During his honeymoon in Kuala Lumpur, Malaysia, while gazing at the Petronas Twin Towers from his hotel window, Frank made a life-altering decision: he needed to be taller. He confessed to his new wife, Emilia, that his height had been a major insecurity since his youth.

Frank immediately called a clinic in Turkey specializing in limb-lengthening surgery and scheduled an appointment.

"I had a lot of hesitation," Frank, 38, said, propped up in his Istanbul hotel bed. His legs were outstretched, each thigh encased in a metal frame.

Beside him, Emilia cared for him, administering pain medication and ice packs to soothe the wounds where the steel frame pierced his skin.

For the first two weeks post-surgery, Frank needed Emilia's help even to use the restroom. Six weeks later, he only required assistance getting out of bed.

Every day, at the sound of a timer, Emilia would announce, "Time to grow." Frank would use a key to turn a mechanism within the metal frame on his thigh, gradually separating the metal rods within his femur. New bone would grow into the gap, millimeter by painful millimeter. Each turn of the key determined his daily height increase. Frank aimed for five turns a day instead of the doctor-recommended four, to gain an extra 0.25 cm. Despite the increased pain, he was determined to achieve his goal.

"I'm creating my own height," he said. "I'm very ambitious. If I want something, I'll see it through. Until I achieve it, it almost haunts me."

At 1.7 m, Frank was only slightly shorter than the global average for men, but he still felt he had lived a "short" life. He was determined to be taller than his wife by lengthening his legs by 9 cm, exceeding the maximum safe limit recommended by doctors.

Inside the world of leg-lengthening surgery

At the Wanna Be Taller clinic in Istanbul, the concept of "short" is relative. Many patients are already 1.8 m tall; some seek to correct bowed legs in addition to gaining height. Even women as tall as 1.6 m desire an extra 5 cm.

The seemingly simple pursuit of increased height is arduous. Frank groaned in pain as a physical therapist tried to lift his leg.

Frank was in the recovery phase after the first surgery to cut his femur, insert metal rods, and attach the external fixator. After completing the "turning the key" process (a three-month elongation period), he would undergo a second surgery to remove the frame.

Some patients choose to have their tibia lengthened instead of, or in addition to, their femur to maximize height gain.

While the idea of having one's bones severed is painful enough, the true ordeal begins afterward. At a hotel outside Istanbul, around 20 leg-lengthening patients spent their days tending to their muscles and tendons. They underwent physical therapy to relearn how to walk, took anticoagulants, received massages, and consumed copious amounts of pain medication.

Frank begins to learn how to walk again. Photo: The Guardian

Frank begins to learn how to walk again. Photo: The Guardian

The limb-lengthening industry

Global figures on the number of people undergoing this surgery annually are incomplete, but a market research firm in India estimates the limb-lengthening industry will grow significantly, reaching 8.6 billion USD by 2030.

The idea of breaking bones to lengthen or shorten limbs is attributed to Soviet surgeon Gavriil Ilizarov. He developed the "Ilizarov" technique, which uses external ring fixators to stabilize fractured bones, secured with pins or wires. If a patient wants to lengthen a limb, the fixator can be adjusted to gradually separate the bone segments. Ilizarov discovered that new bone would grow into the gap, increasing the limb's length. This technique is now used worldwide.

More advanced techniques now exist, but the core principle remains the same. Today, leg lengthening is even performed within the UK's National Health Service (NHS) at a specialized clinic at the Royal National Orthopaedic Hospital.

In China, the Ministry of Health banned cosmetic leg-lengthening surgery in 2006. However, the procedure continues elsewhere. In the UK, private treatment can cost upwards of 50,000 GBP, even reaching 240,000 GBP. Consequently, more people from as far as Australia and Japan are traveling to Turkey for more affordable surgery.

The lurking risks

"I always tell patients that 1 cm isn't as important as your health," said Serkan Aksoy, who oversaw Frank's physical therapy at Wanna Be Taller, noting that most patients are men. Aksoy has advised numerous clients against excessive height increases.

According to experts, the primary risks stem from patients not adhering strictly to post-operative care. However, complications, including fatalities, can still occur.

Potential complications include: blood clots, joint problems, failure to grow new bone tissue, vascular damage, scarring, chronic pain, and "ballerina syndrome." This syndrome occurs when the Achilles tendon doesn't stretch sufficiently, causing excessive arching of the foot and rendering the patient unable to walk.

Last year, a patient from Saudi Arabia died from a blood clot 16 days after leg-lengthening surgery. The subsequent investigation found no fault with the surgeon at Wanna Be Taller.

Frank also experienced complications. Four large ice packs did little to alleviate the intense pain in his leg. He was eventually taken to a nearby hospital and diagnosed with a blood clot that had traveled to his lung.

Frank and the Saudi Arabian patient were two of 700 cases at the clinic who experienced blood clot complications, a rare but potentially fatal risk.

The price of height

Even while hospitalized and in severe pain, Frank continued turning the key on his fixators. However, after consulting with his doctor, it became clear that his nerves and tendons had been stretched to their limit, preventing him from fully straightening his legs. It was time to remove the fixators prematurely, ending the lengthening process. Frank had gained 7.3 cm, just shy of his 1.75 m goal.

Although Frank opted for the less expensive external fixators instead of internal electronic devices, the 32,000 USD cost, including hotel stays and months of physical therapy, significantly depleted the savings the newlyweds had planned to use for a house down payment.

For Emilia, anything that brings satisfaction and happiness, even enduring pain to gain height, is worthwhile.

Frank vowed not to treat shorter men differently. But every time a woman approached whom he was taller than, he felt a sense of joy.

"It's all worth it if you see the difference between me and Emilia," he said, gesturing toward his wife.

Minh Phuong (The Guardian)