Internal or external appliance? The safest method for cosmetic bone lengthening

Cosmetic bone lengthening is a serious medical decision. If you are considering surgical height increase, you have likely come across terms such as external fixators, the LON method, or intramedullary magnetic nails. Which method is the safest? Why are modern clinics moving away from external fixators in cosmetic procedures?

In this article, we explain how these solutions differ and why we prefer fully internal magnetic systems for cosmetic limb lengthening.

What is surgical bone lengthening?

Every lengthening method—regardless of the implant used—is based on a biological principle known as distraction osteogenesis.

During the procedure, the surgeon makes a controlled cut in the bone (osteotomy). The bone segments are then gradually moved apart—usually at a rate of about 1 mm per day. The body forms new bone tissue in the resulting space. At the same time, the muscles, tendons, fascia, blood vessels, and nerves stretch to accommodate the change.

This process is safe and predictable provided that:

• adequate bone stabilization,
• the appropriate stretching pace,
• regular X-ray examinations,
• intensive physical therapy.

The key difference between the methods lies in how elongation is stabilized and controlled.

External camera – when is it necessary?

External fixators have been used in reconstructive orthopedics for years. They are extremely useful in:

• severe congenital limb defects in children,
• significant axial and rotational deformations,
• significant shortening (e.g., 5–7 cm),
• in situations where an internal implant cannot be used.

In such cases, an external camera is often the only viable option, and it performs its function very well.

However, the situation is different when it comes to cosmetic bone lengthening in healthy patients.

Risk of infection in external devices

In the external fixator, metal pins pass through the skin, subcutaneous tissue, fascia, muscles, and bone. This means that throughout the entire lengthening process, there are constant points where the metal passes through the tissues—so-called sites of infection.

In clinical practice:

• Minor infections at the pin sites occur in nearly all patients,
• more serious infections are common,
• In hybrid methods, the risk of chronic osteomyelitis can be as high as several dozen percent,
• Some patients require additional revision surgeries.

During intensive physical therapy, tissues shift relative to the pins, causing microtraumas and minor wounds. This facilitates the spread of bacteria from the skin’s surface to deeper structures and even to the bone itself.

In the treatment of severe deformities, such a risk is sometimes acceptable. In a procedure performed solely to increase height, however, it is difficult to justify.

The LON method – a compromise involving a large number of operations

One solution that combines an external appliance with an internal implant is Lengthening Over Nail (LON).

In this method:

1. An intramedullary nail is inserted into the bone.
2. An external device is applied to mechanically perform the lengthening.
3. Once the desired length is achieved, the brace is removed.
4. Once treatment is complete, the nail is also removed.

Although this method reduces the time the braces need to be worn, in practice it means:

• at least two operations during the lengthening process,
• the third implant removal surgery,
• a significant risk of infection at the pin entry points,
• a significant opportunity for additional treatment in the event of complications.

For the patient, this means a greater physical strain, a longer recovery period, and higher overall costs.

Internal magnetic nail – a modern and safe solution

Currently, fully intramedullary magnetic systems, such as the PRECICE Intramedullary Limb Lengthening System, are the gold standard in cosmetic limb lengthening.

The entire lengthening mechanism is located inside the bone. No components pass through the skin. The patient controls the rate of lengthening using an external magnetic controller, without the need for daily wound care.

Key benefits:

• no chronic skin wounds,
• minimal risk of infection (less than 1%),
• a single implant procedure,
• a minor procedure to remove it after treatment is complete,
• the ability to undergo comprehensive and safe physical therapy,
• a lower risk of contractures and loss of range of motion.

In terms of safety, the difference between the internal and external methods is one of the most pronounced in modern orthopedics.

Scars and patient comfort

With an internal pin, there are a few small surgical scars—one incision about 2 centimeters long and several smaller ones.

External fixation devices can cause deep scars from the pins that affect not only the skin but also the deep tissues. These adhesions can limit knee mobility and require additional treatment.

For those who choose to have their legs lengthened for cosmetic reasons, both the functional and visual aspects are of great importance.

Which method should you choose for height increase?

If you're considering:

• operational growth acceleration,
• cosmetic leg lengthening,
• lengthening of the femur or tibia,
• a safe method of limb lengthening,

The most important questions should concern:

• risk of infection,
• number of operations,
• recovery period,
• return to full fitness.

For procedures performed on healthy patients to improve height and body proportions, the internal method using a magnetic nail offers the highest level of safety and predictability.

Consultation on cosmetic bone lengthening

Each patient requires an individual medical evaluation. During the consultation, we discuss:

• possible range of elongation,
• choosing the right bone,
• operational plan,
• recovery period,
• the full risks of the procedure.

If you’d like to find out whether you’re a candidate for cosmetic bone lengthening surgery and which method would be safest for you, please contact us to schedule a consultation with a specialist.

Modern height-enhancement procedures can be safe. The key lies in choosing the right technology and an experienced team.