Height increase surgeries in children and adults

It is both plastic surgery and there are cases where lengthening surgeries are mandatory. There are height standards that vary from society to society and differ for men and women. But generally people who are under 1.50 m tall are diagnosed with ‘constitutional short stature’. If it is under 1.35 to 1.40, it is in the class of dwarfism. Dwarfism is considered a disease and treatment is started early. There are lengthening treatments that are started at the age of 5 years.

These are done in sessions between the ages of 5 and 10 and in adolescence. Not only the legs but also the arms are extended. Constitutional short stature, on the other hand, is seen in people whose height stops with the end of adolescence and whose height is below the standard. Patients in this group suffer severely from their condition. In this group of cases, which are actually healthy people, lengthening surgery can be performed after some preliminary examinations.

How long can the height be extended in aesthetic surgeries?

It’s medically possible to do this, but ethically it’s not right. If we think that short stature has become a spiritual obsession in this person, we refer the person to a psychiatric consultation. If the psychiatric consultation report ‘If this treatment is not done, the patient will have permanent mental disorders’, then the patient can be treated by explaining all possible complications. The rate of patients in this class is 1 percent.


How is height increase surgery performed on people diagnosed with dwarfism, and what techniques are used?

Such cases come to us at the age of 2-3 upon the guidance of pediatricians or when the family notices them. At first, we measure their height and calculate the average height they could have as a teenager if they don’t receive any treatment. Lengthening treatments in children are done externally without damaging the growth cartilages. Depending on the patient’s condition and the applied part, lengthening treatments are applied with devices that we attach longitudinally next to the leg or in a circle-like manner. Circle-like ones below the knees and longer ones above the knees are preferred.

Combined techniques are applied to adult patients. Implants are placed inside the bone to prevent slipping, curving and shortening, and most importantly, to shorten the treatment time by two thirds. For example, in conventional treatments, that is, with hoops and rods, the process that takes six to seven months can be reduced to two or three months. This increases the comfort of the patient.”


Is the process of convincing parents that a four- or five-year-old child will become a dwarf in the future is easy?

Dwarfism has a number of special external appearances. Parents can also diagnose this problem from images such as the excessive growth of the head compared to the arms and legs, the inconsistency of the body, trunk and head with the arm-leg ratio. Parents come knowing the problem with the symmetry of the body. By showing similar children’s photos on this subject, we help them to be enlightened. Thanks to the internet, parents already apply by learning many things. We even come across many families who are knowledgeable enough to talk to us about surgical techniques.

We divide short stature into two as proportional and disproportionate. In dwarfism, excluding growth hormone deficiencies, disproportionate dwarfism is seen in those that occur very frequently, such as ‘achondroplasia’ and ‘hypochondroplasia’.

In this case, the trunk and head continue to grow normally, while the arms and legs remain short. In these patients, lengthening of 10-15 cm can be done in each session. Because the arms and legs, which are short, 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 trunk, head, arms and legs remain short in direct proportion. Body proportions remain normal in constitutionally short stature of 1.50 and below. In these patients, no more than 8 cm lengthening should be done per session. Because there is a risk of deterioration of body proportion.

If the patient has extremely long legs and a short torso, this is also an eyesore. This simulation is done with the help of photoshop and the situation is explained to our patients. Because patients come with a request for 15-20 cm lengthening. This is not such an easy thing. It also spoils the aesthetics and proportion.


Which techniques do you use in height increase surgeries for people over the age of 18?

If the patient’s bone structure is suitable, an implant is placed inside with the combined technique, and lengthening is performed with a device both externally and internally. The biggest advantage of the method is that the treatment time of the patient is shortened by two thirds.

Another method is performed with implants placed completely inside. Remote controlled, magnetic or electro-motor based devices are used. Telescopic nails on remote controls extend by themselves.

These are somewhat costly treatments because the implants used are brought from abroad. Insurance does not cover these implants. The insurance pays the cost of treatment of diseases of pathological origin, such as dwarfism.


Can you elaborate on the practices in the treatment process?

Minimally invasive methods are used in all procedures performed on the bone in lengthening with an external fixator. The operation is performed through a few incisions with a maximum size of one centimeter without making 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, a one-millimeter extension per day is started by the patient himself or his relatives, as if pulling the gum from both ends.

A 0.25 millimeter extension is performed every six hours, four times a day. This is a painless lengthening process. Patients are examined every 15 days. Our aim is to examine the course of the lengthening period, to diagnose the condition of the new bone tissue formed. If it is determined in the control that the bone tissue is not well formed, the lengthening speed can be slowed down and reduced 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. Of course, along with the bone, the muscles, connective tissues, nerves and veins around it also lengthen.

Therefore, controls are checked to see if there is a problem occurring in these tissues as well. When the targeted amount of lengthening is reached, it is waited until the elongated tissue reaches the bone consistency and hardens. Afterwards, the device called ‘external fixator’ is removed. If there is a dwarfism, one or two more sessions of treatment are performed at intervals of 3-5 years.


What should patients pay attention to during this treatment?

Especially to patients, ‘Our relationship with you starts with surgery. I say it doesn’t end with surgery. In this type of intervention, if the patient is a child; parents, if the patient is an adult, we need to do an intense team work with the physiotherapist. Problems called contractures can occur in elongated joints. These should be opened with good physical therapy. The bottoms of the nails of the patient should also be cleaned two or three days a week. It is also extremely important that the patient has a very good dialogue with his doctor.

We need to be reachable at the slightest problem. We explain these to patients in great detail. We introduce patients who have undergone this treatment before, if they allow it and if they wish, to patients who are considering lengthening surgery. They share their experiences as patients and relatives of patients. This is how we direct treatments.

Do you use the lengthening technique in the treatment of bone fractures?

Lengthening surgeries make up 10 percent of all our applications. As you mentioned, the rest are applied in cases such as shortening after an accident, non-union fractures, leg and arm curvatures, one leg being shorter than the other for different reasons. Sometimes, in bone inflammation, bone transplantation is performed by removing the inflamed part. We use the same principles here as well.

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