Limb lengthening surgery was historically designed to treat height discrepancies due to defects or disease, although many people are seeking it for cosmetic purposes.
The procedure is also referred to as height enhancement surgery, and it can add between two and six inches of height.
Experts question the medical risks and psychological implications of this kind of elective surgery.
People looking to gain up to six inches of height are able to seek elective cosmetic height surgery—a procedure that has seen a rise in popularity. According to recent news reports, one patient paid over $90,000 for the surgery, which increased his height from 5 '9 to 6 '0. His goal was to become taller “after struggling with feelings of insecurity and inadequacy about his height for seven long years.”
Limb-lengthening surgery, in general, is a fairly recent advancement. Only since the 1980s have people with uneven limbs due to trauma, disease, or defect had the option to seek treatment.
According to the Hospital for Special Surgery (HSS), the procedure involves “using the body's own capacity to regenerate new bone, as well as the soft tissues, ligaments, blood vessels, and nerves that surround and support it.” 
Here’s how it works: In surgery, an osteotomy is typically made in both femur bones. Next, an orthopedic lengthening device (such as the Precise nail) is applied internally to the bone, although external lengthening fixators have also been used in lengthening surgeries. About a week after surgery, the lengthening process begins. This involves using an external remote controller a few times a day for a few weeks to activate a magnetic motor within the Precice nail, which lengthens the rod up to 1 mm per day.
According to the International Center for Limb Lengthening, an additional procedure in which the tibia bones are lengthened can be done a year later to gain an additional few inches of height.
Benefits and risks of height-enhancing surgery
There is a high rate of overall success in limb-lengthening surgeries, especially those done with intramedullary versus external fixators.
Kellie K. Middleton, MD, MPH, an orthopedic surgeon, says that while some patients undergoing this procedure do experience “increased confidence and improved self-esteem,” the procedure is not without risks. Risks, Middleton says, include “nerve damage, infection, delayed healing time, and a potential need for revision surgeries.” More so, some patients report limitations in athletic ability after surgery.
She emphasizes the importance of having a transparent discussion about potential risks and realistic expectations so that patients can make an educated decision based on the facts.
Middleton also adds that any coveted extra inches may not even be guaranteed. “Depending on the person’s body type and existing condition, the amount of increase in height is variable,” she says.
While the surgery is purported to increase self-esteem, professionals question the social and psychological implications of this kind of surgery.
Raffaello Antonino, Ph.D., clinical director and counseling psychologist at Therapy Central, says that the desire for this surgery is rooted in social norms around gender and body image. “Insecurities about height can be tied to deeper issues, such as long-standing negative core beliefs—stemming from childhood experiences and other events in one’s life trajectory,” Antonino says. “These may be strongly perpetuated by societal norms and expectations, leading to feeling a powerful sense of body dissatisfaction.”
In fact, research in Body Image shows that male height is closely linked to Western notions of masculinity. One study of 2,733 men found that a height of 6’0 was ideal—taller than many of the subjects’ actual heights. Eleven percent of men also reported heightism, which led to lower life quality. 
Although one doctor reports that 85 percent of his patients are men, women also feel the effects of height insecurity. One news report featured a woman undergoing limb lengthening for $100,000 to “close this gap between my personality and my perception of myself.” 
But can height enhancement surgery fix this sense of insecurity?
A small study of 28 patients who’d undergone height enhancement surgery found that self-esteem increased after a year. However, psychosocial evaluation “deteriorated” in the long term, “returning to near pre-operative levels of self-esteem.” 
According to Strategies in Trauma and Limb Reconstruction, researchers assert that healthcare providers must investigate the ethical parameters around the surgery and its relationship to height dysphoria—a pathological dissatisfaction with one's height. In fact, other researchers recommended that patients with body dysmorphic disorder not be eligible for this kind of surgery.
The importance of a multidisciplinary team approach
Antonino says physicians offering this surgery must consider a multi-disciplinary team approach to patient care. “It [should] involve collaboration between medical professionals and mental health professionals to ensure that all aspects of the patient's physical and mental health are taken into account,” he says.
The patient’s psychologist plays a critical role, Antonino emphasizes: “[They] help identify psychological needs, identify any underlying issues contributing to their desire for surgery, and help them explore alternative treatments such as therapy or self-acceptance.”
This collaboration, Antonino says, should be aimed at “addressing the complex and interrelated physical, psychological, and psychosocial needs involved in such a significant body modification, which no professional alone would be able to otherwise assess and address.”