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[lostinsole]

I have been conflicted as to whether to share this experience. However, if my experience can help others decide if this is the correct course of action for them then it is at least worth sharing as I had some unique experiences.

Background information: Male, about 40, starting height 5'3 and 1/2

March: I did two surgeries three weeks apart - one leg at a time. In each surgery, they did femur lengthening and corrected my bowleg from my tibia.

Pre-surgery: Spent three months prior to surgery going to Stretchlab and working on flexibility. I went to Stretchlab 5-7 days/week and my flexibility improved substantially. I recommend everyone stretch as much as possible prior to the procedure. I shudder to think about what my experience would have been like if I did not do this.

Initial recovery (first two months): Pain was 10 out of 10 for me. It took some time to figure out pain management. I was definitely the odd man out compared to others. Everyone else I spoke with had nowhere near as much pain as I did.

Mid recovery (months 3-6): Pain was manageable to almost non-existent. Legs feel heavy and sore all the time. Muscles tightened substantially. Outside of this though, the process was very manageable and it's just a daily grind. I had to accordion on one leg and slowed down lengthening substantially towards the end of the process. I went for the full 8cm and was able to accomplish this.

Late recovery (months 6-now): Went home after lengthening and was able to book time on anti-gravity treadmill as well as go to Stretchlab frequently. This has helped recovery move at a very fast pace. I was able to fully consolidate and weight-bear about two and a half weeks after lengthening in each leg.

Was it worth it? 100% Absolutely! Would do it again in a heartbeat! I am adjusting to the experience of being taller. I am about 3 and 1/4 inches taller now and still have some slight duckass. I anticipate I will be about 3 and 1/2 inches taller from the first surgery when all is said and done. 3.15 inches from lengthening and up to 1/2 inch from bowleg correction.

Next steps: I am going back to Sinai to do Tibia lengthening. My surgery is scheduled for early November. I am aiming for two inches from Tibias and will be happy to get to that point.

If you have any questions please feel free to ask and I will respond as well as I can. 

[EndGame]

So you had bowlegged tibias on both right and left?
They couldn't do the correction and lengthening on tibias at the same time? Or just easier to do it first since already surgery for femurs?

[shortisnotfun]

Interesting. Do you feel more confident now?

[lostinsole]

So you had bowlegged tibias on both right and left?
They couldn't do the correction and lengthening on tibias at the same time? Or just easier to do it first since already surgery for femurs?

There were a few different options all with their own pro’s and con’s.

Quadrilateral
I knew I wanted to lengthen as much as possible. The highest probability of success was doing that over two surgeries. We have all heard how difficult quadrilateral lengthening is. We have  also seen how many people have tried that and come up short of their goals so that approach was not a serious consideration. I was interested in getting six inches if possible.

Femur lengthening followed by Tibia later
Ideal approach. Allows you to get the most length possible in the safest way. Staging it this way also provides a more clean exit point if I decided after the first surgery I am happy with my height. If I did tibia lengthening first, then I would get less height most likely. If it was a horrible experience, I would also be less inclined to do a second procedure. Lengthening from Tibias only also increases probability of knee/joint pain later on.


Bowleg correction and Tibia lengthening at the same time
While it can be done together, it gets complicated and harder to control results. Separating them seems to be the best course of action.


Femur lengthening and bowleg correction - followed by Tibia lengthening later
This is the option I settled on. It addressed my desire to lengthen and get the most height possible if I only did one lengthening procedure. It also allowed me to correct my bowleg and knee alignment issues at the same time. Otherwise, I would need to wait 6-12 months and then get them corrected. I didn’t imagine I would want to do that again, particularly if I had a bad experience in the first surgery. Another upside of this approach was that because a portion of the surgery was medically necessary, insurance was able to cover costs associated with that part of the procedure.

[cllin2022]

How much calcium/vitamin D did you consume throughout lengthening? Did it differ when you started consolidating? I’m in the consolidation phase for 8cm Precice femur but consolidation is taking longer than expected. I’m scheduling tibias to hit 6’ but I don’t want it to be a year-long ordeal.

[lostinsole]

Interesting. Do you feel more confident now?

Hmmm, not sure how to answer this. I didn’t really have confidence issues prior. I was at the extreme end of short for an American male which makes people less likely to take you seriously. Despite this, I have had a lot of professional and personal success. Instead of spending time fixated on my height, I spent time and effort working on everything I can control.

With that said, I found out about the procedure through an IG meme October 2021 and spent about a month researching before flying out to meet Dr. Assayag and scheduling surgery. I feel that the increased height will open more doors for me professionally and socially. The ugly truth is that there are a lot of doors that are harder to open when you’re short. Not impossible, just more difficult. The height increase levels the playing field.

I can give a more thorough update on life after the surgery when I am 6-9 months post the next procedure. I think next summer I will get a better feel for that.

[lostinsole]

How much calcium/vitamin D did you consume throughout lengthening? Did it differ when you started consolidating? I’m in the consolidation phase for 8cm Precice femur but consolidation is taking longer than expected. I’m scheduling tibias to hit 6’ but I don’t want it to be a year-long ordeal.

I may be off on the numbers as I am doing this from memory but I took the same amount that I was taking throughout the entire procedure. I think that is 500mg of calcium 3x/day and then vitamin D as well. Don’t kill me if I have the dosage wrong and you are seeing this Dr. Assayag.

The things that I think helped my consolidation along were the following:

- I had slowed down to 0.50 towards then end and had to accordion one leg so there may have been more bone there than others at that point
- I did the alter G at least 2x/week while in Baltimore. When I went back home, I found a place where I could buy alter G sessions and went 4-5x/week. Each time I went I raised the body weight % by 1-3%. The bone responds to stress and I think this probably helped.
- I used the walker and stood a lot, even for stretches and moving around as much as I could. I noticed I did more than others throughout the procedure. Now if I bent a nail from putting on too much weight before I was ready, I could be singing a different song right now but I did not.
- I purchased one of those ultrasound bone growth stimulation devices. Dr. Assayag doesn’t recommend them that often but he was able to write me a script for one which I purchased and used a lot during consolidation.
 

[Torbjorn]

Can you tell us the cost for your procedure? Thanks.

[lostinsole]

The cost of the first procedure was partially covered by insurance. The second procedure costs about $55k not including PT after that.

[Ceiling]

Thank you for sharing your experience!

May I ask whether you stay near Sinai for the first few months, e.g months 1-3? If not, is it okay to have PT in your local clinic?

My concerns are mostly about time management for the recovery stages since my daily working hours are pretty long (WFH).  I am not sure whether the pain and the PT would take up most of my day to deal with.

I would appreciate any of your input!

[SpeedDialer]

What were some differences (if any) in stuff you would bring with you for tibia lengthening?
Compared to femur lengthening I mean

I'm doing gnail femurs now in Athens, I'm thinking of doing tibia precise 2.2 in Athens about 1 year from now and I'm thinking about my packing list

I'm also thinking about doing nail removal with Dr. Assayag eventually and am trying to work out the logistics of it, I might be able to stay at someone's house a few hours drive away from him in Maryland

[Black Android]

Insightful. May I ask:

1. Did you use plate fixation for the tibial correction part?
2. When did you start lengthening for the first and second legs? Did the first leg reach its goal first, soon followed by the second leg?

[SpeedDialer]

whoops, I made an unnecessary post please ignore this, see above

[lostinsole]

Every Procedure is Different - 6 Week Update

The difference between the first two surgeries in March and this surgery in November is night and day. On a scale of 1-10, my pain level with the first series of procedures was a 10 out of 10. I needed to remain on opioids for much longer than the standard time of 10-14 days. This time around, my pain level on a scale of 1-10 was hovering around 2-4 when I first got out. By about days 8 and 9 after the procedure, I was able to stop taking all pain medication. I have taken Tylenol occasionally since then, but pain levels are much more manageable than the first set of procedures. From my interactions with others here, I seem to have an experience that is more in line with the norm this time.

Dr. Assayag made some slight adjustments in my right tibia for bowleg and therefore I did not start my lengthening until November 16, 2 weeks after my procedure. People normally start lengthening 7 days after the procedure. Since then, I have lengthened .75mm every day. The time is moving by fast, and I am almost halfway to my goal of 2 inches. I am currently at 22mm.

Bone growth has been great and I have an appointment with Dr. Assayag this Friday and will get an update on how things look.

Other things I would note are:

1) Just like my first set of surgeries, each leg seems to have its own experience and the aches and pains will come and go. This time around my right leg hurts at the osteotomy site (still there). The top right portion of the left foot tingled and felt numb for a few weeks (that has now gone away). Back left where the tendon release was performed felt like a muscle was tearing weeks 4-5 and that is now going away. Right knee is starting to hurt at times but that is going and coming. Everyone has random pains, its just part of the process.

2) I have used my TENS and EMS machine much more frequently. Really helps when trying to address any aches and pains as well as when doing exercises and ensuring the correct muscles are firing.

3) I have the 75lb weight-bearing nails. I was standing frequently but have cut back on that due to the pain in the right leg at the osteotomy site.

4) My new routine is to stretch while in the shower both in the morning and the evening. The heat helps, and it is really easy to put your leg up and stretch your calf on the shower ledge that they have at HP house.

5) I purchased a shiatsu foot and calf massager. That has really helped to massage my calves and release tension. Also, by controlling the tilt, I can get a foot massage and stretch my calf muscles simultaneously. I use this at least twice a day.

All in all, this time around the procedure has been much easier than the last time, and I have no complaints. The major difference that I would highlight is more about the daily grind. I'm past the excitement and now it's just the daily grind of getting up and making sure you are doing everything you should do. I will be happy to get through lengthening and consolidation to focus on building muscle and getting back to walking and being mobile.

[lostinsole]

Thank you for sharing your experience!

May I ask whether you stay near Sinai for the first few months, e.g months 1-3? If not, is it okay to have PT in your local clinic?

My concerns are mostly about time management for the recovery stages since my daily working hours are pretty long (WFH).  I am not sure whether the pain and the PT would take up most of my day to deal with.

I would appreciate any of your input!

I am staying at the HP house, which has great logistics and is only $15 per night. If your insurance covers outpatient PT at Sinai, it is right across the street. The majority of us purchase mobility carts, and we just drive ourselves over to get PT when we need to. The mobility cart also gives you the ability to go the hospital cafeteria or park whenever you want. If your insurance does not cover outpatient PT, you can use Moshe, and he comes right to your room.

Finding handicap-friendly accommodations in Baltimore is challenging. I would suggest just staying at HP house and making things easy on yourself.

[lostinsole]

Insightful. May I ask:

1. Did you use plate fixation for the tibial correction part?
2. When did you start lengthening for the first and second legs? Did the first leg reach its goal first, soon followed by the second leg?

Yes, I had plates for the tibia correction. I also could not bear weight for six weeks on each leg. Think about this being a total of 9 weeks when you include the three-week break between each surgery.

I started lengthening about a week after surgery. The first leg finished lengthening about 2-3 weeks before the second leg.

[lostinsole]

What were some differences (if any) in stuff you would bring with you for tibia lengthening?
Compared to femur lengthening I mean

I'm doing gnail femurs now in Athens, I'm thinking of doing tibia precise 2.2 in Athens about 1 year from now and I'm thinking about my packing list

I'm also thinking about doing nail removal with Dr. Assayag eventually and am trying to work out the logistics of it, I might be able to stay at someone's house a few hours drive away from him in Maryland

I somewhat discussed this but the things I am using more frequently than I did during my first surgery are:

- TENS/EMS machine
- Shiatsu Massager (wouldn't bring with you but would order when there)
- Orthofix Bone stimulator; using it a lot more frequently this time around
- Slant Board; used a lot for a week or two but have cut back recently. Also another item I wouldn't bring but would get delivered to me when I get there.

You will probably need to buy a plantar fasciitis leg brace as well. Outside of that, I don't think the packing list is much different and the majority of items are things you can order when you get to the facility.

Regarding the removal, staying at HP house is always an option. I met a guy who came in to have his nails removed and stayed at HP house for about 4 days. It is $15/night to stay so no reason why that is not a viable option.

[lostinsole]

I haven't been as consistent with this as I would have hoped but I would like to provide some quick updates.

Lengthening Complete - February 8, 2023
I finished lengthening. I stopped at 50mm and was happy with the process. Compared to the first procedure, the pain was a lot less. My right leg, however, was extremely tight. At this time, I was unable to straighten my right knee while laying down or standing. Outside of the extreme tightness in my right leg, everything else went smoothly. One thing I would note is that my bone growth during the procedure was particularly strong. Dr. Assayag indicated that this is one of the best regenerates they have ever seen.

Final Appointment with Assayag - March 3, 2023
I had my final appointment with Assayag before heading home on March 4, 2023. Bone growth continued to look really solid and I was cleared to walk as tolerated. I flew home the following morning, and have been home since.

Recovery at Home
This Saturday, will make it three weeks since I have been home. Compared to last September/October when I came home, I feel a lot weaker. This makes sense given I had another procedure prior to fully recovering from the first. The first week home was a bit of a wash as I was focused on transitioning care to new physical therapists/etc. The second week and this week have been much more productive.  I have put in place a routine of PT 2-3x/week coupled with 3-5 days of stretching at StretchLab and also working out at the gym or on the alter G treadmill. I am aiming to be walking without crutches or support sometime in May with a more normalized gait by June/July. Friends have been super supportive and I am looking forward to that engagement.

It seems like a lot of people disappear from the forums after they go home so I will try and stop in every few weeks with an update so people can understand the amount of work and time it took to recover.

[slowed & reverb]

Hey, congrats and thank you for this thread, would it he possible to share some post pics of proportions after youre finished? Just because i am planning to do quadri too. If its too personal for you i understand that. See ya and take care

[lostinsole]

Hey, congrats and thank you for this thread, would it he possible to share some post pics of proportions after youre finished? Just because i am planning to do quadri too. If its too personal for you i understand that. See ya and take care

I did not have plans to post pictures but I will think about it. What I can share is that my wingspan indicated I should be about 5' 8" while my starting height was 5' 3.5". I gained at least 5" and I am now the same height as one of my friends. When he came over, we compared the torso/leg ratio and we are pretty much the same.

Taking a step back, I believe proportion concerns are generally overblown. There are racial differences in torso/leg ratios -- black people tend to have shorter torsos and longer legs while white and asians tend to have longer torsos and shorter legs. On top of that, there is also a lot of variability in the population. Unless you are adding an excessive amount of height, I don't think it's anything to worry about. I guess we can always debate what an excessive amount of height is but for most people who do this surgery I think there should be no concerns with 2-3" and based on my experience and what I saw at the clinic also no concerns for less than 5" for most people.

[lostinsole]

1 Month Update

I have been home for a month and wanted to provide an update on my recovery. When speaking with Assayag before I left, it felt like a realistic timeline would be to focus on building strength and flexibility in March/April. In May, continue to transition to walking with less support with an eye towards walking without support by June/July. My personal goal, however, was to build enough strength and flexibility to be walking with no support (walker or crutches) by May and have a fully normalized gait by June/July. I felt the May deadline, which is maybe a little faster than discussions with the doctors, could be achieved because when I was home in September/October, I was able to walk with crutches in about 4-5 weeks and continued to improve quickly from there. So my assumption was that two months back home again with an increased focus and discipline should get me there in two months. 

Seeing as though I had been in Baltimore for about a year, it took about two weeks to get adjusted to being at home and on a routine. When I came home I was in the following condition:

• Flexibility: Almost able to lock out left leg, but far away from being able to do that with the right leg. Extremely tight ankles, calves, hamstrings, quads, hip flexors, IT band/QL, and pretty much anything else you can name in the anterior and posterior chain.
  
• Strength: Very weak both on the upper body and lower body. Probably able to stand for a max of 3-5 minutes. Able to walk with a walker for maybe 5 minutes max. This was with a horrible walk/gait however as my ankle flexibility was almost zero. Unable to stand up unassisted from any height.

I am currently doing the following to help with my recovery:

• Going to Physical Therapy 2x/week: These are orthopedic physical therapists that are not experts in limb lengthening. Given I go to StretchLab, we spend almost close to zero time on manual therapy/flexibility and the majority of time on strength training.
  
• Going to StretchLab 5-6x/week: I started off at 2-3x/week and was not making progress as fast as I wanted to. After increasing the frequency in the past two weeks I am progressing much faster.
• Going to the gym or walking on anti-gravity treadmill 2-3x/week: This is separate and apart from the physical therapists.

After the last month of work, I am now in the following condition:

• Flexibility: Pretty much able to lock out the left leg, almost able to lock out the right leg. Hamstring and calf flexibility have improved substantially. Absolutely think I can get both legs locked out within the next few weeks. Able to transition to traditional stretches that we needed to modify a few weeks ago. Everything is loosening up.
  
• Strength: Considerable improvement but still weak overall. Able to stand unassisted for much longer. I haven't tested it but maybe 20-30 minutes. Able to walk with a walker for at least 15-20 minutes with good form/technique. Able to stand up unassisted from a seat height of 19-20". Almost close to being able to do that from a regular seat height. 

Now that I am four weeks in, my goal of walking with no support by the beginning of May seems to be slightly out of reach at this time. I think there are two things causing this that I didn't fully appreciate. The first is a much lower baseline of strength to start from this time vs. when I was home in September/October. Essentially, I did a second surgery before I fully recovered from the first and I am starting from an even lower point this time around vs. September/October. The second is that it took longer to get a routine in place. I think this is emotional exhaustion in a way. Realizing I was weaker than the last time and also being on this road to recovery for so long made it challenging to get on a routine as fast as I did last time.

With that said, I am happy with the progress, particularly what I have been able to achieve in the last two weeks. I think I'm in a good place now and continue to get closer to my goal. I am still aiming for being able to walk unassisted by May and will update you guys as I progress.

[Hagane]

hey lostinsole,
were you in a wheelchair the entirety of your tibial lenghtening?

[lostinsole]

hey lostinsole,
were you in a wheelchair the entirety of your tibial lenghtening?

Yes, I had 75lb nails and was encouraged to stand/walk as much as I can. However, I did less of that in the first two months due to 1) hitting my hard max on PT visits insurance would cover which left me with no access to the alter-G, and 2) pain in my right leg at the osteotomy site when standing. In regards to the second point, there was nothing structurally wrong with the leg or bone growth, I just needed to push through the pain/discomfort. When the new year came and I was able to go to Sinai PT and start to use the alter-G, the pain around the osteotomy site disappeared fairly quickly.

[lostinsole]

Early Thoughts - What Does it Feel Like Being 5" Taller? Are you happy you did this?

I have been asked the above questions repeatedly and the truth is I don't know yet or some variation of I think I will be happy but I will let you know in a few months. For context, I do not go out to socialize -- only for PT. I have had interactions with some friends and women I am dating, but a lot of this is from a mobility scooter so I am not standing. The only time I am consistently standing around others is within the last week and a half when I use the walker to walk into PT. Prior to that, I would utilize a wheelchair service to bring me from the car valet at the front of the hospital to the PT clinic b/c the walk was too far. One thing I can say is that my reference point for everything has changed:

• I have to bend down a lot more to wash the dishes and reach sinks/etc.
  
• I can now reach shelves and cupboards I couldn't before.
  
• Doorknobs, tables, windows in doors, everything is at a different level when standing
• A girl I am dating now has to stand on her tippy toes to kiss me and I am looking down - before, we just kissed, no adjustments needed. Random thoughts when this first happened, "This is new" and "Oh, this is what a lot of women experience when dating taller guys"
• I no longer am able to determine with any level of accuracy whether someone is shorter or taller than me from a distance - Of course, if they are extremely tall/short I can, but it's crazy how often I look at someone and I think, are they taller than me or am I taller than them
• When I look at my legs in bed, sometimes I'm shocked at how long they appear relative to what I have had most of my life

The place I see the most individuals while standing is PT. Maybe 20-50 people in there at any one time. While I still don't know how it feels to be taller, it is weird that I have gotten used to not being the shortest already. I now look at people that are shorter than me and try to remember what it felt like to be shorter than them and how taller/shorter would I have been in relation to them and it's not something that I can easily connect with. Seeing as though I am now hovering around average height for a male, I am also aware that there are still a lot of people "taller" than me so it is not like I have a physically commanding presence just from height. Outside of that, I am still working out what the feelings and emotions of this procedure will be post-recovery. I will continue to share updates on my perspective and whether this surgery was worth it or not based on my interactions both professionally and personally over the coming months.

[Hagane]

Yes, I had 75lb nails and was encouraged to stand/walk as much as I can. However, I did less of that in the first two months due to 1) hitting my hard max on PT visits insurance would cover which left me with no access to the alter-G, and 2) pain in my right leg at the osteotomy site when standing. In regards to the second point, there was nothing structurally wrong with the leg or bone growth, I just needed to push through the pain/discomfort. When the new year came and I was able to go to Sinai PT and start to use the alter-G, the pain around the osteotomy site disappeared fairly quickly.

interesting im currently doing mine with dr gdalevitch in canada. shes pretty much said to be walking with a walker day one and discouraged any wheelchair use. im curious if that will help speed up a return to normal walking gait.

[Robert Adam]

If you lengthen the femurs by 8 cm and the tibias by 5 cm, (8+5), how much will you actually grow? How much less than 13 cm?

[lostinsole]

If you lengthen the femurs by 8 cm and the tibias by 5 cm, (8+5), how much will you actually grow? How much less than 13 cm?

From my understanding, you should gain all the height. With consistent work over the next 12-24 months, you can also regain 100% of your previous athletic ability. I will actually gain a little more than the 13 cm as I also had a bowleg correction. That may add up to about 1/2". I am waiting for my posture and flexibility to go back to normal to get the official measurement of how much height I gained.

[lostinsole]

interesting im currently doing mine with dr gdalevitch in canada. shes pretty much said to be walking with a walker day one and discouraged any wheelchair use. im curious if that will help speed up a return to normal walking gait.

I think everyone's situation is a little different. I think your initial starting weight and the size of the nails also come into consideration. If you have the 50lb nails, there is less flexibility vs. someone who has the 75lb nails in. Also, different doctors have a different level of comfort with how much they want you to stand/walk during lengthening.

I was unable to use the alter g (anti-gravity treadmill) for the first two months of recovery given I ran out of PT visits and could not go to PT at Sinai. I am sure if I was able to utilize that, and did more standing/walking in my room as Dr. Assayag recommended, my recovery would be faster.

[Hagane]

I think everyone's situation is a little different. I think your initial starting weight and the size of the nails also come into consideration. If you have the 50lb nails, there is less flexibility vs. someone who has the 75lb nails in. Also, different doctors have a different level of comfort with how much they want you to stand/walk during lengthening.

I was unable to use the alter g (anti-gravity treadmill) for the first two months of recovery given I ran out of PT visits and could not go to PT at Sinai. I am sure if I was able to utilize that, and did more standing/walking in my room as Dr. Assayag recommended, my recovery would be faster.

definitely, i belive i also have the 75lb nails in.
i wish i had access to an alterg treadmil but i just walk to my buildings gym and use the cardio bikes 

[BlueThunder]

Hey, don't know if you're still active, but if you are could you estimate a percentage of what was covered by insurance? Actually in a similar situation because I have bow legs and was curious as to how much it cost in your situation.

[sphenopetroclival]

If you have recent imaging data please put it at this thread. Redact any information that could be used to dox you.