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[ten]

On average how many people get operated at Betz institute per month?

Do most of them come alone or with someone for help?

[lessthanavg8300]

Im going alone and others do the same.  I envy people who have a wife/gf that is there for them through the process though I think thats fantastic.

[RealLostSoul]

Most go alone. Sometimes a family member visits people but it‘s rare because most live far away. Be prepared for a huge amount of loneliness during LL. It will take a big toll on your mental health

[Unknown]

What about other places? Anyone doing alone also?

[RealLostSoul]

What about other places? Anyone doing alone also?

I think at most places you will be alone but it really depends on your personal situation. If you have a great partner or sibling or parent they may help you, but it will probably depend on how far you have to go from home etc. Just my experience was that most are alone.

[Unknown]

I think at most places you will be alone but it really depends on your personal situation. If you have a great partner or sibling or parent they may help you, but it will probably depend on how far you have to go from home etc. Just my experience was that most are alone.

How do you take care of yourself when crippled by LL? Usually im not afraid to travel by myself but the fact that im defenseless when lengthening makes me scared.

[lessthanavg8300]

I honestly have no idea how people manage with non-weight bearing nails.  You for sure need someone.  Personally thats just not an option for me.  With weight bearing it will suck but you can still move around especially with crutches.  I plan on getting delivery a lot so that will take care of food.

[RealLostSoul]

I honestly have no idea how people manage with non-weight bearing nails.  You for sure need someone.  Personally thats just not an option for me.  With weight bearing it will suck but you can still move around especially with crutches.  I plan on getting delivery a lot so that will take care of food.

I agree with this. It’s hard enough with weightbearing. Impossible without.

[Unknown]

I agree with this. It’s hard enough with weightbearing. Impossible without.

What about LON?

[RealLostSoul]

What about LON?

If you want disadvantages from both internals and externals for some saved money then do LON…

[Limbfan2020]

I agree with this. It’s hard enough with weightbearing. Impossible without.

For someone who wants to do LL with non-weightbearing nails like PRECICE, i'd recommend to do one leg at a time. It gives you optimal mobility with crutches. The downside is that you need to do two surgeries.

[RealLostSoul]

For someone who wants to do LL with non-weightbearing nails like PRECICE, i'd recommend to do one leg at a time. It gives you optimal mobility with crutches. The downside is that you need to do two surgeries.

No don’t do that. It’s long. You will have big discrepancy. It costs you more in the end. You will most likely quit early

[Limbfan2020]

You will most likely quit early

What do you mean?

[RealLostSoul]

What do you mean?

If you lengthen one leg only you will have a huge hindering and ugly discrepancy. There is no universe in which you will “like” your new look and thus tend to quit early.

[Limbfan2020]

If you lengthen one leg only you will have a huge hindering and ugly discrepancy. There is no universe in which you will “like” your new look and thus tend to quit early.

I think quiet the opposite. When I see that one leg is getting longer than the other, i'd be highly motivated to continue the lenghtening. With the discrepacny i can also justify to wear higher shoes and to do the second surgery.

[RealLostSoul]

I think quiet the opposite. When I see that one leg is getting longer than the other, i'd be highly motivated to continue the lenghtening. With the discrepacny i can also justify to wear higher shoes and to do the second surgery.

With all due respect. One leg at a time for cosmetic lengthening is the worst idea I have ever heard. You haven‘t done the surgery yet, right?
Before you think you can just deal with it, “ it‘s gonna be uncomfortable but not too bad and I can do this thn that and then another surgery and maybe even arms”. But let me tell you, it IS gonna be horrible. Even if you are a good case. You just want to recover and get it over with.

Now, imagine you are only lengthening one leg. Have all the horrible stuff from LL and still having to do it twice. And what u gonna tell people that see you, you are fine before and then afterwards an abomination with one leg being much longer?  “i had knock knee surgery” “i had an accident” no one is going to buy that. In fact I think they won’t even buy that you had cosmetic LL bc that is not cosmetic at all and you aren’t taller (you can wear plateau shoes without LL). I can absolutely promise you will not be motivated to lengthen if you are creating more and more discrepancy. Plus with normal LL you pretty much always have one worse leg anyway. So what’s the point? Do one leg just so you can limp with one healthy leg? Get a weight bearing nail. I have one and can walk better than if I would limp around on one leg. Plus also how can you recover fully if you are dependent on the shoe.
Also, did you see the shoes you need to wear for 5-10cm discrepancy? They are huge plateau shoes that everyone will notice if you have one normal shoe and then one fat weird shoe on the other side.

Overall tldr; one leg at a time for cosmetic is a laughably terrible option. And once you did the surgery you will understand that you will absolutely not want to go through it again. But that’s something you will only truly understand once you did it.

(Also you don’t need to justify anything. You can wear whatever shoe you want. I wore elevator shoes for many years before and nobody ever said a word. And if anyone did I couldn’t care less because I’d knew they are idiots not worth my time. Why care about ignorant people)

[Taller90]

With all due respect. One leg at a time for cosmetic lengthening is the worst idea I have ever heard. You haven‘t done the surgery yet, right?
Before you think you can just deal with it, “ it‘s gonna be uncomfortable but not too bad and I can do this thn that and then another surgery and maybe even arms”. But let me tell you, it IS gonna be horrible. Even if you are a good case. You just want to recover and get it over with.

Now, imagine you are only lengthening one leg. Have all the horrible stuff from LL and still having to do it twice. And what u gonna tell people that see you, you are fine before and then afterwards an abomination with one leg being much longer?  “i had knock knee surgery” “i had an accident” no one is going to buy that. In fact I think they won’t even buy that you had cosmetic LL bc that is not cosmetic at all and you aren’t taller (you can wear plateau shoes without LL). I can absolutely promise you will not be motivated to lengthen if you are creating more and more discrepancy. Plus with normal LL you pretty much always have one worse leg anyway. So what’s the point? Do one leg just so you can limp with one healthy leg? Get a weight bearing nail. I have one and can walk better than if I would limp around on one leg. Plus also how can you recover fully if you are dependent on the shoe.
Also, did you see the shoes you need to wear for 5-10cm discrepancy? They are huge plateau shoes that everyone will notice if you have one normal shoe and then one fat weird shoe on the other side.

Overall tldr; one leg at a time for cosmetic is a laughably terrible option. And once you did the surgery you will understand that you will absolutely not want to go through it again. But that’s something you will only truly understand once you did it.

(Also you don’t need to justify anything. You can wear whatever shoe you want. I wore elevator shoes for many years before and nobody ever said a word. And if anyone did I couldn’t care less because I’d knew they are idiots not worth my time. Why care about ignorant people)

Fully agree, doing leg by leg is the worst you can do. In Addition it might create other problems as well (hip, muscle rehab etc).

[Siegfried]

With all due respect. One leg at a time for cosmetic lengthening is the worst idea I have ever heard. You haven‘t done the surgery yet, right?
Before you think you can just deal with it, “ it‘s gonna be uncomfortable but not too bad and I can do this thn that and then another surgery and maybe even arms”. But let me tell you, it IS gonna be horrible. Even if you are a good case. You just want to recover and get it over with.

Now, imagine you are only lengthening one leg. Have all the horrible stuff from LL and still having to do it twice. And what u gonna tell people that see you, you are fine before and then afterwards an abomination with one leg being much longer?  “i had knock knee surgery” “i had an accident” no one is going to buy that. In fact I think they won’t even buy that you had cosmetic LL bc that is not cosmetic at all and you aren’t taller (you can wear plateau shoes without LL). I can absolutely promise you will not be motivated to lengthen if you are creating more and more discrepancy. Plus with normal LL you pretty much always have one worse leg anyway. So what’s the point? Do one leg just so you can limp with one healthy leg? Get a weight bearing nail. I have one and can walk better than if I would limp around on one leg. Plus also how can you recover fully if you are dependent on the shoe.
Also, did you see the shoes you need to wear for 5-10cm discrepancy? They are huge plateau shoes that everyone will notice if you have one normal shoe and then one fat weird shoe on the other side.

Overall tldr; one leg at a time for cosmetic is a laughably terrible option. And once you did the surgery you will understand that you will absolutely not want to go through it again. But that’s something you will only truly understand once you did it.

(Also you don’t need to justify anything. You can wear whatever shoe you want. I wore elevator shoes for many years before and nobody ever said a word. And if anyone did I couldn’t care less because I’d knew they are idiots not worth my time. Why care about ignorant people)

Hey there, I did unilateral quadrilateral lengthening. I had a very pain-free and pleasant experience to be honest, and I am finished now. My doctor said Im fully weightbearing in two weeks, one year and two months after the first surgery.

- The main disadvantage with unilateral lengthening is the timeframe. It takes twice as long, thats about it.
- The cosmetic issues you mentioned are only an issue if you make it one. People dont take notice that one leg is longer than the other.


Apart from these things, it was actually a very good option, since you are quite mobile from day one, since you have a healthy leg to weightbear on. This would NOT be possible if you would be doing a bilateral procedure with Precice 2 Nail. You would be limited to a wheelchair for months. So the question is what is more damaging, being stuck in a wheelchair for 5-6 months or being on crutches for 1 year. This is a decision, which everyone needs to make for themselves.

I definitely wouldn't call it a terrible option.

I guess in the end it comes down to, if you are willing to spend twice as much time lengthening, ON the other hand I was able to do tibia + femurs in the same time span, which would have probably taking 1 year with a bilateral approach as well.

[RealLostSoul]

Hey there, I did unilateral quadrilateral lengthening. I had a very pain-free and pleasant experience to be honest, and I am finished now. My doctor said Im fully weightbearing in two weeks, one year and two months after the first surgery.

- The main disadvantage with unilateral lengthening is the timeframe. It takes twice as long, thats about it.
- The cosmetic issues you mentioned are only an issue if you make it one. People dont take notice that one leg is longer than the other.


Apart from these things, it was actually a very good option, since you are quite mobile from day one, since you have a healthy leg to weightbear on. This would NOT be possible if you would be doing a bilateral procedure with Precice 2 Nail. You would be limited to a wheelchair for months. So the question is what is more damaging, being stuck in a wheelchair for 5-6 months or being on crutches for 1 year. This is a decision, which everyone needs to make for themselves.

I definitely wouldn't call it a terrible option.

I guess in the end it comes down to, if you are willing to spend twice as much time lengthening, ON the other hand I was able to do tibia + femurs in the same time span, which would have probably taking 1 year with a bilateral approach as well.

Did I understand it right? You did one side femur and tibia in one surgery then the other side? So 2 total surgeries (not counting nail removal)?
If yes then that may be ok time wise because even with bilateral you need to have 2 surgeries for tibia then femur or other way around. Plus similar time inbetween. So in that case you don‘t have additional surgeries so it may be ok. However I still can‘t see how you can live with 10cm leg discrepancy for some time.

I was thinking about 4 surgeries so every leg segment at a time would be a bad idea. Or if you only want femurs or only want tibias I wouldn‘t do it in 2 surgeries. But if you want quadri like you did you need 2 surgeries anyways.
Hope you understand what I mean.

[ten]

- Staged LL is recommended by many good surgeons for medical safety. People have died doing bilateral LL.
- Some people don't want to do LL with ratcheting nails. Some even want a surgeon who is exclusively trained in deformity correction. That leaves just Precice and Fitbone which imply wheelchair usage for months.

I agree staged takes so long to complete especially when you have weight bearing nails around, but each to his own. It's certainly not a stupid decision to do bilateral or staged.

[challengeaccepted]

If cost and time isn't an issue then weight bearing > unilateral > non weight bearing bilateral imo

I don't see myself in wheelchair for months not even 1 week due to my house having stairs everywhere.

[Siegfried]

I was thinking about 4 surgeries so every leg segment at a time would be a bad idea. Or if you only want femurs or only want tibias I wouldn‘t do it in 2 surgeries. But if you want quadri like you did you need 2 surgeries anyways.
Hope you understand what I mean.

Yes, I understand the point you are making. To anybody considering quadrialteral lengthening, I would recommend staged/ unilateral lengthening, since you can do one lateral side (tibia + femur) in one surgery and do the other lateral side 5-6 months later.

I don't see myself in wheelchair for months not even 1 week due to my house having stairs everywhere.

This is a very good point. I myself live in an apartment building with multiple floors of staircase to climb, in order to leave and enter my apartment. Bilateral Precice would NOT have been an option for me, as this would have meant, I could not leave my home for half a year.

[RealLostSoul]

- Staged LL is recommended by many good surgeons for medical safety. People have died doing bilateral LL..

First,
Name one surgeon who recommends 1 segment at a time for stature lengthening.
 
Second,
You die from pulmonary embolism: either from fat emboli or a DVT. Fat emboli happens from reaming the bone marrow etc. It‘s the reason why Paley and many others won‘t offer installment of femur and tibia (4 segments) in one surgery but rather a few weeks apart. The risk of fat emboli syndrome increases with each segment more. So yes for 1 segment surgery it‘s lower but  there is NO increased risk with bilateral compared to tibia+femur unilateral. Both are 2 segments

[ten]

First,
Name one surgeon who recommends 1 segment at a time for stature lengthening.
 
Second,
You die from pulmonary embolism: either from fat emboli or a DVT. Fat emboli happens from reaming the bone marrow etc. It‘s the reason why Paley and many others won‘t offer installment of femur and tibia (4 segments) in one surgery but rather a few weeks apart. The risk of fat emboli syndrome increases with each segment more. So yes for 1 segment surgery it‘s lower but  there is NO increased risk with bilateral compared to tibia+femur unilateral. Both are 2 segments

First, Peter Thaller. Even Assayag thinks it's a great idea to do staged.

Second, I was not comparing unilateral tibia + femur here. I was comparing bilateral femur vs staged femur. I would personally do bilateral too for practical reasons but staged is medically safer.

[RealLostSoul]

First, Peter Thaller. Even Assayag thinks it's a great idea to do staged.

Second, I was not comparing unilateral tibia + femur here. I was comparing bilateral femur vs staged femur. I would personally do bilateral too for practical reasons but staged is medically safer.

Send me a source please (eg cyborg4lifeinterview) because I can‘t believe that they think it‘s a good idea for cosmetic lengthening.

Yes. The one segment at a time. Like left femur then right is what I think is ridiculously bad. The only benefit is you have a less chance of fat emboli syndrome, a shorter anesthesia and you can limp around on one leg (again I think that this is not really beneficial, you won‘t be living normal like that AND especially if you can just use a weightbearing nail).
But the downsides are a lot and very many significant ones.
Sorry but if you use a bit of common sense you see it‘s not a good option.

[Siegfried]

First, Peter Thaller. Even Assayag thinks it's a great idea to do staged. Second, I was not comparing unilateral tibia + femur here. I was comparing bilateral femur vs staged femur. I would personally do bilateral too for practical reasons but staged is medically safer.

I can confirm Peter Thaller and Dr.Koehne exclusively do staged lengthening with precise 2 patients, as I have talked to them personally. They also do not manage their own clinic for ll patients, such as Paley or Assayag, to accomodate wheelchair patients for an extended period of time. Which is why treating a wheelchair patients is highly inconvenient for them and the patients themselves.

The reason why they do it, is for safety reasons primarily. The chance of breaking a partially weight-bearing nail with a bilateral patient is significantly higher than with a staged ll patient.

(again I think that this is not really beneficial, you won‘t be living normal like that AND especially if you can just use a weightbearing nail).

The logic here is not very consistent. You are saying a staged ll patient wont live a normal life with, but a bilateral wheelchair patient will?

Again there are pros and cons for both and it also depends on each and everyones OWN personal situation. For example, I would not have been able to have done it bilaterally, as living in a wheelchair would not have been possible for me, for any time period for various reasons.

So completely dismissing it, as you are doing, is simply not correct.

[RealLostSoul]

I can confirm Peter Thaller and Dr.Koehne exclusively do staged lengthening with precise 2 patients, as I have talked to them personally. They also do not manage their own clinic for ll patients, such as Paley or Assayag, to accomodate wheelchair patients for an extended period of time. Which is why treating a wheelchair patients is highly inconvenient for them and the patients themselves.

The reason why they do it, is for safety reasons primarily. The chance of breaking a partially weight-bearing nail with a bilateral patient is significantly higher than with a staged ll patient.

That does make somewhat sense. I didn’t consider that they don‘t have a rehab for these patients. I still would never do this, probably would be the lowest of all my choices (if you put aside externals in turkey and india of course)
i rather do weightbearing or at least where I can lengthen bilateral (at a rehab). Tbh rn I could not think of doing LL without weight bearing. I think I would have quit a long time ago with precice.

The logic here is not very consistent. You are saying a staged ll patient wont live a normal life with, but a bilateral wheelchair patient will?

Again there are pros and cons for both and it also depends on each and everyones OWN personal situation. For example, I would not have been able to have done it bilaterally, as living in a wheelchair would not have been possible for me, for any time period for various reasons.

So completely dismissing it, as you are doing, is simply not correct.

No the logic is; you are indicating that you can live a normal life if you limp on one leg but I am saying that‘s not the case. So if both are hindering you, I don‘t see it as a big benefit over the other.

I would still completely dismiss it man. I do see the point though. Yes maybe in some cases where you can only go to these doctors and this is better for you, then maybe it has some value but if I am honest I would rather save up more money and do it either nonweightbearing at a great center like Paley or even better weightbearing.

[Body Builder]

First,
Name one surgeon who recommends 1 segment at a time for stature lengthening.
 
Second,
You die from pulmonary embolism: either from fat emboli or a DVT. Fat emboli happens from reaming the bone marrow etc. It‘s the reason why Paley and many others won‘t offer installment of femur and tibia (4 segments) in one surgery but rather a few weeks apart. The risk of fat emboli syndrome increases with each segment more. So yes for 1 segment surgery it‘s lower but  there is NO increased risk with bilateral compared to tibia+femur unilateral. Both are 2 segments

Monegal also did 1 segment at a time. But I don't know what happened with him as was many years out of the LL world. Last time I remembered some butchered cases with him, especially a girl that had a diary (quitargirl was her nickname if I remember right).


Generally speaking, doing different surgeries for each leg (not necessarily wait to finish lengthening to the one leg to do surgery on the other but even waiting 2-3 weeks between surgeries of each leg) are safer in terms of embolism, the most life threatening risk of LL.
But due to more money (2 surgeries cost more than one of.course) needed, most patients prefer to just do one surgery with both feet at once. But it is not safer than doing 2 surgeries, each for every foot.

[RealLostSoul]

Monegal also did 1 segment at a time. But I don't know what happened with him as was many years out of the LL world. Last time I remembered some butchered cases with him, especially a girl that had a diary (quitargirl was her nickname if I remember right).


Generally speaking, doing different surgeries for each leg (not necessarily wait to finish lengthening to the one leg to do surgery on the other but even waiting 2-3 weeks between surgeries of each leg) are safer in terms of embolism, the most life threatening risk of LL.
But due to more money (2 surgeries cost more than one of.course) needed, most patients prefer to just do one surgery with both feet at once. But it is not safer than doing 2 surgeries, each for every foot.

Yes of course that is why with quadri they do tibias first then femur after 2-3 weeks. To not ream 4 segments in one go as that has a high risk of fat emboli syndrome because more fat droplets would accumulate in the circulation. That‘s what I said. And yes unilateral is theoretical even safer than bilateral.

What we are talking about here is doing an entire lengthening process but only one segment, then after a year or so do the other segment and go over it again. I think it‘s a terribly awful idea. Lengthening into a huge discrepancy and waiting a long time to fix it by going over same process again. It‘s not about avoiding a lengthier surgery and fat emboli and thus do it weeks apart. It‘s lengthening into a huge discrepancy that is fixed 1 year later