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[erenyeager1]

Introduction
Hi everyone. I have been reading diaries on this forum since early 2018 when I first found out about this procedure. I have been thinking about this ever since 2018, and it's been almost 5 years now. I can say that I've read almost all the diaries of those who did the surgery in the US. After visiting Paley's institute at WPB last summer, I decided to do it this year. Surgery is scheduled in late Nov 2022. I will update here around the time I begin the procedure. BTW, I stole this formatting from a diary by "belowthemean", credit to him/her.

I am going to do bilateral femur lengthening with precice 2.2. My goal is to reach 8 cm, but would be happy as long as I got above 7 cm.

Basic Stats
Demographics: early 20s, male, Chinese
Starting Height: 174 cm (5'8.5")
Wingspan: about 6 feet
Lengthening Goal: 7-8 cm
Starting weight: 197 lbs (I am pretty fit. Weight mostly come from muscle)

Starting Height and Lengthening Goal
174 cm. Goal is to reach 182 cm.

Physical Shape
My weight is pretty high - 197lbs. I love benchlifting so I have big chest muscle. I also do snowboarding in winter, so my thigh is pretty bulky. I plan to do some cardio to bring my weight down a little, but not sure how much I could lose without losing some muscle as well. Will update my weight again before the surgery.

Sports
Nothing regularly. On-snow sports in winter.

Flexibility
I've been doing PT since June, twice a week. It is covered by my insurance because of my back injury. I just ask my PT trainer to include half an hour of hamstring and front-of-thigh stretch. He's happy to do it. My flexibility was rated "tight, like everyone else" when I visited last summer. We will see how it goes. Not sure if it will help.

Health Status
Overall healthy, other than I have herinated disc l5/s1. It's been a few years since the incident happened (from snowboarding). This is also the main reason why I visited last summer. Back then, Dr. Robbins told me that this injury shouldn't have any impact on my lengthening.

My Backstory
I've been thinking about this since around the end of high school. It's been so long that I am convinced that if I don't do it I would regret it for the rest of my life. Jeff Bezo mentioned this regret minimization framework in one of his early interviews:

I am pretty much a follower of this framework.

Who Knows About This
Every one in my family and my extended family (think of grandparents, parents' sibliings and their kids). All my close friends who are at least my height and my girlfriend. My mental health consoler (I've known her for years). I am pretty open about it. I just don't want my choice to have an impact on other people.

Cost of the Procedure
97.5k plus room and board and food (budget is 30k). If you stay in one of Paley's partner hotel, it will cost around 15k for the time I am doing the surgery because it's peak season in FL. All is in USD.

How I’m Paying
My parents pay for room and board. My savings can pay for the surgery.

Time Off Work
I work in tech so I can work remotely. Also for the past 1.5 years, I didn't use a single day of vacation or holidays or sick days, so that summed up to be around 50 days of PTO (unused PTO days roll over). My company also has very generous PTO policy for short-term disability, which I am waiting on the result of my application.

Why Dr. Paley?
Paley is widely recognized as the best. I also visited the hospital last summer and really liked it. At the end of the day, you pay premium for his experience. If everything goes well, maybe the experience and the result would be the same if I do it somewhere cheaper. The premium goes to the possibility where things don't go as planned, and I trust Paley's experience on dealing with these.

Next Steps
Just booked tickets to WPB yesterday and arranged my hotel stay at the SHS I95. I will update more as we get closer to the surgery date.

Some Motivation
Sometimes late at night I would get scared thinking about the procedure. I would watch this video:

Vader was my favourite Star Wars character when I was a kid. Picturing this procedure as Anakin's transformation to Darth Vader would give me strength to move forward.

[c]

不错的佩利，有很中国人在别的国家做P针出了问题 尽管他们很便宜 其实我觉得韩国李东勋也不错 但他的手术预约日期很久

[tao]

betz 怎么样？ 我在法国，现在看看周围最靠谱的可能就是betz了，betz bone还可以负重。

[we.live.once]

betz 怎么样？ 我在法国，现在看看周围最靠谱的可能就是betz了，betz bone还可以负重。

我的愿望也是betz，可靠，疤痕小，但是太贵了，负担不起

[tao]

betz现在算是便宜的了，千万别去土耳其做，容易断腿

[tallerwouldbenice]

Good luck man. I recommend you do not exercise your legs any further. Best to have less muscle, in my experience. You will lose it all anyway and muscle gives extra tightness.

[erenyeager1]

Thanks dude! That's good advice. Do you think just stretching and all that help with the lengthening? Also would love to read your story if you decide to write it out someday. I will keep updating mine here.

[erenyeager1]

In the pre op room now. Kinda nervous but tired at the same time because I couldn’t fall asleep earlier. Will update here hopefully tonight or tomorrow.

[the188cmdream]

In the pre op room now. Kinda nervous but tired at the same time because I couldn’t fall asleep earlier. Will update here hopefully tonight or tomorrow.

I wish you luck, health and a great recovery. Please keep us updated, your diary will be invaluable to me since I am in a similar position.

[Harry1309]

Yeah man all the best keep us updated!

[erenyeager1]

The surgery went well. They were able to put the biggest mail in my femur because I have big bones. This means weight bearing is 75 lbs per leg.

Day 0:
I was wheeled in around 7 am and woke up in recovery room around 12 pm. It was a strange experience, but I remembered nothing. I tried to move my legs and they are heavy. The movement also hurts a little bit. They let my girlfriend in. I then passed out again and slept for another 2 hours probably because I didn’t sleep at all the night before. Around 3 pm, they wheeled me in my private room. So far all is good. The pain level was 3-4. The nurses came in regularly to check on me and gave me painkillers and also antibiotics injection. The pain increased steadily as anesthesia worn out. I was nauseous when eating the dinner they gave me. It was good food. I am just nauseous due to the anesthesia.

Day 1:
Nurses came in once a few hours at night to check my vitals. They also gave me the ice machine which really helped my femur pain. The painkiller is not as effective as it was yesterday. It is 12 pm as I am writing this post. I will be doing PT soon. I am in a lot of pain but I believe this is the worst it will get, so it’s only uphill from here.

[AllinStryde]

The worst pain of the surgery is over and tolerable due to heavy narcotics.  The worst pain for me was toward the end of the lengthening phase.  Just a warning.  Never stop stretching.

[erenyeager1]

Thanks for the tip! I haven’t started stretching yet as the PT is mainly focused on standing up. I think I will start stretching next week when lengthening starts.

Day 1-2:
Overall is great. I was able to stand up and sit in my wheelchair and tour the floor, but standing up and sitting up get me dizzy pretty soon. Also I feel nasty because I haven’t showered for a long time. I will probably just use wash clothes before wound check next week. I am scheduled to get discharged tomorrow or in two days.

[erenyeager1]

Sorry about no updates. Has been busy with resting and tolerating the pain. Overall, all is well. I will post a few lessons I learnt around Christmas when my parents get here. I am excited to remove my wound patches tomorrow and lengthen for the very first time.

[thankscience]

Did you manage to get your weight down before the surgery?

[erenyeager1]

No I stayed the same weight going into the surgery. I think most of my weight comes from my leg though. I also got the biggest nails so I am not too worried. From time to time, I do wonder: what if the nails are broken and I just don’t know it. I am going to do a wound check and follow up today so we will see.

[erenyeager1]

Woke up in the middle of the night probably because I slept too much in the day. Life is getting better and more routine every day. Now I don’t feel much pain because the surgery pain has mostly gone (sometimes no pain at all) and can move my legs without much pain. I can roll onto my belly, sit at the edge of the bed for an extended amount of time, etc. I still hire a caregiver for the day 8am to 8pm. PT is the one thing I look forward to every day. I’ve lengthened 8 mm so far. With the 1 mm that they did at the surgery, I will hit the 1cm mark tomorrow. I do 3-4 stretches a day, once before every turn. The only worry is bending the mail but statistically it’s very rare that the bending will impact lengthening. Some people will have some small degrees of bending to their nails but most of them still okay to continue lengthen. I asked the most experienced PT, and he can only recall 2-3 cases of nail bending where they had to do another surgery. If you do a search with keyword “bend” on this forum you’ll get the same impression.

[c]

希望你顺利 请问你怎么看待p针大小腿各做4.5厘米 这对于我们中国大部分人来说是容易的吗 还是需要很多拉伸才能完成

[RealLostSoul]

希望你顺利 请问你怎么看待p针大小腿各做4.5厘米 这对于我们中国大部分人来说是容易的吗 还是需要很多拉伸才能完成

4.5 can be reached with minimal stretching. I met one guy who didn‘t stretch at all and he reached around 4.5, but only under severe pain and extreme discomfort. He didn‘t want to stop but had to stop early because he refused to stretch (very bad idea). He was suffering and very miserable. Despite that 4.5 is reached quickly but I must add that most people I spoke to me included did not notice anything at that length.

[erenyeager1]

希望你顺利 请问你怎么看待p针大小腿各做4.5厘米 这对于我们中国大部分人来说是容易的吗 还是需要很多拉伸才能完成

Little to no stretching is definitely a bad idea. I don’t think you can get very far with little stretching. For tibia 4.5cm + femur 4.5cm, I think it is a reachable goal. Most people I talked to that are doing both legs end up with more than 9 cm. I am only doing femur so I can’t give much info about tibia. Most people will have nerve pain at one point and then will be on gaba. As of myself, I am pretty confident that I can reach at least 6 cm and most likely 7.x cm.

I am on day 19 post op. Surgical pain is almost completely gone. I’ve lengthened 1.2 cm myself, and there’s the 1 mm they put in during the surgery. I just stopped taking oxy today. I was advised by other patients to save some oxy (at least 100 mg) for the later days when I get tight. I don’t feel much pain most of the time. I get shooting pains once in a while but they disappear in a few seconds. Sleeping is good. I just can’t get a full night of sleep because I need to do a turn every 6 hours, but my total sleep time is healthy. For flexibility, the key is to make sure that my knees can bend at least 90 degrees and that I can keep my legs straight when standing.

[seattleperson]

erenyeager1， that is very nice of you for sharing all this and i am considering Paley as well. I am quite jealous of you. I am 1.65 and my gaol is 1.73 with femur LL. In your opinion, is it that possible?

[erenyeager1]

Hi Seattleperson, it is very possible but not guaranteed. Here is what I learned from conversations with PTs and other folks. It is basically guaranteed that you will reach 5 cm as long as nothing crazy happens like you fall and break your rods etc. Most people make it very close to 7 cm. The last centimeter is the most difficult. A few people I met stopped at 7.x cm because they are happy with it and honestly a few millimeter difference is not significant. If you don’t smoke and are relatively young like 20 to 40, average flexibility, you have a pretty good chance of reaching 7 cm as long as you stretch diligently at the hotel.

[seattleperson]

understood, thank you very much!

[erenyeager1]

Day 25:
Surgical pain is completely gone. 99% of the time I feel no pain at all. Also stopped taking oxycodone on day 20. I am only taking Tylenol for pain, around 1000 mg every day. X ray was taken on day 23, and everything looks good. Quads are great. Hamstrings are average tight. No nerve pain yet. Most people start to get nerve pain somewhere between 2 cm to 6 cm, so I are expecting it to happen at one point. Honestly, the pain that bothers me the most is my lower back pain from my herniated disc (injury a few years ago), because I sit on the wheelchair a lot. Also it makes stretching my left hamstring much difficult because hamstring stretches all irritates my lower back. The pain is the same as pre-surgery so nothing to worry about.

[erenyeager1]

Day 30:
So far so good! I’ve reached 2.4 cm. Flexibility is good. No nerve pain yet. Stretching every other day for 3 months before the surgery definitely helped me with the lengthening process. Life is getting routine, and I am planning on getting back to work remotely starting next week.

[the188cmdream]

Day 30:
So far so good! I’ve reached 2.4 cm. Flexibility is good. No nerve pain yet. Stretching every other day for 3 months before the surgery definitely helped me with the lengthening process. Life is getting routine, and I am planning on getting back to work remotely starting next week.

You are doing great, stay strong buddy! Thanks for keeping us updated.

[Harry1309]

Hello and thank you for sharing your experience, may I ask what exercise regime you followed before your surgery? And how helpful has it been because I thought Payley said on his interview it doesn’t make much of a difference to the surgery outcome

[erenyeager1]

Hello and thank you for sharing your experience, may I ask what exercise regime you followed before your surgery? And how helpful has it been because I thought Payley said on his interview it doesn’t make much of a difference to the surgery outcome

I have a herinated disc (L5S1) so my insurance offers me physical therapy. I just asked my PT to add in a few stretches recommended by Paley's PT like Thomas stretch, hamstring stretch, and some quad stretch. How flexible you are is not going to help the surgery itself, i.e. putting the rod in your legs, but I do think it helps a lot with the lengthening process. The daily PT during the lengthening phase is basically some leg exercises to strengthen the muscles that you don't use because of inability to walk and some stretches (hamstring, quad, and hip flexor). If you put in a lot of efforts and stretch 3 times a day at the hotel (the same intensity as you do at the PT), you would likely get the same outcome as not doing any stretch at all before the surgery, but not many people are like that. You don't really know if you can religiously follow what the PTs tell you to do at home until you actually have the rods in your body. Does stretching before the surgery enable you to lengthen longer? I am not sure and probably doesn't make much of a difference. However, getting a habit of stretching these muscles pre-surgery is definitely going to make your life in lengthening phase much easier. If you are 100% sure that you can religiously follow whatever the PT ask you do at home and push yourself very hard, then stretching pre-surgery is not really necessary, but at least I can't follow that routine 100%. I say I've been trying my best and can do like 70%. Sometimes I just get really tired and procrastinate. 

Also, I met a patient who is in his 60s. He maxed out the rods and gained full 8cm. I was very impressed. He was stretching in the hotel very religiously and pushed his body to do everything that was asked. It was very inspiring to me. He recommended taking an aquatic therapy session every week, which I am planning to do starting next week if there is an open spot. The PT's been telling me to try to get into pools for exercise but I am just not comfortable with the hotel pool. I have to pay an extra 25 dollar for the pool therapy session, and I need to uber there, but I think it is worth it. I just didn't know this was an option. I did cross country running in high school, and we did a lot of pool exercises then. Running in pool is more intense than running on land. As long as the pool waterline is around your chest level, it is okay for the rods. Plus, there will be someone watching me. I will update here later on how it is in a few weeks.

I am getting back to work next week. So far nothing scary happen, and honestly I think most patients have a pretty smooth journey, albeit painful (tight + nerve pain). The number of Paley diaries on the forum is pretty low compared to the number of cosmetic LL patients they take every year. Probably 1 in 80 writes a diary here if not fewer. Most patients just come here, go through the journey and go back home. Scary things do happen but it is very rare.

[stretched]

Hello erenyeager1, thank you for posting your diary it was great to read.

During your first few days post op, was there any point at which the pain was unbearable or was it generally kept under control with the help of pain meds? How would you rate the pain on a scale of 1-10? Do you know if your experience of the pain is similar to others at the Paley institute?
Thank you.

[erenyeager1]

Hello erenyeager1, thank you for posting your diary it was great to read.

During your first few days post op, was there any point at which the pain was unbearable or was it generally kept under control with the help of pain meds? How would you rate the pain on a scale of 1-10? Do you know if your experience of the pain is similar to others at the Paley institute?
Thank you.

Hi stretched! When I woke up after surgery, because the anesthesia is still there, I didn’t feel any pain, just legs are heavy. Then anesthesia goes away in a few hours maybe a day. Then they give you oxycodone 5mg every 8 hours or so for a few days. The pain level was low like 2 for the first 2 days. Then it starts to go higher to like 4-5 for last two days in the hospital mostly because they stop giving me oxycodone and switched to a different pain killer. From time to time there is like a 1-sec level 7-8 pain, but that’s like once an hour or so. The surgical pain remained like this for two weeks, then it slowly goes away. For most people, the surgical pain should be gone in around 3 weeks. Looking back, the pain wasn’t that bad. It was manageable for 99% the time, and most people have similar experience. Apparently, tibia hurts less than femur for most people. I didn’t do tibia but I talked to a few who did both femur and tibia, and they say that the pain after femur surgery is much worse than that of the tibia surgery.

After surgical pain is gone, you probably have already lengthened like 1.x cm. Soon, depends on your flexibility, you are going to get muscle tightness. Then some people get nerve pain. If you get nerve pain, it’s probably going to stay for the entire lengthening period. The only way to delay or prevent this is by stretching religiously. It is a painful process too, but it’s a different kind of pain than the surgical pain. And this pain you can experience pre surgery. Just find a physical therapist and ask them to stretch you real hard. As of now for me, 5 weeks post op, I feel 0-1 pain for the most part. The only pain in my life is when I do stretches. Hopefully I don’t get nerve pain. Most people get it between 2 to 6 cm lengthened, but I’ve met a few who never got it, but they are either very flexible to begin with or stretched really hard.

Also my overall energy level was low until recently, like the first few weeks I am always super tired everyday. It slowly gets better as time goes on.

[BrentL]

So in 2 weeks you gained 1cm.

2cm/month x 4 months = your 8cm goal

Is this correct?