"It is both aesthetic surgery and there are cases where it is mandatory to perform height-lengthening surgeries. There are height standards that vary from society to society and differ for men and women. But generally, people with a height below 1.50 are diagnosed with 'constitutional short stature'. Below 1.35 to 1.40 is classified as dwarfism. Dwarfism is considered a disease and treatment is started early. At the age of 5, there are treatments to increase height. These are done in sessions between the ages of 5 and 10 and in adolescence. Not only legs but also arms are lengthened. Constitutive short stature is seen in people whose height growth stops at the end of puberty and whose height remains below the standard. Patients in this group suffer severely from their condition. Cases in this group, who are actually healthy people, can undergo height lengthening surgery after some preliminary examinations."
How much can height be increased in aesthetic surgeries?
It is medically possible to do this, but ethically it is not right. If we think that short stature has become a mental obsession in this person, we refer the person to a psychiatric consultation. If the psychiatric consultation reports that "If this treatment is not performed, it will cause permanent psychiatric problems in the patient in question", then the patient can be treated by explaining all possible complications. The rate of patients in this category is 1 percent.
How is height-lengthening surgery performed on people diagnosed with dwarfism and what techniques are used?
Such cases come to us at the age of 2-3 with the guidance of pediatricians or when the family notices them. At first, we measure their height and calculate the average height they can have in adolescence if they do not receive any treatment. Lengthening treatments in children are performed externally without damaging the growth cartilages. Depending on the condition of the patient and the department applied, lengthening treatments are applied with devices that we attach to the side of the leg longitudinally or in a way that wraps the leg like a circle. The one below the knee, like a hoop, and the one above the knee, which is long on the side, is preferred. Combined techniques are applied to adult patients. Implants are inserted into the bone to prevent slipping, bending and shortening and most importantly to shorten the treatment time by two thirds. For example, the process that takes six to seven months in conventional treatments, i.e. with hoops and rods, can be reduced to two to three months. This increases the comfort of the patient.
What are the symptoms of dwarfism?
Dwarfism has some special external manifestations. Parents can also diagnose this problem from images such as the excessive growth of the head compared to the arms and legs, the body, torso and head not being suitable for the arm-leg proportion. Parents come knowing the problem in the symmetry of the body. We also enlighten them by showing them photos of similar children. Thanks to the internet, parents apply by learning many things. We even meet many families who are knowledgeable enough to discuss surgical techniques with us.
We divide short stature into two categories: proportional and disproportionate. Except for growth hormone deficiencies in dwarfism, disproportionate dwarfism is seen in very common conditions such as 'achondroplasia' and 'hypochondroplasia'. In this case, while the trunk and head continue to grow normally, the arms and legs remain short. These patients can be lengthened by 10-15 centimeters in each session. Because the short arms and legs are tried to be adapted to the proportion of the body with these sessions.
In proportional dwarfism due to growth hormone deficiency, the child grows but the body, head, arms and legs remain short in proportion. In 1.50 and below constitutional short stature, body proportions remain normal. These patients should not be lengthened more than 8 centimeters per session. Because there is a risk of disruption of body proportion. If the patient has extremely long legs and a short torso, this is also an eyesore. This simulation is made with the help of photoshop and the situation is explained to our patients. Because patients come with a desire to grow 15-20 centimeters. This is not such an easy thing. It also disrupts aesthetics and proportion.
For people over 18 years of age, which techniques are used in lengthening surgeries?
If the patient's bone structure is suitable, lengthening is performed with a combined technique by placing an implant inside, both externally and internally with a device. The biggest advantage of this method is that the patient's treatment time is shortened by two thirds. Another method is performed with implants placed completely inside. Remote-controlled, magnetic or electro-motor based devices are used. With remote controls, the telescopic nails extend on their own. These are costly treatments because the implants used are imported from abroad. These implants are also not covered by insurance.
Minimally invasive methods are used in all procedures performed on the bone in lengthening with external fixators. The operation is performed through a few incisions of at most one centimeter in size without large skin incisions. A fracture is created by weakening the bone. Then a device called external fixator is attached and sufficient material is expected to form in the fracture area for the first 10 days. After that material is formed, the patient or his/her relative starts to extend the bone by one millimeter a day, as if pulling the gum from both ends.
An extension of 0.25 millimeters is performed four times a day every six hours. This is a painless lengthening process. Patients are examined every 15 days. Our aim is to examine the progress of the lengthening period and to diagnose the condition of the new bone tissue. If the examination reveals that the bone tissue is not forming well, the lengthening rate can be slowed down, from one millimeter to half a millimeter. Sometimes, on the contrary, when it is determined that bone formation is going well, it can be increased to 1.5 millimeters. In the meantime, the muscles, connective tissues, nerves and vessels around the bone are also lengthening. Therefore, during the controls, it is checked to see if there is a problem in these tissues. When the targeted amount of lengthening is reached, the lengthened tissue is waited until it becomes bone-like and hardens. Then the device called 'external fixator' is removed. If there is dwarfism, one or two more sessions of treatment are performed at 3-5 year intervals.
What should patients pay attention to during this treatment?
I especially tell the patients, 'Our relationship with you starts with the surgery. In such interventions, if the patient is a child, we need to work as a team with the parents, and if the patient is an adult, we need to work as a team with the physiotherapist. Problems called contractures can occur in the joints that are elongated. These need to be opened with good physical therapy. The bottoms of the nails in the patient should also be cleaned two to three days a week. It is also very important that the patient has a very good dialog with the doctor. We need to be accessible in case of the slightest problem. We explain these to the patients in great detail. If they allow and desire, we introduce patients who have already undergone this treatment to patients who are considering undergoing height-lengthening surgery. They share their experiences with each other as patients and relatives. This is how we guide the treatments.
Frequently asked questions:
1. How many cm is the average lengthening surgery, is it determined according to the person's wishes?
It can be determined according to the person's wishes, but for lengthening more than 5-7 cm, it is necessary to lengthen from both the thigh and tibia of the patient.
2.How long does it take to stay in the hospital after the surgery and how long does the person's recovery process take?
Depending on the patient's condition, he/she can be discharged within 3-5 days. An extension of 1 millimeter per day is provided. For example, if the patient wants 5 cm lengthening, the lengthening part lasts for 50 days. Afterwards, it is necessary to wait an average of 3-4 months for the ossification of the lengthened part. Depending on the type of lengthening system, the patient can or cannot step on his/her feet during this period.
3.What are the risks of lengthening surgery?
There are risks of infection and clotting after lengthening surgery, which can be seen after every surgery. These are low risks. There may also be problems in the ossification of the part that is lengthened at a low rate.
4.Is there an age restriction for lengthening surgery?
Between the ages of 18 and 50, cosmetic lengthening surgeries are more successful. However, if there is a length difference between the legs due to a medical problem, leg lengthening can be performed on patients of all ages.