February 22, 2024

Should bioethicists look more closely at cosmetic leg-lengthening?

There has been little to no debate

Cosmetic leg-lengthening is an orthopaedic procedure which is not for the faint of heart. Although it is well-established, it is very painful and has up to a 100% rate of minor complications.

However, it is becoming more and more popular. Short men often feel inferior professionally and romantically and believe that a few more inches will give them greater stature. “I always thought that being tall and being successful were linked,” a New York man told the BBC. He had an operation which added 3 inches (8 cm) to his height.

“After I had the operation I was in physical therapy maybe three or four times a week for a few hours each day. I did that for probably six months. It was a very humbling experience. It is kind of crazy… breaking both of your legs and learning to walk again. It's seen as a cosmetic surgery, but I did it a lot more personally for my mental health.”

At leading centres in the US, Germany and South Korea the procedure is carried out between 100 and 200 times a year. Clinics in Spain, India, Turkey and Italy perform between 20 and 40 operations a year. In the UK there are only about 15. All clinics report growing interest.

Dr David Goodier, a British orthopaedic surgeon told the BBC that some of his patients “have psychological problems”, including body dysmorphia. And as more people opt for the procedure, he is worried that patients will choose the cheapest option – leading to serious complications.

The ethics of the procedure have not been discussed in any depth, but as one site pointed out, there are “risks in other aesthetic procedures such as breast augmentation, breast implants, and even gender re-assignment surgery, and say ‘Why not legs?’”

In 2017 an Australian surgeon wrote an editorial which was very critical of cosmetic lengthening in the Journal of Limb Lengthening & Reconstruction.

cosmetic limb lengthening is a misuse of limb lengthening surgery. We are, rightly, worried about the potential complications of limb reconstruction surgery. While there may be tones of self-righteousness underpinning this position, many of us are seeing an unacceptable increase in severe limb-threatening complications, especially among medical tourists, returning to their home countries and cities. The burden of managing these complications then falls on the health systems of these countries.

International medical tourism has meant that in many places it is a booming but unregulated industry. Like with many new technologies, ethics and regulation have not kept pace with speed of change. The arrival of motorized distraction intramedullary nails has made cosmetic lengthening “easier” and thus more “acceptable” to patients. Yet there has been little to no debate about the ethics of cosmetic limb lengthening.

Michael Cook is editor of BioEdge

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