Traditionally performed to correct leg length discrepancies from birth defects, trauma, or disease, limb lengthening surgery is becoming more popular as an elective application in cosmetic height gain. 

The PRECICE Max system, a cutting-edge internal lengthening solution, has revolutionized the patient experience and outcomes of height surgery in both scenarios.

Read on to find out the differences in PRECICE Max applications when limb lengthening surgery serves a medical necessity and when it is used for cosmetic enhancement.

What Is the PRECICE Max System?

The PRECICE Max system represents the latest generation in internal limb lengthening surgery technology: a significant advancement over older, more cumbersome methods. The system uses an internal magnetic rod, or nail, that is surgically implanted into the bone (either the femur or tibia). 

This innovative internal fixation method eliminates the need for external frames, which were historically associated with higher rates of infection, discomfort, and a more challenging recovery.

Key features of the PRECICE Max include its precision-controlled, motorized adjustment mechanism. Patients use an external remote controller (ERC) to non-invasively lengthen the internal nail by a tiny fraction of a millimeter each day, typically between 0.75 mm and 1.0 mm. 

This gradual, controlled lengthening minimizes pain and promotes consistent new bone formation. The system is approved for both cosmetic and orthopedic indications, offering a versatile tool for skilled orthopedic surgeons in Burbank. 

Its design aims for lower complication rates and a more comfortable lengthening phase compared to its predecessors and traditional external fixators.

What Is Medical Limb Length Discrepancy?

Medical limb length discrepancy refers to a condition where one leg is noticeably shorter than the other. Typical origins include congenital anomalies (differences present from birth), traumatic injuries, infections that affect bone growth, bone diseases, or complications from previous surgeries.

The functional problems stemming from a significant limb length discrepancy can be considerable. Patients often experience an uneven gait, and over time, this asymmetry can lead to chronic pain in the hips, knees, ankles, and lower back.

When the limb length difference becomes medically significant (more than 2 centimeters), surgical intervention may be recommended to restore balance, correct alignment of the pelvis and spine, and prevent long-term orthopedic complications.

What Is Cosmetic Height Lengthening?

Cosmetic height surgery, also known as cosmetic stature lengthening, is a procedure pursued by patients proportionate in their limb lengths but who desire an increase in their overall stature for non-medical reasons. 

This surgery is often sought for psychological, social, or self-esteem reasons, driven by a desire to feel more confident, enhance career prospects, or simply achieve a personal height goal.

This elective leg lengthening surgery typically involves lengthening both femurs in the first phase, with some individuals opting for a second round of lengthening on both tibias (shin bones) after the initial recovery. 

Cosmetic lengthening is not medically necessary to improve function or correct pathology.  Patients considering cosmetic height surgery must have realistic expectations and a thorough understanding of the extensive commitment required for recovery.

Key Differences Between Height Lengthening and Limb Discrepancy Surgery

Medical lengthening with PRECICE Max addresses functional impairment and anatomical asymmetry to restore balance and prevent long-term orthopedic issues. 

Cosmetic lengthening, conversely, is an elective procedure using the same system but performed on a functionally normal person seeking to increase overall stature.

A medical correction usually involves lengthening a single limb, whereas cosmetic gain invariably involves bilateral lengthening (both legs), often in multiple segments, to maintain bodily proportionality. This difference in scope has a significant impact on recovery intensity and duration.

Shared Elements of the PRECICE Max Journey

Both medical limb discrepancy correction and cosmetic height lengthening using the PRECICE Max system share fundamental procedural steps and recovery phases:

The journey typically begins with extensive pre-surgical planning, including physical examinations, advanced imaging, and evaluation by a specialized orthopedic surgeon to determine the precise amount of lengthening required. 

Following the surgical implantation of the magnetic nail, patients enter the active lengthening phase, where they use the external remote controller (ERC) diligently and daily to adjust and lengthen the internal rod by small increments precisely, typically 0.75mm to 1.0mm per day. 

Regular weekly follow-up appointments will include X-rays to monitor new bone formation and ensure proper alignment. 

Intensive physical therapy is also required. Patients engage in specific exercises to maintain joint mobility, muscle strength, and flexibility throughout the lengthening process. 

Once the desired length is achieved, the consolidation phase begins, where the newly formed bone hardens, allowing for gradual weight-bearing and increased activity under strict medical supervision.

Risks and Considerations

General surgical risks include infection, which can be severe and affect the bone; nerve pain or damage; delayed bone healing (non-union) or premature consolidation; joint stiffness or instability; and hardware complications requiring additional surgery.

For cosmetic patients seeking height surgery, there's an additional layer of psychological pressure and considerations. The entire procedure is elective and self-funded, a significant financial and time commitment. 

The psychological readiness and realistic expectations of cosmetic patients are paramount, as the journey is long and demanding. 

For discrepancy patients, the primary risk is that if their condition goes untreated or is improperly managed, it can lead to chronic, debilitating pain, significant gait abnormalities, and long-term joint damage or spinal issues. 

Who Is a Candidate for Each Procedure?

For medical limb discrepancy correction, ideal candidates are typically patients with a measurable length difference of 2 centimeters or more, experiencing visible gait issues, chronic pain, or functional disability that significantly impacts their quality of life. The decision is often driven by orthopedic necessity to restore biomechanical balance.

For cosmetic height gain, candidates are healthy adults who are proportionate in their existing limb lengths but desire an increase in overall stature. These patients must possess realistic expectations regarding the amount of height gain possible, the demanding recovery process, potential risks, and the long-term commitment to rehabilitation. 

Psychological readiness is thoroughly assessed, as the procedure is not medically necessary but aims to address self-esteem or social concerns. Screening and consultations for cosmetic patients are often more extensive, focusing on mental preparedness and motivation, whereas for discrepancy patients, the emphasis is on functional impairment and anatomical assessment.

Cost and Insurance Considerations

For medical purposes, such as correcting a limb discrepancy that causes functional impairment or pain, the PRECICE Max procedure is often covered by health insurance providers. 

Coverage typically hinges on demonstrating medical necessity through a detailed diagnosis, documentation of functional limitations, and meeting specific criteria set by the insurance company. 

Conversely, cosmetic height surgery is almost universally considered an elective procedure and is therefore not covered by insurance.  

In U.S. clinics, the typical cost for cosmetic leg lengthening surgery involving one segment can range anywhere from $80,000 to $120,000, while a two-segment procedure (femurs then tibias) can escalate to $140,000 to $200,000 or more. 

Additional cost factors may include extended physical therapy sessions, X-rays, medications, and potential future hardware removal surgery.

Recovery Timelines

For medical limb discrepancy correction, which typically involves lengthening a single limb, the recovery process can be slightly faster. The body focuses on healing just one area, and patients may regain full weight-bearing and normal activities sooner.

For cosmetic height gain, the recovery is more intensive and protracted due to the bilateral lengthening and the greater overall length gained. This requires more extensive and prolonged physical therapy to manage muscle and nerve adaptation. 

During the consolidation phase, patients gradually transition from using crutches or walkers to walking unassisted. Return to work or normal activities varies greatly; sedentary work might resume sooner (e.g., 2-3 months post-surgery for femurs), while strenuous physical jobs could require 6-12 months or longer. 

The full healing and rehabilitation process for cosmetic lengthening can easily span 6-12 months per segment, or even longer for two-segment procedures.

Two Goals, One Advanced System

The PRECICE Max system is a revolutionary tool in modern orthopedics, yet it serves two fundamentally different patient journeys: to restore anatomical symmetry and alleviate pain from medical limb discrepancy, or to increase overall stature through elective height surgery.

For any prospective patient considering limb lengthening surgery, a thorough consultation with a qualified limb lengthening specialist is the first step. Request an appointment today with Dr. Shahab Mahboubian, Burbank’s #1 orthopedic specialist for leg lengthening surgery. 

PRECICE MAX DISCLAIMER: The nail is currently not available from Globus Medical, and the anticipated release date is uncertain. If you are interested in discussing other options or to be wait-listed, please reach out to us.