Procedure · Leg Lengthening Surgery
Leg Lengthening Surgery: How the Procedure Works, Step by Step.
Medically reviewed by Dr. Hrayr Basmajian, dual fellowship-trained orthopedic trauma surgeon. Last reviewed: September 2026.
Leg lengthening surgery, also called limb lengthening surgery, is an orthopedic procedure that makes a bone longer. A surgeon divides the thigh bone or shin bone, then an internal magnetic nail slowly pulls the two ends apart about one millimeter a day so new bone grows to fill the gap.
What is leg lengthening surgery?
Leg lengthening surgery, also called limb lengthening surgery, is an orthopedic procedure that makes a bone longer. A surgeon divides the thigh bone or shin bone, then an internal magnetic nail slowly pulls the two ends apart about one millimeter a day so new bone grows to fill the gap. The medical name for that process is distraction osteogenesis, first described by Ilizarov and cited in the references below.
People search for this under two names, leg lengthening surgery and limb lengthening surgery, and they mean the same operation. Leg lengthening is the everyday phrase because most patients are focused on the legs. Limb lengthening is the clinical term, because the same technique can lengthen an arm bone when there is a medical reason to. On this page the procedure is the subject, and the words are interchangeable.
How leg lengthening surgery works, step by step
The procedure is not a single event. It is a controlled sequence that works with the way bone heals, and it unfolds over months rather than hours. Here is the sequence, start to finish.
- The surgeon makes a small, precise cut across the target bone. This is called an osteotomy.
- An internal lengthening nail is placed inside the hollow center of the bone and fixed at both ends.
- The bone is left to rest for several days so early healing can begin at the cut.
- The lengthening phase starts. A handheld magnetic remote turns the nail a fraction of a turn each day, pulling the two bone ends apart about one millimeter a day.
- New bone forms in the widening gap as the ends separate. This regenerate bone is soft at first.
- Once you reach your target length, the consolidation phase begins and the new bone hardens into mature bone.
- The nail stays inside until the bone is solid, then it can be removed in a short second procedure.
The three phases of the procedure
Every case moves through the same three phases. The timelines below describe what is happening inside the bone. The day-to-day experience of each phase, from pain to physical therapy, is covered in full on the recovery page linked below.
Phase 1: Surgery day
The osteotomy and nail placement happen in a single operation, usually an hour or two per bone. There is no external frame and no pins passing through the skin. You are lengthening from the inside, which is the core reason this approach is different from the older external methods.
Phase 2: The lengthening phase
This phase usually runs about two to three months, depending on how much length you and Dr. Basmajian are aiming for. You turn the nail with the external magnet on a daily schedule, and the bone lengthens roughly one millimeter a day. The pace is deliberate, because the nerves, muscles, and soft tissue need time to stretch and adapt alongside the bone.
Phase 3: The consolidation phase
Once you hit your target length, the lengthening stops and the new bone is given time to harden, usually another three to six months. The regenerate bone mineralizes and remodels until it is strong enough to carry your full weight. This phase is slower and quieter, and it is the part patients tend to underestimate, which is why the recovery timeline is worth reading closely.
Femur or tibia: which bone is lengthened?
Leg lengthening is done on the thigh bone, the shin bone, or both in separate stages. The choice shapes how much length is realistic and how the recovery feels, and it is made with your anatomy and your goal in mind rather than pulled off a menu.
| Segment | Common name | Notes on the procedure |
|---|---|---|
| Femur | Thigh bone | The most common segment. Its size allows more length in a single stage. |
| Tibia | Shin bone | Carries extra considerations around the nerve and soft tissue, so it is planned carefully. |
| Both, in stages | Thigh then shin | Chosen when the goal calls for more total length than one segment can safely give. |
How many total inches each path can add, and what is realistic for your body, is its own question with its own page.
Full guide → How much taller can I get with limb lengthening?
Internal nail vs external fixator
There are two broad ways to lengthen a bone. The older way uses an external fixator, a frame outside the leg connected to the bone by pins through the skin. The modern way uses an internal nail that sits entirely inside the bone and is driven by a magnet held against the skin. We use the internal method only. We do not use external frames and we do not use Stryde.
| Internal nail | External fixator | |
|---|---|---|
| Where the hardware sits | Inside the bone | Outside the leg, pinned through the skin |
| Visible frame | None | Yes, worn for the whole lengthening |
| Pin-site openings in the skin | None | Multiple, needing daily care |
| How it lengthens | Magnetic remote, one millimeter a day | Manual strut adjustment |
The trade-offs between the two systems, and why internal nails have become the standard for cosmetic cases, are covered in depth on the fixation page.
Full guide → Fixation methods in limb lengthening: internal vs external
The PRECICE nail explained
The internal nail we use is the PRECICE system. It is a titanium rod placed inside the bone with a small magnet sealed inside it. When you hold the external remote against your leg, it turns that internal magnet, which lengthens the nail by a tiny, precise amount. You are not adjusting anything by hand and nothing passes through the skin. PRECICE comes in more than one version, and the version chosen depends on your bone and your goal.
- PRECICE 2 is the standard internal lengthening nail used for most cases.
- PRECICE Max is built for patients who need more strength or length during the lengthening phase.
- Both are controlled by the same kind of external magnetic remote and both lengthen at the same careful daily pace.
Is limb lengthening surgery the same as leg lengthening surgery?
Yes. Limb lengthening surgery and leg lengthening surgery are two names for one procedure. Limb lengthening is the broader clinical term, since the same distraction osteogenesis technique can be applied to other long bones. Leg lengthening is the specific, everyday phrase most patients use, because the legs are what they are lengthening. If you have been comparing the two names wondering whether they are different operations, they are not.
How much does leg lengthening surgery cost?
Cost is a bundle, not a single sticker, and it belongs on its own page so the numbers stay current. In short, cosmetic leg lengthening in the United States is an out-of-pocket procedure whose price depends on your surgical plan. The full breakdown of what is included, financing, and insurance lives on the pricing page. For the broader consumer overview of height surgery, see the height surgery hub.
Full guide → Limb lengthening cost, financing, and what is included · Height surgery overview
Recovery and what to expect
Recovery runs alongside the lengthening and consolidation phases and stretches across the better part of a year. You are mobile with support early, and you progress on a schedule your bone earns rather than a fixed calendar. The week-by-week timeline, physical therapy, and milestones are covered in full on the recovery page, and how much the process actually hurts has its own honest answer.
Full guide → Limb lengthening recovery and expectations · Limb lengthening pain: the truth
Risks and rewards
This is real orthopedic surgery, and an honest look at the trade-offs matters more than a highlight reel. The specific risks, how they are managed, and the rewards patients report are laid out plainly on their own page rather than softened here.
Full guide → Limb lengthening: what you gain and what you risk
Are you a good candidate?
Not everyone is a candidate, and a good surgeon will tell you so before anyone talks about a date. Candidacy turns on your bone quality, your health, your goals, and your readiness for the recovery. Whether the procedure fits you is worked through on the candidacy page and confirmed in a consultation with Dr. Basmajian.
Full guide → Are you a good candidate for limb lengthening?
The surgeon you choose matters as much as the procedure itself. Full guide → How to evaluate a limb lengthening surgeon · About Dr. Basmajian, board-certified limb lengthening surgeon
Frequently asked questions
It is an orthopedic procedure, also called limb lengthening surgery, that makes a bone longer. The surgeon divides the thigh or shin bone and an internal nail slowly separates the ends about one millimeter a day so new bone forms in the gap.
A small cut is made in the bone, an internal magnetic nail is placed inside it, and a remote turns the nail a little each day. The bone ends move apart about a millimeter daily and new bone grows to fill the space, a process called distraction osteogenesis.
The lengthening phase runs about two to three months, then consolidation takes roughly three to six more months while the new bone hardens. The exact length depends on how much length is being added.
Yes. They are two names for one procedure. Limb lengthening is the clinical term and leg lengthening is the common phrase, because the legs are what most patients are lengthening.
PRECICE is the internal lengthening system we use. It is a titanium nail with a magnet sealed inside, placed within the bone and lengthened by an external magnetic remote, so nothing passes through the skin.
Either, or both in stages. The femur, the thigh bone, is the most common because its size allows more length in one stage. The tibia, the shin bone, is planned with extra care around the nerve and soft tissue.
References
- Ilizarov GA. The tension-stress effect on the genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. Clinical Orthopaedics and Related Research, 1989, issue 238, pages 249 to 281. PubMed 2910611
- Paley D. PRECICE intramedullary limb lengthening system. Expert Review of Medical Devices, 2015, volume 12, issue 3, pages 231 to 249. PubMed 25692375
Leg lengthening surgery is a long, deliberate process that works with your body rather than against it, one careful millimeter at a time. Understanding the procedure is the first step. The next is an honest conversation about whether it fits you, what it costs, and what the year of recovery really asks of you, and every one of those has its own page linked above so you can read the full story before you ever book.
Begin
Dr. Basmajian takes a limited number of cosmetic limb lengthening cases. This is where you start.
Consultations are confidential, held virtually or in-person, and carry no obligation. Dr. Basmajian evaluates every patient personally. No associates. No rotating surgeons.