growth.
The new study explained exactly why the old studies were not reliable. Science works that way, always looking for the truth and if a new truth is found, that is accepted and seen as the new basis.

If you remember, our conversation started with me asking about Dr. Lee's LON method, you mentioning ultrasound, I gave you evidence that it doesn't work and then you started to distract from Dr. Lee by talking about Dr. Giotikas. It's weird.

I am honest in my diary, I also wrote there that I don't know if my slow consolidation is Dr. Giotikas fault. But future LL patients like you if you ever start a diary will most likely omit problems because you won't be able to admit that even with the best doctor you will face problems. LL is not a walk in the park. No doctor can bring you back to 100%.

I know a Lee patient who said that he wanted to die during his LL path. Aside from numb shins he seems to be ok now. I didn't ask him if he can do all those things that I took for granted before LL though.

[limewalk]

With you on this Great321. Your diary is genuine and you seem like a logical person. I think you will recovery well. I also congratulate you for putting most of LL behind you which is a very difficult thing to start with.

I think it's a bit rude of the other poster to take problems faced by other LL doctor patients just to push a point about Dr Lee. May be it makes him feel optimistic about his decision to do LL if he ever actually does it.

[TemakiSushi]

Oh Great321 I think I know which Lee patient you are talking about
I asked him numerous times if he ever felt unsafe or some even smallest negative thing about Donghoon
But I couldn’t get any from him.  He only said Donghoon is good surgeon
I still ask him though . He gave us very helpful informations
Sure he said skin numbness lasted for sometime
He didn’t have anything like drop foot
LON is supposed to be super painful,
yeah if being very active during lengthening it’s understandable for what happened
You remember what he was telling us right?
Please let me know if there’s something more than I know about the guy or tell him to tell me directly 😊
Or if you talking about someone else warn me WARN me please now🤣

Don’t worry I’m not gonna write a thing about my surgery until after 3 years post surgery to be very fair
I need at least 3 years to see if my surgery really succeeded or not

[TemakiSushi]

With you on this Great321. Your diary is genuine and you seem like a logical person. I think you will recovery well. I also congratulate you for putting most of LL behind you which is a very difficult thing to start with.

I think it's a bit rude of the other poster to take problems faced by other LL doctor patients just to push a point about Dr Lee. May be it makes him feel optimistic about his decision to do LL if he ever actually does it.

Oh it’s him who started asking about what Donghoon does for consolidation
And started saying Donghoon is not good because he use ultrasounds🤣

Who else is really better then? Giotikas is not better at least

Besides it’s you who many times asked me about Donghoon 😱 in other threads

[California2]

Can you explain why Mahboubian would have been a good choice (apart from being local to you) based on your research?

I am not going to cheerlead for any particular surgeon.  I researched many surgeons the world-over and conclude that only a handful of top-level leg lengthening surgeons exist.  I am not going to set out a list of names because reasonable minds can disagree about who should be on the list.

What criteria did I consider to characterize a surgeon as top-level? 

In general, that the surgeon performs leg lengthening regularly (or exclusively); that is, that leg lengthening is a primary focus of the surgeon's practice.  That the surgeon also conducts research regarding leg lengthening and is published (books or peer-reviewed articles).  That the surgeon performs both medically necessary and elective leg lengthening.  That the surgeon has no public record of discipline or gross malpractice and is regulated by a professional body.  That the surgeon employs a team of qualified professionals.  That the surgeon practices in a first world country with modern facilities.

Though at the time Mahoubian was still a bit new to the game for my liking, Mahoubian ticked all of these boxes as did several other surgeons.

I ultimately decided as I did because, all other things being relatively equal, I could not come close to the value offered by the Solomin/Kulesh team.  But every potential patient must do his or her own analysis and draw his or her own conclusions.

Though I wrote that I was not going to cheerlead, I will add that I was concerned I would get to Russia and be disappointed.  The opposite happened.  Facilities were new and modern and I have never experienced such a high degree of medical expertise, thoughtfulness, and attention.

This is NOT to say that others may not be equally impressed by services offered in other first world countries--but I cannot speak to matters I did not experience.

[limewalk]

What criteria did I consider to characterize a surgeon as top-level? 

In general, that the surgeon performs leg lengthening regularly (or exclusively); that is, that leg lengthening is a primary focus of the surgeon's practice.  That the surgeon also conducts research regarding leg lengthening and is published (books or peer-reviewed articles).  That the surgeon performs both medically necessary and elective leg lengthening.  That the surgeon has no public record of discipline or gross malpractice and is regulated by a professional body.  That the surgeon employs a team of qualified professionals.  That the surgeon practices in a first world country with modern facilities.

Though at the time Mahoubian was still a bit new to the game for my liking, Mahoubian ticked all of these boxes as did several other surgeons.

Good criteria. But Mahboubian doesn't satisfy all of them.

- surgeon performs leg lengthening regularly (or exclusively)
Yes Dr M does CLL regularly

- that is, that leg lengthening is a primary focus of the surgeon's practice
Yes Dr M primary focus is CLL

- That the surgeon also conducts research regarding leg lengthening and is published (books or peer-reviewed articles).
No, Dr M does not do this. I have found 0 examples of Dr M involved in research or lectures or books.

- That the surgeon performs both medically necessary and elective leg lengthening.
Not a whole lot of evidence on this one. Most of his work is branded as CLL and not deformity correction

- That the surgeon has no public record of discipline or gross malpractice and is regulated by a professional body
I guess Dr M is clean here

- That the surgeon employs a team of qualified professionals.
I dont know what you mean here. M operates alone and doesn't have a partner or right hand. Nor does he have a dedicated PT team. I believe Paley is an example of someone who employes a team of qualified professionals.


You have repeatedly multiple times that your words are not advice to anyone and one should do his own research. I agree. But I am just pointing the obvious contradiction with one surgeon. Dr M has the best diaries on the forum however.