Men who risk it all to be tall

Limb lengthening can cost up to £50,000 - and leaves patients in agony for months. Is this extreme surgery the height of folly? Joe Kita and Lee Kynaston report

The cages that surround Jim Conran's legs look like scaffolding. Each has 11 metal pins that screw into his broken bones. Every six hours he must turn these pins ever so slightly in order to tighten the wires that then pull the bones apart and align them correctly. He has been doing this for 68 days. And all the time the pain has been intensifying.

"It's like tuning a violin," he explains. "With each turn of the knobs, the ligaments, muscles and skin come under more tension. Each day everything gets tighter. It's incredibly painful." So much so, in fact, that Conran won't allow himself to sleep for longer than three hours. "I'm frightened I'll miss a dose of medication, and the pain will get ahead of me," he says. Recently, he was given morphine, and that has helped somewhat. But he's still confined to a wheelchair and can stagger only short distances.

Before you start pitying Conran, you should know that he was not in a horrific accident that shattered his legs, nor does he suffer from a birth defect that's finally being corrected. He is an otherwise healthy 45-year-old solicitor who is paying about £50,000 to undertake this procedure voluntarily. Despite the expense and the pain and the incapacity, he is living his dream.

Jim Conran is 5ft 5in tall. Or rather, he was 5ft 5in tall. In the past few months he has "grown" 1mm per day (about 1/25in) by carefully turning his 22 pins. And as he's done so, new bone has been steadily forming in the gaps where the segments of tibiae and fibulae are being pulled apart. When he last checked - and he checks every day - he was 5ft 8in. When he reaches his target height of 5ft 9in and this violin-tuning ends, he's confident his life will finally be in harmony.

Conran is just one of a growing number of short men opting for this radical, some might say desperate, measure to gain some stature. Although "limb lengthening" has been a common procedure for correcting childhood deformities and dwarfism for many years, its application as a cosmetic procedure is relatively new. And while it isn't available on demand in the UK yet, it is in a handful of other countries, including Russia and the US.

Studies have repeatedly shown that tall men are paid more than short ones. It's also a fact that, statistically, women prefer strapping six-footers. According to a study of 5,000 British men conducted by Dr Daniel Nettle at the University of Newcastle, women see height as an important factor when choosing a mate. "This preference probably dates back to a time when, in survival terms, it was advantageous for men to be big," says Dr Nettle. So is it any wonder that some men resort to limb-lengthening as a way to stay in the game? "Not really," says Dr Nettle. "You have to remember that height in males is a secondary sexual characteristic signalling our readiness to mate, the equivalent of breasts in women - and look at how many women have breast enlargements."

About 2,500km east of Moscow, at the western edge of Siberia, is the Ilizarov Scientific Centre for Restorative Traumatology and Orthopaedics, founded in 1971 by Professor Gavril Abramovich Ilizarov. Decades earlier, faced with treating a large number of Second World War veterans with complicated limb fractures, he began experimenting with "circular external fixators" to keep bones aligned and to speed healing. Their use as limb-lengthening tools, however, was discovered by accident. While Ilizarov was on holiday, a nurse adjusted a fixator in the wrong direction. When the doctor returned and examined the patient's X-ray, he noticed new bone forming in the gap. This set the stage for a variety of new applications, including the correction of leg-length deformities, bow legs, achondroplasia (dwarfism) and short stature. More than 50 years later, the Ilizarov method is still being used in a surprisingly unevolved form throughout the world.

To begin with, a series of X-rays is used to map out the precise dimensions of the bones. The surgeon then orders a regional anaesthetic and makes two half-inch-long incisions in each leg (usually below the knee). Using a surgical chisel, he then cracks the tibiae and fibulae. Next, he attaches the circular aluminium frames. This requires piercing each leg with 11 arrow-sharp carbide pins and pushing them in until they hit bone. Once the pins are in position, the surgeon slowly screws them into the hard calcium-and-collagen shell that surrounds the marrow.

The rest of the operation is reasonably straightforward: affix the adjustment wires to the pins, sew the two osteotomy incisions shut, and treat and bandage the pin wounds. The entire operation takes just two hours. Patients typically remain in the hospital for two or three days, after which they can only take a dozen or so steps. But that's the easy part.

The frames usually stay on for three to six months, during which time the bones are gradually separated. This is called the "distraction phase". All but one of the men we spoke to said that, even with heavy doses of narcotics, the resulting pain was just on the edge of bearable. "The pain you have to endure would reduce even the toughest man to a crying baby in a matter of weeks," says Jack Turner, a 39-year-old salesman who "grew" two inches as a result of this surgery.

Just as difficult as the pain is the helplessness. Patients are dependent on wheelchairs and walkers to get around. Most are bedridden except for periodic doctor visits and daily physical therapy. Work is out of the question. This is true not only during the distraction phase, but also for the three months or more after the frames come off when the new bone is hardening.

Although some doctors make lofty promises, most legs won't tolerate being stretched past three inches. It's not the bones that balk, but rather the muscles and tendons that surround them. Overall, there's a 25 per cent complication rate from this surgery, with the most frequent problem being pin-site infection. If an infection goes unnoticed, it will spread into the deep leg tissue, and then the bone.

A less common but equally serious complication is nerve damage. In one study of 814 limb lengthenings, approximately 10 per cent of patients had experienced some form of temporary nerve damage, characterised by chronic pain or impaired motor skills.

But the most catastrophic possibility doesn't present itself until the frames are removed. Even though the doctor will have taken X-rays to gauge structural integrity (the whiter the area, the stronger the bone), there's still a one-in-12 chance that what took months of agonising pain and tens of thousands of pounds to build will, at the moment of truth, snap. Or the new bone will hold, only to buckle and break weeks later.

Half of all limb lengthenings for height are performed at the International Center for Limb Lengthening in Baltimore, the first facility of its kind in the US. The bulk of its business, however, is in correcting functional deformities. "I'm very strict when it comes to doing this surgery on otherwise healthy people," says the chief surgeon, Dr Dror Paley. "In fact, I try to discourage it. What you have to go through is simply not in the realm of having your nose done or your tummy tucked."

Dr Paley generally will not operate on men over 5ft 6in, and he requires that all prospective patients undergo apsychological examination. Only about 10 per cent go on to have the operation. "You must be careful," says Dr Paley. "I've had some real nutcases - people who were willing to sell their houses, steal their wives' money, do unbelievable things for a few extra inches." Those inches typically cost between £27,000 and £44,000.

Some of the men who don't pass the screening process go elsewhere - like Turner, who ended up in Italy after being "dumped", as he calls it, by Dr Paley. "The cost was one-eighth of the US price," he explains, "And I felt I got better care." And yet, even though it's been almost three years since Turner had his operation, he says he's still at only 80 per cent of his former physical ability. "I don't think anyone can break both legs and come back 100 per cent," he says. "I can't run as fast, and I have pain when the weather is damp."

So can this extreme solution ever be worth it? "Seeing the profound impact this surgery can have on someone has convinced me that for a very select group of people, yes, it should be done more freely," says Dr Robert Rozbruch, the director of the Institute for Limb Lengthening and Reconstruction, at the Hospital for Special Surgery in New York.

Not all specialists agree with him. "I'm appalled that our society has become so obsessed with self-image that patients are willing to put their necks on the line like this," says Dr William Tipton, of the American Academy of Orthopaedic Surgeons.

Among the patients, though, feelings seem to be mixed. "Not getting three-and-a-half inches was disappointing, but I am much more comfortable being 5ft 7in than 5ft 4in," says Turner. "I think it's a great way for men with a height issue to increase their rank in the pecking order, but you're not suddenly going to be dating supermodels."

"I've gained about two inches," says Conran, "and it feels great. I'm almost 5ft 9in. I don't consider that tall. It's average, but that's all I ever wanted to be."

Some names have been changed. A longer version of this feature appears in the May issue of 'Men's Health' magazine, on sale 9 April