Candidates: Men—18 to 52 years old who are shorter than 5 feet 9 inches
Women—18 to 52 years old who are shorter than 5 feet 3 inches
Initial Consultation: The first step is to make an appointment for a surgeon to evaluate you. Special X-rays will be taken at the time of this visit. The surgeon will examine you, and together you will discuss stature lengthening. If you choose to pursue this treatment, you will need to undergo a psychological evaluation. In many cases, the initial evaluation by the surgeon is done on a Thursday and the psychological evaluation can be scheduled in advance for the next day (Friday).
Psychological Evaluation: Before being accepted as a candidate for cosmetic stature lefngthening, you need to undergo a psychological evaluation by our staff psychologist. The psychological evaluation consists of an in-depth clinical interview and a battery of psychological tests. Once the psychological evaluation has been completed and the results have been shared with the surgeon, you will be informed about whether you have been approved for limb lengthening treatment. This process takes approximately two or more weeks after test administration. The psychological evaluation requires one full day or two half-days to complete.
Scheduling Surgery: Someone from our staff will contact you to inform you whether you have been accepted into our program. If you have been accepted, you will then be able to schedule a surgical appointment. The surgeon’ s secretary can schedule this for you. You cannot schedule the surgery before being officially accepted into the program.
Costs: The initial consultation, psychological evaluation and surgery are not covered by insurance. The cost of lengthening both femora (upper leg bones) is $100,000, which includes physical therapy for 3 months. The entire cost must be paid before the operation. You will need to pay for your initial consultation and initial X-rays at the time of the visit. The initial consultation and the X-rays will cost a minimum of $1,110. Similarly, if you undergo the psychological evaluation, you will need to pay for it at the time of that visit. The cost of the initial psychological evaluation is approximately $2,300. No refunds will be made for the initial consultation or the psychological evaluation if you are not accepted into the program.
Not Included: The costs noted herein do not include medications, durable medical goods, equipment purchase or rental. You will need to pay for a wheelchair, crutches, walker and possibly a commode. The estimated cost of renting a wheelchair ranges from $125 to $225 per month. The estimated cost of buying a walker, crutches and commode are $100, $60 and $220, respectively. You will be responsible for obtaining and paying for your own room and board after discharge from the hospital; it is not included in these costs. Removal of the intramedullary skeletal kinetic distractor (ISKD) one year after surgery incurs an additional charge of approximately $12,000. The physician’s fee for follow-up visits during the first 90 days is included in the package cost, but the cost of X-rays is not. Generally, these X-rays cost a minimum of $446/visit but may be more if additional X-rays are necessary. After the 90-day period, you will be responsible for paying the physician’s fees as well.
Unexpected Costs: If the initial hospital stay is longer than three days, additional charges will apply and will be billed. Unexpected expenses may occur if complications arise that require additional surgery. Unplanned surgery occurs in approximately 25 percent of the cases and can cost between $7,000 and $50,000. The cost of treatment for complications is not covered by insurance because it is a result of cosmetic limb lengthening.
Method: The ISKD is an implantable limb lengthening device. It consists of a telescopic rod (nail) that is inserted through a very small incision into the marrow of the bone and is fixed to the bone with four screws. Movements of the leg during activities of daily living activate lengthening. A digital magnetic monitor is used to make sure that lengthening does not occur too slowly or too quickly. The activity level is adjusted to the rate of lengthening.
Which Bones: We usually start with lengthening of both femora (thigh bones). Two femoral ISKDs are inserted during one surgery. The total lengthening amount is 2 inches (5 cm). If you want to gain an additional 2 inches (5 cm), both tibiae can be lengthened at a separate surgery six or more months later. This requires inserting two tibial ISKDs. The 5-cm limitation is not negotiable. This is because lengthenings of more than 5 cm have much higher complication rates.
After Treatment: Expect to be in the hospital for three days after surgery. If problems occur, your hospital stay might be longer. Please note that the hospitalization cost is based on a three-day stay; a surcharge is billed for longer stays. Next, you begin daily physical therapy as an outpatient. During lengthening, you will not be able to walk. You will be in a wheelchair and will be allowed weight bearing only for transferring from chair to bed or bed to chair. You need to come to the Institute one week after surgery for distraction training (lengthening training). After that, you need to be seen by your surgeon every two weeks. Although your rate of lengthening may be faster or slower, the average rate is 1 mm/day or 3 cm/month.
We prefer that you remain in the Baltimore area during the lengthening process; however, if you cannot, you still must come to Baltimore every two weeks for follow-up visits. These include clinical examinations and X-rays. Regardless of where you are staying, it is helpful to have the help of a caregiver. If family or friends are not available to help, this type of service can be hired. Patients intending to stay at the housing on the Sinai campus must have a caregiver with them at all times during their stay.
After you complete the lengthening, you will need to see a doctor at the following points during your recovery: one, two, three, six and 12 months after lengthening. Your local physician cannot do these follow-ups. Even after the lengthening is completed, you cannot bear weight right away. You will have to wait until the X-rays show that the bone is sufficiently healed to permit full weight bearing. This usually takes one or two months after the lengthening stops but can take longer in some cases. If the bone does not heal, bone grafting will be required, but this is not common.
Complications: Many potential complications are associated with limb lengthening. These will be discussed with you in detail during your evaluation and again during your preoperative visit. The main risks come from lengthening too quickly or too slowly. The ISKD can lengthen faster than desired. If this occurs, activities need to be decreased and a brace might be used. The maximum amount of lengthening allowed per bone is 2 inches. Therefore, the lengthening process will stop automatically when 2 inches have been gained. Usually fast lengthening is well tolerated and has no associated complications. However, in some cases, the bone might fail to heal completely and bone graft surgery might be required. Lengthening that occurs too quickly can also irritate and stretch the nerves and occasionally requires minor surgery to decompress a nerve. It can also lead to tight muscles and tendons and might require tendon-lengthening surgery. In most cases, these problems are unlikely, but, should they occur, they can usually be corrected by surgery. The opposite can also happen: lengthening too slowly. Lengthening that occurs too slowly can lead to premature bone healing. If this happens, additional surgery is needed to re-break the bone(s).
Results: The majority of our patients achieve excellent results without significant complications. Those who do experience complications usually achieve excellent outcomes as long as the complications are recognized and treated promptly. To date, all our patients who have undergone cosmetic stature lengthening have been able to return to normal function, including sports activities, within one or two years after the lengthening(s).
The costs contained in this document are the current costs and will apply until the end of this calendar year (2010). They are subject to change in future years.
