THE PSYCHOLOGY OF SHORT STature AND COSMETIC LIMB LENGTHENING

Cosmetic limb lengthening – a growth procedure

Being short is no longer a problem. Thanks to advances in orthopedics, we can easily gain a few extra centimeters and balance the length of our limbs in proportion to the rest of our body. Dr. Walter Windisch, a psychologist, used the term “height dysphoria” (dysphoria literally means dissatisfaction, as opposed to euphoria). In other words—dissatisfaction with one’s own height. In the literature, we find another term, coined by Karen Horney—height neurosis.

Growth standards and body image

The growth distribution curve in a given population follows a bell-shaped pattern, known as the Gaussian curve (normal distribution). At its peak lies the mean value, which is characteristic of the largest percentage of the population. Values falling within ±3 standard deviations (SD) of the mean are considered normal height. Height below 3 SD from the mean, in individuals not affected by dwarfism or growth hormone deficiency, is considered short stature. For a physician, normal height falls between the 5th and 95th percentiles. The lower limit of so-called normal height for men is 166 cm, and for women, 153 cm.

The relationship between growth and growth dysphoria

This condition is linked to actual height, but there is no specific threshold above which one cannot experience height dysphoria. Most of us assume that dissatisfaction with one’s height can only affect “short” people.

The problem, however, is that perceptions of short stature can vary greatly depending on racial, national, and cultural factors—178 cm is considered tall in India, but short in the Netherlands.

Growth dysphoria – a clinical case study

This phenomenon is well illustrated by an anecdote described by Dr. Dror Paley, founder of the Paley Institute:

“A man flew all the way from the Netherlands to see me for a consultation about limb lengthening. He was 180 cm tall. He told me that even as a teenager, he felt short. He was the shortest man in his family; even his sister was the same height as him. All of his friends were much taller. He reminded me that the Dutch are the tallest nation in the world.”

We were the same height. I never considered myself short, nor had I heard such comments from family or friends. That’s why I found it difficult to qualify him for limb-lengthening surgery. I sent him for a psychological consultation. The psychologist’s report confirmed that the patient had the same body image issues as all the other patients we had examined.

Despite his objectively tall stature, he suffered from height dysphoria. When examining the relationship between height and the diagnosis of height dysphoria, we found that the initial height of our patients ranged from 147 to 180 cm for men and from 137 to 173 cm for women. Although most patients were closer to the lower end of the range, the presence of individuals at the upper end indicates that height alone is not the primary issue.

"What matters most is one’s own perception of height and proportions—what we call body image. Body dysmorphia is a disorder of body image. The patient considers themselves short regardless of their actual height, and regardless of what others think."

Patient Eligibility and Patient Safety

In practice, we have learned not to rely on our own opinions when determining a patient’s eligibility for surgery. What matters is how the patient feels. As for the risks involved in the procedure, they are not higher for taller individuals. In theory, they should actually be lower, since the increase in bone length is proportionally smaller relative to the patient’s overall body size.