The Latest Boom in Medical Tourism: Male Leg Lengthening

It was on his honeymoon in Kuala Lumpur, looking out of his hotel window at the silvery points of the world’s tallest twin skyscrapers, that Frank decided it was time to become taller. He had recently confessed to his new wife how much his height had bothered him since he was a teenager. As a man dedicated to self-improvement, Frank wanted to take action. He picked up the phone, called a clinic in Turkey that specialises in leg lengthening surgery – and made a booking.

“I had a lot of second thoughts – at the end of the day, someone’s going to break your legs,” he says, propped up on a hotel bed in Istanbul, his legs splayed in front of him, bracketed by a brace on each thigh. His wife, Emilia, tends to him, fetching painkillers and ice packs for the wound sites where the braces puncture his legs. For the first two weeks after surgery, Frank needed her help to get on and off the toilet, but now, six weeks later, it’s largely only to get off the bed.

The bleep of an alarm interrupts our conversation: time to insert a key into the metal bracket on the side of Frank’s thigh and turn it, forcing apart the rods that have been inserted into his femurs. New bone grows into the gap in his thigh bones, one agonising millimetre at time. Each turn of the key dictates how much the patient can grow, and Frank is aiming for five turns each day rather than the four recommended by his doctors, to gain a precious extra quarter of a centimetre. It means more suffering, but Frank is all about putting in the work to get what he wants. “Time to grow!” Emilia says, with a little laugh, as the alarm sounds.

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At 1.7 metres (five feet, six inches) tall, slightly under the average male height worldwide, Frank, 38, feels he has lived life “as a short man”. But speak with any patient at the Wanna Be Taller clinic in Istanbul, where Frank chose to undergo leg lengthening, and it becomes clear that shortness is relative. Men over six feet have had the procedure. One tells me he needed surgery to “correct” his bow legs and decided to add some height at the same time. A slim blond woman – a rare example of a female patient here – who was 1.6 metres before surgery, looks me square in the eyes as she deadpans that shortness “is the last acceptable prejudice in society” to explain why she underwent the procedure to gain two inches. (The clinic also offers leg shortening surgery, though this is far less common; only nine patients have so far had it done, mainly women.)

Frank, meanwhile, is determined to become taller than Emilia – who is 1.65 metres – by gaining 9 centimetres, just above the 8.5 centimetres, doctors told him is the maximum his muscles and tendons can safely handle. This would make him 1.75 metres. His dream is simple: being average height.

Five turns of the key daily means he stands to gain just over a millimetre a day for 10 weeks. It’s not without its challenges: “Sometimes the nerve pain wrecks me.” Frank prides himself on being a self-starter: he has the words “self made” tattooed across his knuckles and a likeness of his hero, Arnold Schwarzenegger – in his view, the ultimate self-made man – on his thigh. Arnie’s face is slowly being stretched as Frank grows. “I’m making my own height, choosing how tall I want to be,” he says. “I am very ambitious: if I want something, I go for it. Until I do it, it almost torments me.”

To the casual observer, leg lengthening looks like a form of medieval torture, and earlier that day I watched as a physiotherapist gently lifted each of Frank’s new legs while he groaned with pain – straightening his hamstrings feels impossible, as if they might snap. He is in recovery from the first of two surgeries: this one broke his femurs to insert metal rods and add fixators. The second will remove the fixators after he has completed the key-turning process, in three months’ time. Some patients choose to have their shin bones broken instead, or in addition, in a bid to be even taller.

If having your leg bones cut in half sounds painful enough, the true agony comes afterwards. Ensconced on the periphery of Istanbul, in a hotel built from what looks like plasterboard and fake gold leaf, about 20 leg lengthening patients spend their days obsessing over their muscles and tendons, making sure they stretch to accommodate their new bones. This means daily physiotherapy to learn how to walk again, blood thinners, massages and a lot of painkillers. While there are few global statistics on the number of people opting to have this done each year, one Indian market research firm estimated the global limb lengthening industry will balloon by 2030 to be worth $8.6bn.

“I always tell them, 1cm is not more important than your health,” says Serkan Aksoy from Wanna Be Taller, who supervises Frank’s physio. Most of their patients are men, and Aksoy has to dissuade many clients from trying to gain too much height. From the clinic’s perspective, the risks come from patients not adhering to a strict aftercare routine, but problems and even deaths do occur. Blood clots, joint issues, failure to grow new bone tissue, blood vessel injuries, scarring and chronic pain are all potential complications, as well as “ballerina syndrome”, where the achilles tendons fail to stretch adequately, forcing the feet into an exaggerated arch and preventing the patient from walking. Last year, a patient who had flown in from Saudi Arabia died from a blood clot 16 days after undergoing leg lengthening surgery. When I ask Wanna Be Taller about this, they say an investigation by the Saudi authorities found no fault with their surgeon.

Even though Frank chose a cheaper option, involving external fixators rather than an electronic internal device, the $32,000 price tag – including months in a hotel and physiotherapy – has put a major dent in the funds the newlyweds had planned to use as downpayment for a mortgage. When I ask about this, Emilia describes how months of travel across Asia gave them a new perspective. The couple began to think they were placing too much importance on material things rather than aiming for true contentment. “Having food, a comfortable bed – that’s real happiness,” Emilia says. “After that, if it’s buying a house, we’ll go for it. And if it’s breaking your legs and being tall, go for it.”

The idea that breaking bones can provide a way to shorten or lengthen a limb is widely attributed to the Soviet surgeon Gavriil Abramovich Ilizarov, who developed the “Ilizarov technique” in Russia in 1951. This involved adding external metal rings around a broken bone to stabilise it, held in place by metal pins or wires. If the patient wishes to grow, the frame can be used to draw sections away from one another; Ilizarov found new bone grows between them, adding length. His technique has since been adopted globally.

While more sophisticated techniques are now common, the principle remains. Today, leg lengthening is even available on the NHS at a specialised clinic within the Royal National Orthopaedic hospital. Even so, a spokesperson for the RNOH’s limb reconstruction unit tells me the 100 or so patients they treat annually are there to recover from injury or correct deformities – and patients lengthening both legs are rare.

The same spokesperson lists their concerns about patients going overseas for “a procedure with significant risks and an arduous physical therapy requirement”. These include clinics downplaying the dangers while overplaying “the cosmetic benefits”, and a lack of proper aftercare. The NHS routinely treats patients with problems after surgery abroad, and a study conducted by the RNOH “revealed a significant cost burden to the NHS” for treating botched cosmetic leg lengthening.

China’s health ministry banned cosmetic leg lengthening in 2006, fearing the dangers to patients in a growing and unregulated industry, but the practice has persisted elsewhere. Private treatment in the UK can cost upwards of £50,000 ($67,775), with some surgeons charging £240,000 to lengthen two bones in each leg. What makes a growing number fly to Turkey from as far afield as Australia or Japan is lower prices.

Frank can reel off a list of negative experiences stretching back into adolescence that he believes stemmed from his height. There was the pain of his friends suddenly becoming taller than him after he stopped growing around the age of 15. There were the kids at school who taunted him for his height; a longtime online fan of his artwork who remarked, on meeting him, that Frank was “shorter than I expected”; or the guys who randomly shoved him in the street a few years ago, tearing out his headphones. They wouldn’t have done that to a taller man, he reasons. In Frank’s view, tall people don’t realise their privilege. “It’s hard to explain if you’re not a short man yourself, but in modern society it’s almost a curse,” he says, as he carefully keeps watch over his pain medication and blood thinners.

Then, of course, there were all the stinging dating experiences before he met Emilia, such as the woman six inches smaller who showed up for coffee and immediately said he was too short for her. Experiences like this, he says, are standard for his short male friends. The dating app Tinder even recently trialled a feature that lets paying users set a height preference. “Even tall men are having problems now,” he says. “The new fashion is 6ft 4in, otherwise you’re a piece of shit.” All of this wore Frank down before he stumbled across a YouTube video a few years ago, showing leg lengthening surgery.

Our conversation inevitably drifts towards issues of masculinity. A recent study showed that young men in the UK now outspend women on minimally invasive “tweakments” such as Botox injections – which some practitioners now jokingly refer to as “Brotox”. Then there’s the growth of the so-called “manosphere”, which deifies the ripped torso of Joe Rogan or Photoshops Donald Trump onto a picture of a bodybuilder. Surely when we’re talking about male height, we’re really talking about masculinity – and power? Frank bats it away: he doesn’t have any time for those toxic alpha male types. “This surgery isn’t about that – I don’t think it’s about being more masculine, it’s about being average height,” he says.

Not long after our conversation, Frank woke up one night in “some of the worst pain I’ve ever felt”. He tried to scream while struggling to breathe, but the four huge ice packs on his legs did little to dull the pain. After clinicians rushed him to a nearby hospital, he was treated for a pulmonary embolism – a blood clot that travelled into the arteries of the lung. A representative from Wanna Be Taller later tells me Frank and the Saudi Arabian patient are the only two of their 700 clients who have experienced a blood clot following surgery. Frank, it turns out, needed a higher dose of blood thinners. But while a blood clot is a rare side-effect, the fate of the Saudi patient shows that it can be fatal.

Even from his hospital bed, in agonising pain, Frank had continued to turn the key on his fixators. But after speaking with his doctor, it turned out his nerves and tendons had been stretched to their limit – he was unable to straighten his legs. It was time to remove the fixators early, cutting off his growth. He had grown 7.3 centimetres, putting him just under his 1.75 metre goal.

Frank is determined he won’t be treating shorter men any differently now, but one interaction with another patient has stayed with him. “I saw him as a short man for the first time. Not in a bad way, but I saw why people perceived me as a short man – and I felt tall compared with him. Now, every time a woman comes near me, they’re shorter,” he says, with undisguised glee.

“It’s worth it at the end, if you see the difference between me and her,” he says, pointing at Emilia.

By Ruth Michaelson